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Objective To investigate determinants of the physician global assessment (PhGA) of disease activity and the influence of the contextual factors on this relationship in patients with early axial spondyloarthritis (SpA). Methods Five-year data of DESIR, a cohort of early axial SpA, were analyzed. Univariable generalized estimating equations (GEEs) were used to investigate contributory explanatory effects of various potential determinants of PhGA. Effect modification by contextual factors (age, sex, and educational level) was tested, and if significant, models were stratified. Autoregressive GEE models (i.e., models adjusted for PhGA at the previous time point) were used to confirm a longitudinal relationship. Results A total of 708 patients were included. Higher Bath Ankylosing Spondylitis Disease Activity Index individual questions, swollen joint count in 28 joints (SJC28), tender joint count in 53 joints, Maastricht Ankylosing Spondylitis Enthesitis Score, C-reactive protein (CRP) level, and Bath Ankylosing Spondylitis Metrology Index score were associated with a higher PhGA. Sex and age were effect modifiers of SJC28; the contributory effect of SJC28 was largest in the younger male stratum (beta = 1.07 [95% confidence interval (95% CI) 0.71, 1.43]), and the smallest in the older female stratum (beta = 0.13 [95% CI 0.04, 0.22]). Autoregressive GEE models revealed the same determinants as having a longitudinal association with PhGA and the same pattern of effect modification. Conclusion Patients' subjective symptoms, peripheral arthritis and enthesitis, higher CRP level, and impaired spinal mobility contribute to explaining PhGA in patients with early axial SpA, irrespective of sex and age. Intriguingly, physicians consider the presence of swollen joints as more important in males than in females.

Resume Objectifs Evaluer le delai d’initiation d’une biotherapie au cours de la polyarthrite rhumatoide (PR) dans la cohorte francaise ESPOIR, et evaluer les facteurs associes avec ce delai. Methodes 658 patients ayant une PR recente remplissant les criteres ACR/EULAR 2010 ont ete inclus entre 2003 et 2005 et suivis annuellement pendant 10 ans (fin du suivi : 2013-2015). Le delai d’initiation d’une biotherapie et les facteurs predictifs associes etaient analyses selon la methode de Kaplan-Meier basee sur des modeles de Cox a hasard proportionnel. Resultats Au total, 178 patients (31,0 %, IC95 % [27,0–34,7]) ont initie une biotherapie au cours des 10 ans de suivi, avec un delai moyen de 43,6 mois. Le taux d’initiation etait plus eleve pendant les 2 premieres annees de suivi (6 % entre la 1ere et la 2e annee, approximativement 3,3 % chaque annee entre la 2e et la 7e annee, et Conclusions Moins d’un tiers des patients de la cohorte ESPOIR ont initie une biotherapie au cours des 10 ans de suivi. Comme attendu, les facteurs associes a un pronostic defavorable etaient associes a l’initiation plus rapide d’une biotherapie.

Objectives The STRATEGE (Therapeutic Strategy in Patients Treated With Methotrexate for Rheumatoid Arthritis) study aimed to describe treatment strategies in current practice in RA biologic DMARD (bDMARD)-naïve patients with an inadequate response to MTX therapy, and to compare clinical efficacy of the different therapeutic strategies on disease activity after 6 months. Methods The main inclusion criteria of this prospective, observational, multicentre study were confirmed RA diagnosis, treatment by MTX monotherapy and need for therapeutic management modification. Results The 722 patients included had a mean (s.d.) RA duration of 5.3 (6.7) years, a mean DAS28 of 4.0 (1.1); they were all receiving MTX monotherapy, 68% oral, at a mean dose of 15.0 (4.1) mg/week. Two major strategies were identified: (i) MTX monotherapy dose and/or route optimization (72%) and (ii) bDMARD initiation ± MTX (16%). MTX dosing was modified for 70% of patients, maintained (dose and route) for 28% of patients and interrupted for 2%. bDMARDs were started when the MTX mean dose was 17.4 mg/week, 56% parenterally; MTX was maintained concomitantly for 96% of patients. Six-month follow-up results adjusted by propensity score showed that both options were equally successful in improving disease activity and physical function, with 63 and 68% of good-to-moderate EULAR responses, respectively. Conclusion The STRATEGE study shows the importance of initial MTX treatment optimization before initiation of a biological treatment and emphasizes the importance of treat-to-target strategy. Trial registration ClinicalTrials.gov NCT02288520.

Objective To determine the risk of recurrent or a new malignancy with exposure to targeted disease-modifying anti-rheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA), axial spondyloarthritis (AS), or psoriatic arthritis (PsA) and a history of cancer. Methods We performed a systematic search of the literature for articles published up to June 2019 that investigated adults with RA, AS or PsA who had a history of cancer and received biologic or targeted synthetic DMARDs (bDMARDs or tsDMARDs. We compared the risk of relapse or occurrence of new cancer between patients with and without bDMARDs. Rate ratios (RRs) with 95% confidence intervals (CIs) were estimated. The heterogeneity of the studies was evaluated by the Cochran Q test and the I² statistic. Results We included 24 observational studies of chronic inflammatory arthritis; 12 were included in the meta-analysis of RA patients receiving bDMARDs. As compared with RA patients with a history of cancer and not receiving bDMARDs, for those receiving any bDMARD, the overall RR for risk of neoplasia was 1.09 (95%CI [0.92-1.32], p=0.31, I²=8%); with tumor necrosis factor inhibitors, it was 1.11 (95%CI [0.85-1.46], p=0.45, I²=48%); and with rituximab, it was 0.79 (95%CI [0.41-1.53], p=0.49, I²=0%). The RR for risk of recurrence for skin cancer was 1.32 (95% CI [1.02-1.72], p=0.04, I²=0%) and for breast neoplasia 1.21 (95% CI [0.84-1.72], p=0.31, I²=0%). Conclusion Apart from skin cancers including melanoma, the risk of recurrent or new cancer is not increased with the initiation of bDMARDs for RA as compared with no bDMARDs.

Multimorbidity is frequent in rheumatoid arthritis (RA) and could interfere with the therapeutic response. The aim of this study was to evaluate multimorbidity in the French cohort of early arthritis, the ESPOIR cohort, and its possible impact on the therapeutic response.We included patients fulfilling 2010 ACR/EULAR criteria for RA. An adapted MultiMorbidity Index (aMMI) was developed. Each patient was assigned scores of binary aMMI (0=no comorbidity, 1=at least 1 comorbidity) and counted and weighted aMMI. The primary endpoint was achievement of Clinical Disease Activity Index (CDAI) low disease activity after initiation of a first disease-modifying antirheumatic drug (DMARD) according to the aMMI. We collected data from the visit preceding the first DMARD initiation and the visit after at least 3 months of treatment. The impact of aMMI on therapeutic maintenance at 1, 3, 5 and 10 years was evaluated.Analyses involved 472 patients: 302 (64%) had at least 1 comorbidity. Overall, 45.3% and 44.7% with binary aMMI=0 or 1, respectively (non-significant), achieved CDAI low disease activity. Similar results were found with counted and weighted aMMI. Therapeutic maintenance was significantly better with binary aMMI=1 than binary aMMI=0 (OR at 10 years=14.0 [CI 95% 3.3-59.4]). Increased counted aMMI was associated with increased probability of still being on the first initiated DMARD at each time point.In the ESPOIR cohort, therapeutic response to a first DMARD was not affected by multimorbidity but therapeutic maintenance was better in multimorbid patients.

International audience; The 2014 French Society for Rheumatology (Société Française de Rheumatologie, SFR) recommendations about the management of rheumatoid arthritis (RA) have been updated by a task force composed of 12 expert rheumatologists, 2 patient self-help group representatives, and an occupational therapist. The material used by the task force included recent EULAR recommendations, a systematic literature review, and expert opinion. Four general principles and 15 recommendations were developed. The general principles emphasize the need for shared decision-making between the rheumatologist and the patient and for a global management program including both pharmacological and non-pharmacological treatments. The recommendations deal with the diagnostic strategy for RA, treatment targets, management organization, drug selection based on the treatment line and prognostic factors, management of remissions, and global patient management. Disease-modifying anti-rheumatic drug (DMARD) therapy should be started as early as possible. Validated composite scores should be determined at regular intervals to assess disease activity - according to the tight disease control concept - to achieve the treatment target, i.e., a remission. Methotrexate is the recommended first-line DMARD. The treatment should be optimized when methotrexate is poorly tolerated or inadequately effective. While waiting for conventional synthetic DMARDs to take effect, glucocorticoid therapy can be used, for a brief period to keep the cumulative dose low. When a sustained remission without structural progression is achieved in a patient who is not taking glucocorticoid therapy, targeted therapy de-escalation according to tight disease control principles should be considered. Patients should be periodically screened for comorbidities and their risk factors, which should be evaluated and treated.

To assess the interest of MRI and ultrasonography (US) in identifying early and advanced interphalangeal (IP) OA.We conducted a case-control study including patients with symptomatic hand OA (n=33) and young healthy volunteers (n=26). Proximal and distal IP joints were graded according to Kellgren and Lawrence (KL) grades. In OA patients, we separated IP joints into 2 groups: "at risk of OA" joints (potential early pre-radiographic OA joints, KL=0) and OA joints (KL=2-4). All IP joints from healthy participants were KL=0 and were considered strictly normal IP joints. Concurrently, synovitis, effusion, erosions, osteophytes, bone marrow lesions, cysts and cartilage space loss were graded by MRI and/or US. We assessed their prevalence, severity and diagnostic performance in hand OA and then compared normal IP joints from healthy participants and "at risk of OA" IP joints from OA patients as well as "at risk of OA" and OA IP joints from OA patients.The prevalence and grade of most MRI/US-detected lesions were higher in IP joints from OA patients than healthy participants. Except for osteophyte assessment, MRI seemed more sensitive than US. We found more MRI/US-detected lesions in "at risk of OA" IP joints than normal joints but also in OA than "at risk of OA" joints from OA patients. US appeared both sensitive and specific for detecting osteophytes in joints without radiographic abnormalities.MRI and US give good performance for detecting radiographic and pre-radiographic OA lesions and could be interesting tools to identify early hand OA.

International audience; Objective: In rheumatoid arthritis, the association between advanced therapies (including biologic disease-modifying antirheumatic drugs [DMARDs] and targeted synthetic DMARDs) and methotrexate (MTX) is recommended by international societies. When MTX cannot be used, other conventional synthetic DMARDs (csDMARDs) may be proposed. We aimed to compare the safety and efficacy of MTX and non-MTX csDMARDs in combination with advanced therapies.Methods: We systematically searched the literature for studies comparing the effectiveness, retention rate, and safety of MTX versus non-MTX csDMARDs (leflunomide or others) in combination with tumor necrosis factor inhibitors (TNFi), abatacept, rituximab, tocilizumab, and JAK inhibitors. Meta-analysis was performed with RevMan, using an inverse variance approach with fixed or random-effects models. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were estimated.Results: The literature search revealed 3,842 articles; 41 studies were included for the systematic literature review and 21 for the meta-analysis: 13 with TNFi, 3 with abatacept, and 5 with rituximab. For TNFi, the European Alliance of Associations for Rheumatology (EULAR) response at 6 months was lower for patients receiving non-MTX csDMARDs than for those using MTX (RR 0.93 [95% CI 0.87, 1.0], P = 0.04; n = 3,843; I2 = 28%), with a lower retention rate at 12 months. For abatacept, effectiveness and safety were similar between the 2 groups. For rituximab, a good EULAR response was higher with leflunomide than MTX (RR 1.38 [95% CI 1.13, 1.68], P = 0.001; n = 2,078; I2 = 0%), with similar adverse event rates. Meta-analysis for tocilizumab or JAK inhibitors could not be performed.Conclusion: The different csDMARDs seem safe and efficient to combine with advanced therapies in RA patients. Although MTX seems slightly superior to other csDMARDs in combination with TNFi, leflunomide might be superior to MTX in combination with rituximab.

Introduction Notre objectif était de décrire la prévalence de la séroconversion au SARS-CoV-2 par un dépistage sérologique systématique des patients atteints de rhumatisme inflammatoire chronique (RIC) et d’en étudier les facteurs associés. Matériels et méthodes COVID-RIC1 est une étude transversale multicentrique nationale menée dans 17 centres tertiaires en France. Critères d’inclusion : – ≥ 18 ans ; – diagnostic de polyarthrite rhumatoïde (PR), spondylarthrite axiale (axSpA) ou rhumatisme psoriasique (RPso) ; – traitement ≥ 1 mois par AINS, corticoïdes ou DMARD ; – accepter un test sérologique SARS-CoV-2. Données collectées par formulaire électronique centralisé et anonyme : démographiques, RIC, traitements symptomatiques et de fond, symptômes évocateurs de COVID-19. Les tests sérologiques pour le SARS-CoV-2 pouvaient être réalisés soit au centre tertiaire, soit dans le laboratoire habituel du patient. En cas de tests sérologiques antérieurs, les résultats ont également été recueillis. La séroprévalence était estimée comme le rapport du nombre de tests positifs sur le nombre de tests sérologiques SARS-CoV-2. Une régression logistique a été réalisée pour étudier l’impact des différentes covariables sur la séroconversion. Toutes les variables avec p

International audience; Objective: To investigate the impact of baseline and time-varying factors on the risk of serious adverse events (SAEs) in patients during long-term certolizumab pegol (CZP) treatment.Methods: Safety data were pooled across 34 CZP clinical trials in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and plaque psoriasis (PSO). Cox proportional hazards modeling was used to investigate the association of baseline patient characteristics with risk of serious infectious events (SIEs), malignancies, and major adverse cardiac events (MACEs). Cox modeling for recurrent events assessed the impact of time-varying body mass index (BMI), systemic corticosteroid (CS) use, and disease activity on SIE risk in RA and SAE risk in PSO.Results: Data were pooled from 8747 CZP-treated patients across indications. Cox models reported a 44% increase in SIE risk associated with a baseline BMI of 35 kg/m2 or more versus a baseline BMI of 18.5 kg/m2 to less than 25 kg/m2 . Baseline systemic CS use, age of 65 years or more, and disease duration of 10 years or longer also increased SIE risk. Older age was the only identified risk factor for malignancies. The risk of MACEs increased 107% for BMI of 35 kg/m2 or more versus BMI of 18.5 kg/m2 to less than 25 kg/m2 and increased 51% for men versus women. Higher disease activity, older age, systemic CS use, BMI of 35 kg/m2 or more, and baseline comorbidities were SIE risk factors in RA. Age and systemic CS use were risk factors for SAEs in PSO.Conclusion: Age, BMI, systemic CS use, and disease activity were identified as SIE risk factors in CZP-treated patients. Risk of malignancies was greater in older patients, whereas obesity and male sex were MACE risk factors.

Objectives To investigate the determinants of patient well-being over time, and the influence of age, gender and education in patients with early axial spondyloarthritis (axSpA). Methods Five-year data from DESIR, a cohort of early axSpA, were analysed. The outcome was the BAS-G over 5 years. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from five outcome domains (disease activity, physical function, spinal mobility, structural damage and axial inflammation) and BAS-G over time. Longitudinal relationships were analysed using an autoregressive GEE model. Age, gender and educational level were tested as effect modifiers or confounders. Results A total of 708 patients were included. Higher BASDAI questions on fatigue [β (95% CI): 0.17 (0.13, 0.22)], back pain [0.51 (0.46, 0.56)], peripheral joint pain [0.08 (0.04, 0.12)] and severity of morning stiffness [0.08 (0.03–0.13)], and higher BASFI [0.14 (0.08, 0.19)] were associated with a higher BAS-G. In the autoregressive model, the same variables except for morning stiffness were associated with a worsening in BAS-G. Age, gender and educational level were neither effect modifiers nor confounders. Conclusion A higher level of back pain is associated with a worsening of patient well-being, as are, though to a lesser extent, higher levels of fatigue, peripheral joint pain and physical disability. Age, gender and educational level do not have an impact on these relationships.

ObjectiveThis analysis evaluated efficacy and safety of filgotinib, a Janus-associated kinase 1-preferential inhibitor, in methotrexate (MTX)-naive patients with rheumatoid arthritis (RA) with multiple poor prognostic factors (PPFs).MethodsThis was a post hoc analysis of the phase III, randomised, double-blind, active-controlled, FINCH 3 study (clinicaltrials.gov NCT02886728). Patients received once-daily oral filgotinib 200 or 100 mg plus once-weekly oral MTX ≤20 mg (FIL200 + MTX and FIL100 + MTX), filgotinib 200 mg monotherapy (FIL200), or oral MTX monotherapy (MTX-mono) for up to 52 weeks. PPFs investigated were seropositivity for rheumatoid factor or anticyclic citrullinated peptide antibodies, high-sensitivity C reactive protein (CRP) ≥4 mg/L, Disease Activity Score in 28 joints with CRP (DAS28(CRP)) >5.1, and presence of erosions. Filgotinib efficacy and safety in patients with all four PPFs at baseline were explored versus MTX-mono within this subgroup and compared informally with the overall population.ResultsOf 1249 patients in FINCH 3, 510 (40.8%) had all PPFs. Efficacy of FIL200 + MTX among these patients was comparable to the overall population, with higher rates of 20%/50%/70% improvement from baseline by American College of Rheumatology criteria, DAS28(CRP) ConclusionFIL200 + MTX efficacy and safety in patients with multiple PPFs were similar to the overall population.

International audience; Objective: To assess the time to initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs) in ESPOIR, the French cohort of patients with rheumatoid arthritis (RA), and factors associated with the timing of bDMARD initiation.Methods: In total, 658 patients with early RA satisfying the 2010 ACR/EULAR criteria were included between 2003 and 2005 and followed annually for 10 years (end of follow up: 2013-2015). The timing of bDMARD introduction and predictors of use were analysed by the Kaplan-Meier method based on Cox proportional-hazard models.Results: Overall, 178 patients (31.0%, 95% confidence interval [27.0-34.7]) initiated a bDMARD during the 10-year follow-up, with a mean delay of 43.6 months. The penetration rate was higher during the first 2 years of follow-up (6% between the first and second year, approximately 3.3% each year between the second and seventh year, and

International audience; Inflammatory bowel diseases (IBDs) are associated with a decreased bone mineral density, but the impact on fractures is unknown. In our study, global risk of fracture is increased for patients with IBDs versus controls. This result will help to determine the appropriate assessment with early screening and management of osteoporosis. Inflammatory bowel diseases (IBDs), such as Crohn's disease (CD) and ulcerative colitis (UC), are associated with a decreased bone mineral density (BMD). However, the impact on fracture risk is unknown and data are contradictory across studies. In this systematic review and meta-analysis, we aimed to assess the risk of fracture and presence of low BMD in patients with IBDs compared to healthy controls. A systematic search of literature was conducted of MEDLINE, EMBASE, the Cochrane library and abstracts from appropriate scientific congresses. Studies were selected if they compared the incidence of fractures and/or BMD measurement by dual-energy X-ray absorptiometry in patients with IBDs and healthy sex- and age-matched controls. Data were extracted by two independent investigators. Meta-analysis was performed with the inverse variance approach to estimate pooled odds ratios (ORs) and risk ratios (RRs) with their 95% confidence intervals (CIs). Twenty-four studies met the inclusion criteria. On the basis of nine studies, global risk of fracture was increased for patients with IBDs versus controls (RR = 1.38, 95% CI 1.11-1.73; p = 0.005). Fracture risk with IBDs was significantly increased for vertebral fractures (OR = 2.26, 95% CI 1.04-4.90; p \textless 0.001), but not for any other site. The analysis of 16 studies evaluating BMD showed a significant decrease in mean BMD and Z-scores for IBD patients versus controls at all sites. In our meta-analysis, patients with IBDs have an increased risk of fractures, especially in the spine, and significant decreased BMD at all sites, which suggests the need for identifying high-risk individuals among this population.

International audience; OBJECTIVE: In this review, we summarise the clinical efficacy and safety of B-cell targeted therapies for primary Sjögren's syndrome (pSS). METHODS: A systematic literature review was conducted using databases including MEDLINE, EMBASE and Cochrane. Only articles reporting controlled or prospective studies of b-DMARDs modulating B cells in treatment of pSS were selected. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was clinical efficacy at week 24 on fatigue, dryness, Schirmer test, salivary flow rate and the full ESSDAI score including biological domain. For the efficacy criteria used, the difference between rituximab and placebo groups was expressed as mean difference (MD). RESULTS: Eighteen articles (13 of rituximab, 3 of belimumab, 1 of epratuzumab and 1 of baminercept) were identified for detailed evaluation. 4 controlled randomised trials of rituximab treatment vs. placebo involving 300 patients were included for quantitative analysis. No significant differences were observed between groups in the meta-analysis of mean improvements between baseline and week 24 in fatigue VAS [MD -3,24 95% CI (-30,21 to 23,72)], oral dryness VAS [MD -8,41 95% CI (-35,06 to 18,24)], salivary flow rate [MD 0,04 95% CI (-0,03 to 0,11)] and Schirmer test [MD 0,35 95% CI (-2,13 to 2,82)]. Rituximab was relatively safe compared to placebo. CONCLUSION: Our review shows that rituximab is not effective in pSS with the designs and outcomes proposed in the trials. Controlled randomised trials are needed to prove the efficacy of belimumab and epratuzumab in this indication. The randomised controlled trial evaluating baminercept failed to achieve its primary endpoint.

Resume Le traitement de la PR a radicalement change sur les 15 dernieres annees avec l’apparition des biotherapies et de nouvelles strategies therapeutiques mais egalement l’emergence de nouveaux concepts : controle serre (tight control) et traitement par objectif (treat to target). En particulier, la necessite de l’utilisation d’un instrument de mesure objectif et precis de l’activite de la maladie a ete demontree. Le DAS a ete le premier score composite d’activite de la PR. Le DAS28, un score simplifie avec moins d’articulations a evaluer (28 vs 44), a ensuite ete developpe. Ces deux scores necessitent un calculator (algorithme complexe) et un bilan biologique recent. C’est pourquoi d’autres scores composites ont vu le jour – le SDAI – et sa version modifiee – le CDAI (sans biologie). Le DAS28 est le score le plus utilise et permet outre l’evaluation du statut du patient, l’analyse de la reponse EULAR. La prise en charge therapeutique des patients PR se base actuellement sur l’obtention d’une reponse au plus tard a 3 mois et l’atteinte de l’objectif au plus tard a 6 mois. L’objectif est clairement defini comme etant la remission surtout dans la PR recente bien que plusieurs definitions coexistent : de la plus stricte (remission ACR-EULAR 2011 booleenne ou SDAI) a la remission DAS28 CRP, la plus permissive.

Introduction/Contexte Le catastrophisme est defini comme une reaction negative exageree face a un stimulus anxiogene. Il est considere comme un facteur cognitif d’importance dans les pathologies douloureuses. Objectifs Decrire la prevalence et les facteurs associes au catastrophisme dans la polyarthrite rhumatoide (PR). Materiels et methodes Etude prospective sur 1 an bi-centrique de patients suivis pour une PR. Cette analyse porte sur les donnees d’inclusion. Des donnees clinico-biologiques (EVA douleur/globale, articulations douloureuses/gonflees, CRP/VS, DAS28) et les resultats de questionnaires evaluant activite de la maladie (RAPID-3), catastrophisme (Pain Catastrophizing Scale, PCS), coping (CSQ), qualite de vie (Sf12, Eq5D, RAID), impact fonctionnel (HAQ), anxiete, depression (HADS, GAD7), et insomnie (ISI) on ete recueillies. Les analyses statistiques ont consiste en des analyses en composante principale, des tests de Chi2, Fisher, Wilcoxon, Student, ANOVA et calcul de coefficients de correlation pour les analyses univariees et en regressions lineaires et logistiques pour les analyses multivariees. Resultats Un total de 201 patients porteurs de PR ont ete inclus. Le score PCS median etait de 18/52 et la prevalence d’un niveau eleve de catastrophisme (PCS ≥ 20) etait de 48,0 % IC95 %[41,0 ; 54,9]. Des analyses en composante principale etudiant catastrophisme et methodes de coping ont montre une opposition entre des methodes de coping maladaptatives telles que le catastrophisme et la priere et des methodes plus adaptees (distraction, ignorance, re-interpretation des sensations douloureuses). En analyse multivariee, le catastrophisme en continu, etait associe significativement a l’anxiete, la depression, l’impact fonctionnel et l’insomnie. Un niveau eleve de catastrophisme etait quant a lui associe a l’anxiete avec un Odds Ratio (OR) de 1,25 IC95 %[1,18 ; 2,20], a la depression avec un OR de 1,19 [1,07 ; 1,33] et a l’activite de la maladie (DAS28-CRP) avec un OR de 1,61 [1,18 ; 2,20]. Discussion Les donnees concernant la prevalence du catastrophisme sont coherentes avec les donnees de litterature. Concernant les facteurs associes, l’anxiete est retrouvee associee au catastrophisme dans l’ensemble de nos analyses, cependant, c’est un facteur peu etudie dans la litterature. La depression est quant a elle liee au catastrophisme de meme que l’activite de la maladie et l’impact fonctionnel dans quelques etudes dans la PR et dans davantage d’etudes dans les pathologies osteoarticulaires mecaniques. Le lien entre insomnie et catastrophisme a ete tres peu etudie jusqu’ici. Conclusion Pres de la moitie des patients PR ont des scores de catastrophisme eleves, avec une association nette a differents parametres rendant pertinent sa detection et sa prise en charge.

Introduction L’essai francais ToLEDO (Towards the Lowest Efficacious Dose) cherchait a comparer une strategie de decroissance des bDMARDs (tocilizumab (TCZ) ou abatacept (ABA)) a une strategie de maintien a pleine dose chez des patients ayant une polyarthrite rhumatoide (PR) en remission prolongee. La non inferiorite n’a pas ete demontree pour le critere principal (evolution du DAS44). Un des objectifs secondaires de cet essai etait d’evaluer l’impact de cette strategie de decroissance en termes de progression radiographique a 2 ans. Patients et methodes ToLEDo est un essai randomise controle ouvert multicentrique de non-inferiorite (NI). Les patients devaient presenter une PR selon les criteres ACR-EULAR 2010, etre traites depuis au moins 1 an par ABA ou TCZ (seul ou en association) sans ou avec une corticotherapie a une dose ≤ 5 mg/j, et en remission depuis au moins 6 mois (DAS28 ans , et la progression structurale etait evaluee a l’aide du score de Sharp modifie par van der Heijde (vSHS) par 2 lecteurs entraines et en insu du groupe de randomisation. Les criteres de jugement pour cette analyse secondaire etaient : l’evolution vSHS sur 2 ans (compares entre les deux groupes au moyen d’un modele lineaire mixte), et le taux de progresseurs a 2 ans avec ΔvSHS > 0 et avec ΔvSHS > plus petit changement detectable (SDC = 6,9). Les analyses ont ete realisees en per protocol (PP). Resultats 80 sujets avaient un vSHS renseigne a l’inclusion et a au moins un des deux temps de lecture (44 bras M et 36 bras S) et ont ete consideres pour l’analyse de l’evolution du vSHS. La difference d’evolution du vSHS entre le bras M et le bras S sur 2 ans etait non significative, de 2,47 [IC95 % : -0,34 ;5,28]. Parmi les 80 sujets, 62 (34 bras M et 28 bras S) ont ete consideres pour l’analyse du taux de progresseurs (vSHS renseigne a l’inclusion et a 2 ans). Le taux de progresseurs a 2 ans avec ΔvSHS > 0 n’etait pas significativement plus eleve dans le bras S compare au bras M : 75 % contre 68 %, soit une difference de 7 % [IC95 % de precision : -15 % ; 30 %]. De meme, le taux de progresseurs a 2 ans avec ΔvSHS > SDC n’etait pas significativement plus eleve dans le bras S compare au bras M : 29 % contre 15 %, soit une difference de 14 % [IC95 % de precision : -07 % ; 34 %]. Discussion Cet essai a pu etre penalise par un manque de puissance, un nombre consequent de deviations au protocole ainsi que par l’anciennete et la severite de la PR chez les patients etudies. Conclusion Les resultats sur ces criteres de jugement secondaires radiographique sont coherents avec la conclusion sur le critere de jugement principal : bien que non statistiquement significative, la difference entre les deux groupes, en defaveur du groupe espacement, conduisent a ne pas recommander l’espacement des injections de TCZ et d’ABA chez des patients avec une PR tres erosive ou a risque de progression structurale.

Background:A framework has been proposed to explain which disease outcomes impact quality of life or well-being in patients with axSpA; this was based on cross-sectional data and patients with radiographic axSpA.1Objectives:To investigate the determinants of patient’s well-being over time, and the influence of contextual factors on these relationships in patients with early axSpA.Methods:Five-year data from DESIR, a cohort of early axSpA, were analysed. Clinical data were collected every 6 months up to 2 years and annually thereafter. X-rays and MRI of the spine and SIJ were performed at baseline, 2, and 5 years. The outcome was BAS-G, the patient’s global assessment of the disease impact on well-being. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from 5 domains (disease activity, physical function, spinal mobility, structural damage, spinal and SIJ inflammation) and BAS-G over 5 years. Longitudinal relationships were analysed using an autoregressive GEE model. Contextual factors (patient’s educational level, gender and age) were tested as potential effect modifiers or confounders.Results:A total of 708 patients were included, mean age 33.7 (SD 8.6) years, 46% male, 41% lower educated. Higher scores of the individual questions of BASDAI on fatigue (Q1) (β [95% CI]: 0.17 [0.13-0.22]), back pain (Q2) (0.51 [0.46-0.56]), peripheral joint pain (Q3) (0.08 [0.04-0.12]) and severity of morning stiffness (Q5) (0.08 [0.03-0.13]), and BASFI (0.14 [0.08-0.19]) were independently associated with a higher BAS-G over time (Table 1). In the autoregressive GEE model, all variables except for the BASDAI Q5 showed true longitudinal associations with BAS-G. Age, gender and educational level were neither effect modifiers nor confounders.Table 1.Factors associated with BAS-G over time.Multivariable GEE modelMultivariable autoregressive GEE model §Coefficient (95% CI)Coefficient (95% CI)BASDAI Q1 (fatigue, 0-10)0.17 (0.13 to 0.22)*0.15 (0.10 to 0.20)*BASDAI Q2 (back pain, 0-10)0.51 (0.46 to 0.56)*0.54 (0.47 to 0.60)*BASDAI Q3 (peripheral joint pain, 0-10)0.08 (0.04 to 0.12)*0.13 (0.08 to 0.19)*BASDAI Q4 (enthesitis, 0-10)0.03 (-0.01 to 0.07)0.02 (-0.04 to 0.08)BASDAI Q5 (severity of morning stiffness, 0-10)0.08 (0.03 to 0.13)*0.06 (-0.01 to 0.13)BASDAI Q6 (duration of morning stiffness, 0-10)0.03 (-0.01 to 0.07)0.05 (-0.01 to 0.11)SJC28 (0-28)0.01 (-0.11 to 0.13)0.10 (-0.11 to 0.31)TJC53 (0-159) ¶-0.01 (-0.02 to 0.01)-0.01 (-0.03 to 0.01)MASES (0-39)0.00 (-0.02 to 0.02)-0.00 (-0.03 to 0.02)CRP (mg/L)0.01 (-0.00 to 0.01)0.00 (-0.01 to 0.01)Any EAM (presence vs absence)-0.05 (-0.21 to 0.11)-0.09 (-0.28 to 0.10)BASFI (0-10)0.14 (0.08 to 0.19)*0.08 (0.00 to 0.16)*BASMI linear (0-10)-0.07 (-0.16 to 0.02)-0.10 (-0.22 to 0.02)mNY grading (0-8)0.01 (-0.03 to 0.06)0.06 (0.01 to 0.12)*mSASSS (0-72)-0.01 (-0.04 to 0.02)0.00 (-0.03 to 0.04)* p-value < 0.05¶ Each joint graded 0-3§Adjusted for the outcome (i.e. BAS-G) one year before, in order to disentangle the cross-sectional and longitudinal relationships between outcomes and allow the interpretation of a longitudinal relationshipConclusion:A higher level of back pain was associated with a worsening of the patient’s well-being in early axSpA, as were, though to a lesser extent, higher levels of fatigue, morning stiffness, peripheral joint pain and physical disability. Contextual factors like age, gender and educational level did not have an impact on these relationships. Thus, the previously proposed framework of disease outcomes also applies to patients with early axSpA and to outcomes over time.References:[1]Machado, P. ARD 2011.Disclosure of Interests:Fumio Hirano Paid instructor for: Ono pharmaceuticals, Astellas Pharma Inc, Sumitomo Dainippon Pharma, Chugai Pharmaceutical Co., Ltd., Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Floris A. van Gaalen: None declared, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Cecile Gaujoux-Viala: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis

Background:Patients (pts) with rheumatoid arthritis (RA) with poor prognostic factors (PPF) are at risk for RA progression if disease activity is not rapidly controlled. In FINCH 3 (NCT02886728), filgotinib (FIL)—an oral, potent, selective JAK1 inhibitor—was effective relative to methotrexate monotherapy (MTX mono) in MTX-naïve patients with ≥1 PPF—erosions, seropositivity for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP), or hsCRP ≥4 mg/L.1Objectives:This post hoc analysis examined FIL efficacy in FINCH 3 pts with multiple PPF.Methods:The global, phase 3, double-blind, active-controlled FINCH 3 study randomised MTX-naïve pts with moderately to severely active RA 2:1:1:2 to oral FIL 200 mg once daily + MTX ≤20 mg weekly, FIL 100 mg + MTX, FIL 200 mg mono, or PBO + MTX up to week (W)52. This subgroup analysis included pts with all 4 of the following PPF at baseline (PPF pts): erosions, seropositivity for RF or anti-CCP, hsCRP ≥4 mg/L, and DAS(28)CRP >5.1. Comparisons were not adjusted for multiplicity.Results:Of 1249 pts randomised and treated in FINCH 3, 510 had all 4 PPF. At baseline, relative to the overall FINCH 3 population, PPF pts had longer mean disease duration (2.4 vs 2.2 years); higher mean hsCRP (27.9 vs 17.5 mg/L), mTSS (17.9 vs 13.3), DAS28(CRP) (6.3 vs 5.7), HAQ-DI (1.76 vs 1.56), CDAI (44.3 vs 39.8), and SDAI (47.1 vs 41.5); and greater frequency of seropositivity for RF (90.6% vs 67.9%), anti-CCP (92.4% vs 68.5%), or both (82.9% vs 59.6%). Efficacy in PPF pts was comparable to data from all FINCH 3 pts (Table, Figures 1–2). PPF pts receiving FIL 200 mg with or without MTX vs MTX mono had higher frequencies of ACR20/50/70 response and greater improvement in HAQ-DI at W24; responses were numerically greater for FIL 200 mg + MTX vs FIL 100 mg + MTX or FIL 200 mg mono (Table) and were evident by W12 (data not shown). Radiographic progression at W24 was lower in PPF pts receiving FIL 200 mg + MTX or FIL 200 mg mono vs MTX mono (Figure 1). Proportions of PPF pts receiving FIL 200 mg with or without MTX who achieved DAS28(CRP) Table.Efficacy outcomes in patients with 4 PPF and all FINCH 3 patients at W24FIL 200 mg+ MTXFIL 100 mg+ MTXFIL 200 mg monoMTXmonoPPFAllPPFAllPPFAllPPFAlln1724168520787210166416ACR20, %85.5*81.0***83.580.2*81.678.174.771.4ACR50, %70.3***61.5***58.857.0**59.858.1**48.245.7ACR70, %54.1***43.8***37.640.1***43.7*40.0***28.326.0HAQ-DIa−1.2***−0.94***−1.0*−0.90**−1.0*−0.89*−0.9−0.79aMean change from baseline.*, p **, p ***, p FIL, filgotinib; mono, monotherapy; MTX, methotrexate; PPF, poor prognostic factors.Conclusion:FIL treatment provided rapid and deep disease control including higher rates of remission and other clinical outcomes, improved physical function, and less radiographic progression compared with MTX alone in MTX-naïve pts with RA with 4 PPF, a population at risk for severe progressive disease. In pts with 4 PPF, W24 remission rates following FIL 200 mg with or without MTX were higher vs MTX mono and numerically higher vs FIL 100 mg + MTX.References:[1]Westhovens et al.Ann Rheum Dis2019;78(Suppl2):259–60.Disclosure of Interests:Daniel Aletaha Grant/research support from: AbbVie, Novartis, Roche, Consultant of: AbbVie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, Speakers bureau: AbbVie, Celgene, Lilly, Merck, Novartis, Pfizer, Sanofi Genzyme, UCB, Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, Cecile Gaujoux-Viala Consultant of: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Gilead Sciences, Inc.; Janssen; Lilly; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB, Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celgene; Gilead Sciences, Inc.; Janssen; Lilly; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB, Giovanni Adami: None declared, Alan Matsumoto Grant/research support from: AbbVie; BMS; Eli Lilly; Galapagos; Gilead Sciences, Inc.; GSK; Janssen; Novartis; Pfizer; Sanofi; UCB; Regeneron, Consultant of: AbbVie; Gilead Sciences, Inc.; GSK; Novartis, Paul Bird Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer – advisor, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, Osvaldo Messina Speakers bureau: Amgen; Americas Health Foundation; Pfizer, Maya H Buch Grant/research support from: Pfizer, Roche, and UCB, Consultant of: Pfizer; AbbVie; Eli Lilly; Gilead Sciences, Inc.; Merck-Serono; Sandoz; and Sanofi, Beatrix Bartok Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Zhaoyu Yin Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Ying Guo Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Thijs Hendrikx Shareholder of: Galapagos (share/warrant holder), Employee of: Galapagos, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma

International audience; Hydroxychloroquine (HCQ) improves metabolic and cardiovascular outcomes in patients with rheumatoid arthritis (RA), but its efficacy appears to be moderate as compared to placebo. The aim of our study was to assess the current literature on the clinical and structural efficacy of HCQ in the joints of patients with RA.Methods: We systematically searched MEDLINE (via PubMed), Embase, Cochrane Library, and the American College of Rheumatology and European League Against Rheumatism annual scientific meeting abstracts for studies available up to November 2017 comparing the efficacy of HCQ in patients with RA, in monotherapy or combined with other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Data were extracted by 1 investigator and independently checked by a different investigator.Results: The literature search revealed 197 articles and abstracts of potential interest, and 11 studies fulfilled inclusion criteria. The clinical and structural efficacy of HCQ was similar to or lower than that for methotrexate or sulfasalazine in monotherapy. HCQ combined with other DMARDs could increase the clinical efficacy.Conclusion: In addition to its metabolic benefit, combining HCQ with other DMARDs could provide some clinical improvement in patients with RA and inadequate response to previous csDMARDs.

To determine whether patient global assessment of disease activity (PtGA) over the first year of disease course, as part of a Boolean-based definition of remission and considered individually, had a significant relationship with structural progression over 3 years in patients with early arthritis.We conducted a prospective, observational study using ESPOIR (Étude et Suivi des Polyarthrites Indifférenciées Récentes) cohort data. Remission states were defined as 1) 4-variable remission, which included a tender joint count in 28 joints, a swollen joint count in 28 joints (SJC28), a C-reactive protein (CRP; mg/dl) level, and PtGA (scored 0-10, all scores of ≤1); 2) PtGA near remission, which included the same parameters as 4-variable remission with only PtGA1 (of a maximum possible score of 10); 3) 3-variable remission (sum of the proportion of patients in 4-variable remission and the proportion of patients in PtGA near remission); or 4) nonremission. The strictest status satisfied both at 6 and 12 months was considered. Radiographic progression was determined as a change of ≥5 points in the total Sharp/van der Heijde score (ΔSHS) from baseline to 3 years. The predictive capacities for radiographic damage of different remission definitions were assessed by odds ratio (OR). The association between each individual component of remission with ΔSHS was tested through multivariate linear regression analyses.Among 520 patients, 7% achieved 4-variable remission and 12% achieved PtGA near remission. Radiographic progression was observed in 29% of patients who achieved 4-variable remission (OR versus nonremission; OR 0.32 [95% confidence interval (95% CI) 0.15, 0.68]) and in 45% of patients with PtGA near remission (OR 0.65 [95% CI 0.38, 1.11]); the comparison was not statistically different (OR 0.49 [95% CI 0.20, 1.18]). In 3-variable remission, radiographic progression was observed in 39%. Of the individual components, only the SJC28 and CRP level were associated with radiographic progression.All definitions of remission led to low structural degradation in early arthritis, and 4-variable remission led to less radiographic progression than PtGA near remission, but without a statistically significant difference. Both 4-variable remission and 3-variable remission appear to be useful targets when aiming for structural nonprogression.

Background: Rheumatic disorders (RD) provide chronic pain. Catastrophizing is a negative cognitive and affective response resulting in inadequate expression of pain. Catastrophizing in RD patients is suspected to be involved in persistence and amplification of chronic pain. Objectives: To assess catastrophizing level in RD and to evaluate the association between catastrophizing and physical pain intensity, disease activity, disability, depression and quality of life. Methods: We performed a systematic review of literature and search in the following databases: MEDLINE, COCHRANE and EMBASE until April 2018. All observational, cross-sectional and randomized control studies investigating catastrophizing in patients with RD (rheumatoid arthritis (RA), low back pain (LBP), osteoarthritis) were included. Statistical analysis defined pooled mean catastrophizing level by using the Pain Catastrophizing Scale (PCS), the latter ranging from 0 to 52. To assess the association between catastrophizing and disease activity (DAS28), pain (Numerical Rating Scale NRS), disability (ODI) and quality of life (SF36, WOMAC) we collected correlation coefficients and pooled them in meta-analysis using the Fisher’s z transformation with MedCalc v18.11.3. Results: From 1494 articles concerning catastrophizing and RD, 51 were selected for a meta-analysis : - 601 RA patients (mean age 57.4 years, 67.7% female, mean pooled DAS 28 = 3.4 and mean pooled NRS = 3.8) included in 7 studies. The mean pooled catastrophizing level at baseline was 14.7 (SD = 11.4) in RA patients vs 2.7 (SD = 3.0) in control group patients (n= 82 in 2 studies). In one study, a RA sample identified 22% of high catastrophizers (defined by PCS > or = 30). - 2521 LBP patients (mean age 43.6 years, 57% female, mean pooled NRS = 4.5 and mean pooled ODI = 30.3) included in 27 studies. The mean pooled catastrophizing level at baseline was 19.9 (SD = 11.3). - 3388 osteoarthritis patients (knee and hip, mean age 67.7 years, 65% female, mean pooled NRS = 5.0) included in 17 studies. The mean pooled catastrophizing level at baseline was 11.2 (SD = 10). In RA, a significant positive correlation between catastrophizing and DAS 28 was observed: pooled r=0.278 p In LBP, higher PCS scores were significantly associated with higher levels of pain and disability : pooled r=0.486 p Catastrophizing in osteoarthritis was strongly associated with an increase in functional limitations and pain (i.e. higher WOMAC total score, correlation coefficient: r= 0.641 p Conclusion: Catastrophizing is a common psychological trait clearly associated with disease activity, pain, mental health and physical function. Nevertheless catastrophizing is rarely measured. It might be relevant to detect it earlier in order to adapt pharmacologic and non-pharmacologic treatment in at-risk patients. Disclosure of Interests: Soraya Benamar: None declared, Charlotte Hua: None declared, Jacques Morel: None declared, Francoise Flaisler: None declared, Bernard Combe Consultant for: Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Cedric Lukas: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma.

Background: Methotrexate (MTX) is widely used in rheumatology. About 30% of patients receiving MTX do not respond. One of the explanations could be poor adherence. Objectives: The purpose of this study was to assess adherence and to identify predictive factors influencing it. Methods: 188 patients with MTX for at least 3 months (rheumatoid arthritis (RA), peripheral spondyloarthritis (PS), psoriatic arthritis (PA), lupus, Sjogren’s Syndrome (SS)) were enrolled between May 2017 and May 2018. Each patient completed a questionnaire including socio-demographic data, disease and MTX characteristics, 4-question Morisky, rheumatism activity scores including DAS 28, quality of life (EQ-5D), fibromyalgia (FiRST), anxiety and depression (HADS), catastrophism (PCS-CF), coping (WCC-R) and whether or not to participate in a therapeutic education program. Results: 188 were recruited, of which 75% were women, with a mean age of 61.4 +/- 13.24 years: RA (77.12%), PS (7.98%), PA (10.11%), lupus (2.66%) and SS (2.13%). 68.6% were observant, versus 31.4% unobservant minor (28.2%) or major (3.2%) patients. In multivariate analysis, two models were performed and found a poor adherence in case of depression OR: 3.120 [1.051; 9.354], catastrophism OR: 3.974 [1.119; 14.108], anti-CCP antibodies OR: 4.019 [1.277; 12.653] in RA patients and depression OR: 2.715 [1.237; 5.963], absence of comorbidities OR: 2.309 [1.085; 4.915] with all rheumatism. Conclusion: Some modifiable factors such as depression and catastrophism were associated with the risk of non-adherence with MTX. It is important to consider depression and catastrophism when taking care of our patients to improve adherence and avoid therapeutic escalations. Disclosure of Interests: Elisabeth FILHOL: None declared, Charlotte Hua: None declared, Francoise Flaisler: None declared, Cedric Lukas: None declared, Bernard Combe Consultant for: Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Jacques Morel: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma.

Background: Biologic Disease Modifying Anti-Rheumatic Drugs (bDMARD) tapering is possible in rheumatoid arthritis (RA) patients in sustained remission. However, only minimal data are available on progressive tapering of non-TNF bDMARD such as tocilizumab (TCZ) or abatacept (ABA). Objectives: The TOLEDO (Towards the Lowest Efficacious Dose) trial aimed to assess the impact on disease activity of progressive spacing of TCZ or ABA in RA patients in sustained remission compared to their maintenance at full dose. Methods: In this multicenter open-label non-inferiority randomized controlled trial, patients fulfilling ACR-EULAR 2010 criteria for RA were included if they were 1) treated with ABA or TCZ for ≥ 1 year (monotherapy or in combination with csDMARD, corticosteroid allowed at a dose ≤ 5 mg/day), 2) in DAS28VS remission (DAS28 3.2, and DAS28 >3.2 not recovered at the following visit despite bDMARD escalation at previous step) were also compared between the 2 arms. Analysis were done per protocol (PP) according to a non-inferiority hypothesis (non-inferiority margin at 0.25 for DAS44 and 0.07 for relapse rates). Results: 117 patients were randomized in Spacing arm and 116 in Maintenance arm (90 and 112 respectively for PP analysis). 165 (72.4%) patients were treated with TCZ and 63 (27.6%) with ABA. At the end of the follow-up in the Spacing arm, 12.4% of patients were able to discontinue their bDMARD (step 4), 38.9% had tapered them (step 1 to 3) and 23.9% needed to go back to initial step (step 0). In terms of disease activity, the non-inferiority of the Spacing strategy in terms of disease activity (DAS44) was not demonstrated for the whole population and the ABA subgroups: slope difference of 11% (95% CI: -9%, 32%) and 37% (95% CI: -4%, 77%) respectively. However, it was satisfied for the TCZ subgroup: slope difference 3% (95% CI: -21%, 27%) (Figure 1). Relapses (Figure 2) were more frequent in the Spacing arm: +45% (95% CI: 32%, 57%), +48% (95% CI: 24%, 71%) and +43% (95%CI: 29%, 58%) in the whole population, ABA and TCZ subgroups respectively. Durable relapses were more frequent in the Spacing arm: +10% (95%CI: 0%, 19%), 16% (95%CI: -5%, 37%) and 7% (95%CI: -3%, 16%) in the whole population, ABA and TCZ subgroups respectively, compared with Maintenance arm. Conclusion: The TOLEDO trial generally failed to demonstrate the non-inferiority of the proposed tapering strategy in comparison to maintenance at full dose. However, the non-inferiority was satisfied in terms of disease activity for the TCZ subgroup. Disclosure of Interests: Joanna KEDRA: None declared, Philippe Dieude: None declared, Hubert MAROTTE: None declared, Alexandre Lafourcade: None declared, Emilie Ducourau Speakers bureau: BMS and Abbvie, Thierry Schaeverbeke: None declared, Aleth Perdriger: None declared, Martin SOUBRIER: None declared, Jacques Morel: None declared, Arnaud Constantin: None declared, Emmanuelle Dernis: None declared, Valerie Royant: None declared, Jean-Hugues Salmon Speakers bureau: Janssen Novartis, Thao Pham Speakers bureau: Lilly, Novartis, Jacques-Eric Gottenberg Grant/research support from: Bristol-Myers Squibb, Grant/research support from: Bristol-Myers Squibb, Consultant for: Bristol-Myers Squibb, Lilly, Pfizer, Sanofi-Genzyme, UCB Pharma, Consultant for: Bristol-Myers Squibb, Eli Lilly, UCB, Sanofi-Genzyme, Pfizer, Edouard Pertuiset: None declared, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Valerie Devauchelle-Pensec Grant/research support from: Roche-Chugai, Speakers bureau: MSD, BMS, UCB, Roche, Philippe Gaudin Speakers bureau: Roche, Chugai, BMS, Abbvie, Servier, Pfizer, MSD, UCB, ESAOTE, Genevrier, Janssen, Novartis, Lilly, Biogen, Amge, Gregoire CORMIER: None declared, Philippe Goupille: None declared, Xavier Mariette Grant/research support from: Servier, Consultant for: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, UCB Pharma, Francis Berenbaum: None declared, Didier Alcaix: None declared, SID AHMED ROUIDI: None declared, Jean-Marie Berthelot: None declared, Agnes Monnier: None declared, Christine Piroth: None declared, Frederic Liote Grant/research support from: institutional grants from Grunenthal, Ipsen Pharma/Menarini, Novartis, SOBI for the European Crystal Network Workshops, Consultant for: Grunenthal, Novartis, Vincent Goeb: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Isabelle CHARY VALCKENAERE: None declared, David Hajage: None declared, Florence Tubach Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB

Background: Certolizumab pegol (CZP) is an anti-TNF drug approved for rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), psoriasis (PSO) and Crohn’s disease (CD). Older age, comorbidity burden and corticosteroid (CS) use have been linked to increased risk of serious infectious events (SIEs) in CZP-treated patients (pts) with RA.1 However, the impact of overall disease burden on the risk of serious adverse events (SAEs) has not been fully examined for other CZP indications. High body mass index (BMI) has been associated with systemic inflammation and greater comorbidity risk.2,3 Greater disease burden in these pts may lead to increased CS use – a known risk factor for SAEs.1 Objectives: To examine the contribution of BMI and CS use to the risk of SIEs, malignancies and major adverse cardiovascular events (MACE) in CZP-treated pts across indications. Methods: Safety data were pooled across 49 CZP clinical trials (27 RA, 1 axSpA, 1 PsA, 5 PSO, 15 CD). SAEs of potential concern were medically reviewed by an external expert committee using predefined case rules. Incidence rates (IR) were calculated per 100 pt–years (PY). Multivariate Cox modeling was used to estimate relative risk (hazard ratio [HR]) of time to first SIE, malignancy or MACE by baseline BMI ( Results: Across indications, 11,317 pts received CZP (21,695 PY total exposure; max: 7.8 years [yrs]; exposure for RA: 13,542 PY; axSpA: 978 PY; PsA: 1,316 PY; PSO: 1,481 PY; CD: 4,378 PY). Mean BMI was 27.8 kg/m2 in RA, 27.6 kg/m2 in axSpA, 29.8 kg/m2 in PsA, 30.1 kg/m2 in PSO, and 24.0 kg/m2 in CD. Overall, 4,132 pts (37%) took CS at baseline, more so in RA (46%) and axSpA (51%). Across indications, IRs were 0.82/100 PY for all malignancies (IR for malignancies excluding non-melanoma skin cancer [NMSC] was 0.66/100 PY), 0.47/100 PY for MACE, and 3.62/100 PY for SIEs. According to the Cox model, age ≥45 yrs, disease duration Conclusion: In CZP-treated pts across indications, malignancy risk was not influenced by BMI or CS use. As expected, obesity and CS use increased the risk of MACE. The SIE risk associated with CS use was compounded in obese pts, which may reflect the contribution of comorbidities, disease activity or other factors not examined here. References [1] Curtis J. Arthritis Res Ther 2017;19:276; 2. Perez de Heredia F. Proc Nutr Soc 2012;71:332–8; 3. Harpsoe M. Int J Epidemiol 2014;43:843–55. Acknowledgement: We thank the patients who participated. This study was funded by UCB Pharma, medical writing by Emma Phillips, Costello Medical, UK. Disclosure of Interests: Vivian Bykerk Grant/research support from: Mallinckrodt, BMS, Crescendo Biosciences, Sanofi/Regeneron., Consultant for: Amgen, Pfizer, UCB, Scipher, Sanofi/Genzyme/Regeneron, Andrew Blauvelt Grant/research support from: AbbVie, Aclaris, Akros, Allergan, Almirall, Amgen, Boehringer Ingelheim, Celgene, Dermavant, Dermira Inc, Eli Lilly and Company, Galderma, Genentech/Roche, GlaxoSmithKline, Janssen, LEO, Meiji, Merck Sharp & Dohme, Novartis, Pfizer, Purdue Pharma, Regeneron, Revance, Sandoz, Sanofi Genzyme, Sienna Pharmaceuticals, Sun Pharmaceuticals, UCB Pharma, Valeant, Vidac, Consultant for: AbbVie, Aclaris, Akros, Allergan, Almirall, Amgen, Boehringer Ingelheim, Celgene, Dermavant, Dermira Inc., Eli Lilly and Company, Galderma, Genentech/Roche, GlaxoSmithKline, Janssen, LEO, Meiji, Merck Sharp & Dohme, Novartis, Pfizer, Purdue Pharma, Regeneron, Revance, Sandoz, Sanofi Genzyme, Sienna Pharmaceuticals, Sun Pharmaceuticals, UCB Pharma, Valeant, Vidac., Speakers bureau: Janssen, Regeneron, Sanofi Genzyme, Jeffrey Curtis: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, William Sandborn Shareholder of: Stock options from Escalier Biosciences, Gossamer Bio, Oppilan Pharma, Precision IBD, Progenity and Ritter Pharmaceuticals, Grant/research support from: Research grants from Atlantic Healthcare Limited, AbbVie, Amgen, Celgene/Receptos, Genentech, Gilead Sciences, Janssen, Lilly and Takeda, Consultant for: Consulting fees from AbbVie, Allergan, Amgen, Boehringer Ingelheim, Celgene, Conatus, Cosmo, Escalier Biosciences, Ferring, Genentech, Gilead, Gossamer Bio, Janssen, Lilly, Miraca Life Sciences, Nivalis Therapeutics, Novartis Nutrition Science Partners, Oppilan Pharma, Otsuka, Paul Hastings, Pfizer, Precision IBD, Progenity, Prometheus Laboratories, Ritter Pharmaceuticals, Robarts Clinical Trials (owned by Health Academic Research Trust or HART), Salix, Shire, Seres Therapeutics, Sigmoid Biotechnologies, Takeda, Tigenix, Tillotts Pharma, UCB Pharma and Vivelix, Kevin Winthrop Consultant for: Gilead, Galapagos, Eli Lilly and Company, Abbvie, Pfizer, GSK, Christina Popova Employee of: Employee of UCB Pharma., Xavier Mariette Grant/research support from: Servier, Consultant for: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, UCB Pharma

Background: Access to biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) of early rheumatoid arthritis (RA) patients is highly variable across countries and may depend on patient characteristics, disease expression, physicians behaviors as well as care organization in the patient region of living. Objectives: 1) To assess the time to initiation of bDMARDs in the French cohort ESPOIR, and 2) To assess the factors associated with the timing of bDMARD initiation. Methods: In this national multicenter cohort, 813 adult patients with suspected or confirmed early RA were included between December 2002 and March 2005, and followed up during 10 years. In the present analysis, we considered only patients who were fulfilling the ACR-EULAR 2010 criteria for RA at baseline. The primary outcome was the time to initiation of a biologic DMARD, in months, since diagnosis. It was assessed by Cox model based survival analysis with time dependent covariates; the threshold used for p-value was 0.05. Predictors colinearity was then assessed by adapted tests. All statistical analysis were done with R version 3.5.1. Results: Among the 658 patients fulfilling the ACR-EULAR 2010 criteria for RA (77% women, 52% smokers at baseline, mean-aged 48 at diagnosis, with positive RF in 46.6%, positive ACPA in 43% and polyarticular presentation at baseline in 54.5%), 178 patients (31%, CI 95%= [27%;34.7%]) initiated a biologic DMARD during the 10-year follow-up (Figure 1). Variables associated with an earlier bDMARD initiation in the bivariate analysis were: 1) at baseline: younger age (p = 0.0016), younger age of first joint pain (0.0014), younger age of first joint swelling (0.0014), 2) during the follow up: joint pain (p Conclusion: In this study, less than one third of the ESPOIR cohort patients initiated a bDMARD over the 10-year follow-up. RA poor prognostic factors were associated with earlier initiation as expected. Disclosure of Interests: Joanna KEDRA: None declared, Benjamin Granger: None declared, Stephanie Emilie: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Anne-Christine Rat: None declared, Bernard Combe Consultant for: Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB

Introduction Health-related quality of life (HRQoL) is a priority for patients. The objectives were to describe the changes in HRQoL over 5–8 years in patients with early arthritis (EA) or early inflammatory back pain (IBP) and to explore factors associated to HRQoL. Patients and methods In 2 prospective observational French cohorts (ESPOIR for EA patients and DESIR for early IBP patients), HRQoL was assessed regularly over 5–8 years, using the SF36 physical and mental composite scores (PCS and MCS, range 0–100). Disease activity was assessed by DAS28-ESR and ASDAS-CRP. Univariate and multivariate linear mixed-effect models and trajectory-based mapping were applied. Results In all, 1347 patients (701 EA and 646 early IBP) were analysed: mean age 48.4 ± 12.2 and 33.9 ± 8.7 years respectively; mean disease duration 3.4 ± 1.7 and 18.2 ± 10.8 months; and 76.3% and 55.0% females. At baseline, in EA, mean PCS and MCS were respectively 40.2 ± 9.1 and 40.4 ± 11.2 and, in early IBP, were respectively 38.5 ± 8.5 and 39.8 ± 10.9. Over follow-up, HRQoL mean levels improved mostly over the first 6 months (p

Resume Les precedentes recommandations de 2014 ont ete actualisees par un groupe de travail constitue de 12 experts rhumatologues, deux representants des associations de patients et un professionnel de sante. Le groupe de travail s’est appuye sur les recommandations de l’EULAR recemment publiees, sur une analyse systematique de la litterature et sur l’avis des experts. Quatre principes generaux et 15 recommandations ont ete emis. Les principes generaux mettent en avant l’importance d’une decision partagee entre le rhumatologue et le patient et la necessite d’une prise en charge globale de la polyarthrite rhumatoide (PR), sur le plan medicamenteux et non-medicamenteux. Les recommandations concernent l’approche diagnostique de la PR, les objectifs du traitement, l’organisation de la prise en charge, les traitements medicamenteux a utiliser en fonction de la ligne de traitement et des facteurs pronostiques, la gestion de la remission et la prise en charge globale des patients. Le traitement de fond (disease-modifying antirheumatic drug [DMARD]) doit etre initie le plus precocement possible. L’evaluation de l’activite de la maladie par des scores composites valides doit etre reguliere (controle serre) pour atteindre l’objectif therapeutique (la remission). Le methotrexate (MTX) est recommande en premiere intention. En cas d’intolerance ou de reponse insuffisante au MTX, le traitement doit etre optimise. En attendant que les DMARDs synthetiques conventionnels soient efficaces, une corticotherapie peut etre proposee sur une courte duree afin de garder une dose cumulee faible. En cas de remission persistante, sans progression structurale, sans corticoides, une decroissance progressive des therapeutiques ciblees respectant les principes du controle serre doit etre envisagee. Un depistage et une evaluation periodique des comorbidites, de leurs facteurs de risque et de leur prise en charge doivent etre realises.

Background:Since the beginning of 2020, the COVID-19 pandemic has caused a considerable amount of fear, worry and concern in the general population and among certain groups such as the elderly, healthcare providers and people with pre-existing conditions in particular. Our patients suffering from chronic inflammatory rheumatism (CIR), a group of autoimmune pathologies treated by immunosuppressant medication, are particularly concerned. Actions taken – particularly quarantine and its effects on the normal activities, habits or livelihoods of many people – also have a significant impact. There is little information on the impact of the lockdown in patients with CIR with data measured prospectively, in a standardized way, before and during the first lockdown period.Objectives:The objective of this ancillary study was to evaluate the psychological impact of the first lockdown period (anxiety, depression, sleep disorders, catastrophizing...) as well as the evolution of disease activity in patients suffering from CIR.Methods:At two French university hospitals, adult patients with rheumatoid arthritis (RA) according to the ACR-EULAR 2010 criteria, spondyloarthritis (SpA) fulfilling the ASAS 2009 criteria and psoriatic arthritis (PsA) according to the Caspar 2006 criteria were consecutively included in the Catastrophism in Chronic Inflammatory Rheumatism (CRIC) study from September 2019. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires on disease activity (DAS28, CDAI, BASDAI), function (HAQ), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), insomnia (ISI) and catastrophizing scores (PCS). These data were collected prospectively at baseline, 3, 6 and 12 months.In this ancillary study, data from patients with an assessment before and during lockdown were analyzed. Statistical analyses were descriptive with a paired Student’s T-test.Results:In all, 140 patients (49 RA, 69 SpA and 22 PsA) were evaluated before and during lockdown. The median age was 53.5 [44-63] years and 60.7% were women; 74 patients (53.2%) were professionally active and 102 (72.9%) were living as couples. The majority of patients (92.9 %) had a disease lasting more than 2 years. Concerning treatments, 63 (45%) were treated by bDMARD monotherapy, 40 (28.5%) by bDMARD+ csDMARD, 17 (12.1%) by csDMARD monotherapy and 2 patients by tsDMARD; 90.7% were not taking any corticosteroids and 8.6% were taking ≤5 mg/d; 30% were on NSAIDs.When comparing before and during lockdown, pain, tender joint count, swollen joint count, disease activity (CDAI, BASDAI) and function (HAQ, SF12 physical component) were similar. However, there was a significant improvement in psychological status, anxiety (HADS, GAD7), the mental component of SF12, catastrophizing and overall quality of life (EQ5D) (see Table 1 below).Conclusion:There are very few prospective, standardized data on the impact of lockdown in patients with CIR with an assessment before and during the first lockdown period. In patients with CIR, the first lockdown period had no impact on the activity of the disease and was well experienced psychologically with less anxiety and an improvement in quality of life.Table 1.Outcome (N)140 CIR: 49 RA, 69 SpA, 22 PsABefore lockdownMean (SD)During lockdownMean (SD)Mean change(SD)PPain VAS (138)39.4 (25.3)39.4 (25.0)-0.28 (27.1)NSTJC (57)4.0 (6.8)4.7 (4.4)0.7 (5.9)NSSJC (56)1.0 (2.6)1.6 (1.7)0.5 (2.4)NSCDAI (36)11.7 (1.4)12.3 (7.5)1.2 (8.7)NSBASDAI (84)4.7 (1.9)4.9 (2.0)0.14 (1.4)NSHAQ (135)0.72 (0.57)0.72 (0.53)0.03 (0.33)NSSF12 mental(136)32.7 (8.7)36.2 (8.4)3.46 (8.01)GAD-7 (anxiety) (135)7.7 (5.5)5.0 (5.3)-1.73 (0.40)HADS anxiety(137)8.5 (3.9)7.8 (3.9)-0.64 (2.91)0.0113EQ5D(139)0.55 (0.31)0.61 (0.29)0.06 (0.24)0.0078PCS (catastrophizing) (137)18.9 (13.3)15.9 (11.1)-3.10 (9.60)0.0003Disclosure of Interests:None declared

OBJECTIVE: To assess the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA). METHODS: COMEDRA is a French nationwide cross-sectional multicenter study on comorbidities in RA. Renal function was assessed from the estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease equation. RA characteristics and risk factors for renal impairment were collected. Two logistic regression models, 1 with and 1 without the Framingham Risk Score, were constructed from variables that were significantly associated with an eGFR of

Introduction Le catastrophisme est une reponse cognitive et affective negative a un stimulus anxiogene comme la douleur. Le catastrophisme joue un role dans l’amplification et le maintien des douleurs chroniques. L’objectif de cette etude etait d’evaluer la prevalence du catastrophisme dans la spondyloarthrite axiale (SA) et le rhumatisme psoriasique (RPso), ainsi que les facteurs associes au catastrophisme dans ces deux pathologies. Materiels et methodes Etude observationnelle prospective bicentrique de patients suivis pour une SA ou un RPso sur 1 an. Ont ete analysees les donnees a l’inclusion. Des donnees sociodemographiques, sur les traitements, la pathologie, cliniques (Echelle Visuelle Analogique [EVA] douleur, EVA globale patient et rhumatologue, nombre d’articulations douloureuses et gonflees) et biologiques (CRP, vitesse de sedimentation) etaient recueillies. Le patient remplissait ensuite des auto-questionnaires sur l’activite de la maladie (BASDAI), le catastrophisme (PCS), le coping (CSQ), la qualite de vie (Sf12, EQ5D), le handicap fonctionnel (BASFI, HAQ), le depistage de la fibromyalgie (FiRST), l’anxiete et la depression (HADS, GAD7) ainsi que l’insomnie (ISI). Les analyses statistiques comprenaient des tests de Fisher, Chi2, Wilcoxon, Student, ANOVA, calcul de coefficients de correlation pour les analyses univariees et des regressions lineaires et logistiques pour les analyses multivariees. Resultats En tout, 253 patients ont ete inclus (168 SA, 85 RPso). La prevalence d’un score de catastrophisme eleve (PCS ≥ 20) etait de 45,6 % [IC95 % : 39,5 ; 51,8] au total : 45,5 % [38,0 ; 53,1] dans la SA et 45,9 % [35,3 ; 56,5] dans le RPso. Le PCS median etait de 18 (Q1–Q3 : 6–18) dans la population globale. Il etait de 18 (7–27) dans la SA et de 16 (6–29) dans le RPso. En multivarie, le catastrophisme etait significativement associe a l’anxiete, la depression et a l’activite de la maladie dans la SA et a l’anxiete, une qualite de vie plus basse et la douleur dans le RPso. Discussion Il existe tres peu de donnees sur le catastrophisme dans la spondyloarthrite axiale (SA) et aucune dans le rhumatisme psoriasique (RPso). Notre etude est la premiere a evaluer dans une cohorte significative, la prevalence du catastrophisme dans la SA quel que soit le traitement recu, et la premiere a evaluer la prevalence du catastrophisme dans le RPso. Il est interessant de noter que meme en cas de faible activite de la maladie, on retrouvait environ 16 % de patients avec un catastrophisme eleve. Ces resultats permettent deja d’apprehender l’importance du catastrophisme chez nos patients souffrant de SA et de RPso. Il pourrait etre pertinent de detecter le catastrophisme chez nos patients souffrant de rhumatisme inflammatoire pour proposer une prise en charge appropriee. Le depistage du catastrophisme chez les patients souffrant de spondyloarthrite serait particulierement interessant dans la mesure ou l’activite de la maladie est essentiellement evaluee a travers des parametres subjectifs, potentiellement influences par des scores eleves de catastrophisme. Le depistage et la prise en charge du catastrophisme chez des patients chez qui la remission est difficile a obtenir pourraient permettre dans certains cas d’eviter une escalade therapeutique inutile et de privilegier d’autres types de prise en charge. Conclusion Pres de la moitie des patients avec une SA ou un RPso ont des hauts scores de catastrophisme, avec une association nette a differents parametres rendant pertinent sa detection et sa prise en charge.

Introduction Les donnees actuelles suggerent un sur-risque de morbi-mortalite cardiovasculaire (CV) chez les patients atteints d’arthrose. Cependant, il reste a determiner si l’arthrose et les comorbidites CV ne font que coexister chez des patients partageant des facteurs de risque communs ou si des mecanismes physiopathologiques partages sous-tendent une interconnexion entre ces pathologies. Nous avons realise une meta-analyse explorant le role des comorbidites CV dans la progression structurale de l’arthrose. Materiels et methodes Nous avons realise une revue systematique de la litterature puis une meta-analyse sur l’association avec la progression structurale de l’arthrose peripherique, definie par une aggravation du score de Kellgren et Lawrence (KL) avec un KL ≥ 2 initialement, ou la pose d’une prothese articulaire au cours du suivi, avec ajustement sur l’index de masse corporel. Ainsi a partir des bases de donnees de Pubmed, Cochrane, Embase et les resumes des principaux congres de rhumatologie, nous avons selectionne les etudes ayant evalue l’association avec les comorbidites CV et leurs facteurs de risque, incluant les maladies CV, l’atherosclerose, le syndrome metabolique, le diabete, les dyslipidemies, et l’hypertension arterielle (HTA). Resultats Neuf etudes ont pu etre incluses. Le risque de progression radiographique de l’arthrose n’etait pas significativement associe a l’HTA. Le diabete apparaissait comme protecteur avec un OR a 0,81, IC 95 % [0,66–1,00]. Les resultats etaient similaires lors de la stratification par sexe, avec pour les hommes un OR a 0,73, IC 95 % [0,57–0,92], et pour les femmes, un OR a 0,75, IC 95 % [0,63–0,90]. Il n’y avait pas d’association significative avec le HDL bas. Le risque de pose de prothese de genou etait augmente avec l’HTA (OR = 1,22, IC 95 % [1,08–1,37]), tandis que le HDL bas etait inversement associe (OR = 0,77, IC 95 % [0,61–0,97]). Il n’etait pas retrouve d’association significative avec l’hypertriglyceridemie, le syndrome metabolique ou le diabete. L’analyse du risque de pose de prothese de hanche ne retrouvait pas de lien significatif avec l’HTA ou le syndrome metabolique tandis que l’hypertriglyceridemie etait inversement associee avec un OR a 0,88, IC 95 % [0,80–0,97], comme le HDL bas (OR = 0,86, IC 95 % [0,77–0,96]). Il en va de meme pour le diabete (OR = 0,72, IC 95 % [0,54–0,96]). Le risque de pose de prothese de hanche ou de genou, retrouvait aussi le diabete comme facteur inversement associe (OR = 0,75, IC 95 % [0,71–0,79]). Conclusion Notre meta-analyse met en evidence l’HTA comme facteur de risque associe a la pose de prothese du genou, tandis que le diabete est associe a une reduction du risque de progression radiographique, et de recours a la prothese de hanche. De meme, le HDL bas est associe a une reduction de pose de prothese de genou et de hanche, et l’hypertriglyceridemie a une reduction du risque de prothese de hanche. Nos resultats plaident en faveur d’une prise en charge integree des facteurs de risque CV chez les patients atteints d’arthrose.

Introduction Les donnees actuelles suggerent un sur-risque de morbi-mortalite cardiovasculaire chez les patients atteints d’arthrose. Il reste a determiner si l’arthrose et les comorbidites cardiovasculaires (CV) ne font que coexister chez des patients partageant des facteurs de risque communs ou si des mecanismes physiopathologiques partages sous-tendent une interconnexion entre ces pathologies. Nous avons ainsi realise une meta-analyse explorant le role des comorbidites CV dans le developpement de l’arthrose. Materiels et methodes Nous avons realise une revue systematique de la litterature, puis une meta-analyse sur l’association des comorbidites CV et leurs facteurs de risque avec l’incidence structurale de l’arthrose peripherique, definie par un score de Kellgren et Lawrence (KL) ≥ 2 au cours du suivi. A partir des bases de donnees de Pubmed, Cochrane, Embase et des resumes des principaux congres de rhumatologie, nous avons selectionne les etudes ayant evalue au cours du temps l’association avec les comorbidites CV et leurs facteurs de risque, incluant les maladies CV, l’atherosclerose, le syndrome metabolique, le diabete, les dyslipidemies, et l’hypertension arterielle (HTA). Resultats Huit etudes ont pu etre incluses. Le risque d’incidence de l’arthrose etait significativement associe a l’HTA (OR = 1,47, IC 95 % [1,09, 1,98]) et au syndrome metabolique (OR = 2,96, IC 95 % [1,00, 8,77]). Il n’y avait pas d’association significative avec le diabete (5 etudes dont une portait sur la hanche et les autres, le genou). Il n’etait pas retrouve d’association entre le HDL bas et la survenue d’une gonarthrose, et il en etait de meme pour l’hypertriglyceridemie et les maladies CV. Conclusion Notre meta-analyse met en evidence l’HTA et le syndrome metabolique comme facteurs de risque potentiels d’incidence radiographique de l’arthrose. Nos resultats plaident en faveur d’une prise en charge integree des facteurs de risque CV, non seulement pour prevenir les evenements CV mais aussi possiblement pour reduire la survenue d’arthrose.

Introduction Depuis le debut de l’annee 2020, nous traversons une des plus grandes crises sanitaires que l’humanite ait connue due au coronavirus-2019. Cette pandemie suscite un degre considerable de crainte, d’inquietude et de preoccupation dans la population en general et chez certains groupes en particulier, comme les personnes âgees, les prestataires de soins et les personnes souffrant d’affections preexistantes. Nos patients souffrant de RIC, pathologies auto-immunes traites par immunosuppresseurs, sont particulierement concernes. Les mesures prises – en particulier la quarantaine et ses effets sur les activites normales, les habitudes ou les moyens de subsistance de nombreuses personnes – ont egalement un impact important. L’objectif de cette etude etait d’evaluer l’impact psychologique (anxiete, depression, trouble du sommeil, catastrophisme…) de l’epidemie COVID-19 ainsi que l’evolution de l’activite du rhumatisme chez les patients souffrant de RIC pendant le confinement. Patients et methodes Etude observationnelle prospective bicentrique de patients suivis pour une PR, une SA ou un RPso sur 1 an. Des donnees sociodemographiques, sur les traitements, la pathologie, cliniques (Echelle Visuelle Analogique [EVA] douleur, EVA globale patient et rhumatologue, nombre d’articulations douloureuses et gonflees) et biologiques (CRP, vitesse de sedimentation) etaient recueillies. Le patient remplissait ensuite des autoquestionnaires sur l’activite de la maladie (BASDAI), le catastrophisme (PCS), le coping (CSQ), la qualite de vie (Sf12, EQ5D), le handicap fonctionnel (BASFI, HAQ), le depistage de la fibromyalgie (FiRST), l’anxiete et la depression (HADS, GAD7) ainsi que l’insomnie (ISI). Dans cette etude ancillaire, ont ete analysees les donnees des 140 patients RIC avec une evaluation avant le confinement et une evaluation pendant le confinement (teleconsultations). Les analyses statistiques etaient descriptives avec des tests de Student apparies. Resultats En tout, 140 patients ont ete inclus (49 PR, 69 SA, 22 RPso). L’âge median etait de 53,5 [44–63], il y avait 60,7 % de femmes. Le rhumatisme evoluait depuis > 2 ans chez 92,9 % des patients. En tout, 72,9 % vivait en couple et 53 % etaient en activite. Lorsque l’on compare avant et pendant le confinement, l’EVA activite (31[15–60] avant vs 40 [20–60] pendant le confinement) et le NAD (1,5 [0,4] avant vs 4 [2–6] pendant) augmentaient legerement. Le NAG, le HAQ et la composante physique du SF12 restaient semblables. Il n’y avait pas de modification du score d’insomnie. Par contre, il y avait une amelioration significative de l’anxiete, de la composante mentale du SF12 et de la qualite de vie globale (EQ5D). Conclusion Il existe tres peu de donnees sur l’impact du confinement sur les patients souffrant de RIC. Dans cette etude, le confinement a eu peu d’impact sur l’activite de la maladie et a ete bien vecu sur le plan psychologique.

Introduction Un programme de depistage des multimorbidites dans les rhumatismes inflammatoires chroniques (RIC) a ete mis en place depuis 2014 au CHU de Montpellier en prevention primaire. L’objectif de ce travail etait d’evaluer l’impact de ce programme sur la morbidite evaluee par le taux d’hospitalisation dans l’annee suivant le depistage en comparaison a des patients atteints de RIC du sud de la France n’ayant pas beneficie de ce programme. Patients et methodes Les patients atteints de RIC ayant participe a notre programme de depistage en 2015, 2016 et 2017 ont ete identifies dans la base de donnees PMSI et apparies a 3 controles sur l’âge, le sexe, le type de RIC, l’antecedent de biotherapie intraveineuse (IV) et l’annee d’inclusion. Les criteres d’exclusion etaient l’antecedant d’infarctus du myocarde ou de traitement anti aggregant plaquettaire (prevention secondaire). Le critere de jugement principal etait le taux d’hospitalisation toutes causes confondues dans l’annee suivante. Les criteres secondaires etaient les hospitalisations pour evenement specifique (« hors RIC », avec evenements cardiovasculaires [CV] ou avec fractures majeures). Les taux des hospitalisations etaient compares entre l’annee precedant le depistage ou la date indexe et l’annee suivant le depistage pour les patients et les controles ainsi qu’entre les deux groupes dans l’annee suivant le depistage. Des odds ratios bruts, avec intervalle de confiance a 95 % et ajustes par une analyse multivariee ont ete calcules en prenant en compte les antecedents identifies dans les 5 ans precedant (HTA, diabete, insuffisance cardiaque, maladies CV, BPCO, fractures majeures) ainsi que les taux d’hospitalisation dans l’annee precedente. Resultats 486 patients ont ete identifies et apparies a 1458 controles. Les patients etaient majoritairement atteints de polyarthrite rhumatoide (67,08 %) et de spondyloarthrite (21,81 %) et 7 % d’entre eux avaient une biotherapie IV. Les patients non depistes avaient plus d’HTA (19 % vs 10,1 %), de diabete (9 % vs 4,9 %), d’insuffisance cardiaque (2,3 % vs 0,4 %) et d’antecedent d’hospitalisation « hors RIC » (78,5 % vs 72,2 %) dans les 5 ans precedants. Dans l’annee suivant la date index, les pourcentages d’hospitalisation « toutes causes » et « hors RIC » etaient significativement plus importants dans le groupe non depiste que chez les patients depistes (n = 1944, 64,8 % vs 51 %, p 70 ans versus Conclusion La realisation du bilan depistage & prevention au CHU de Montpellier etait associee a une reduction des hospitalisations dans l’annee suivante par rapport a des patients atteints de RIC n’ayant pas beneficie du depistage. Cela suggere un impact positif de la realisation d’un depistage systematique des multimorbidites dans les RIC sous reserve des limites inherentes au travail sur les bases de donnees PMSI.