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Resume La prise en charge du sujet âge rhumatologique doit associer le medecin traitant, rhumatologue, eventuellement, le neurologue en cas de troubles de la marche, et le geriatre si le sujet âge est polypathologique. Pour etre efficace, cette prise en charge doit etre globale en suivant une demarche geriatrique. Ainsi, elle tient plutot compte de l’âge physiologique que chronologique et de la polypathologie/polytherapie du patient, avec une constante interrogation sur le rapport benefice/risque de chaque therapie proposee, pharmacologique ou non pharmacologique.

Le diagnostic d’arthrose repose essentiellement sur l’examen clinique. Nous presentons les principales etapes d’un examen clinique simple et rapide qui permet de suspecter, chez un sujet âge par exemple, lors de l’entree en etablissement d’hebergement pour personnes âgees dependantes, l’existence d’une arthrose. Ce diagnostic sera, si besoin, confirme par une radiographie. Les autres examens d’imagerie sont rarement necessaires dans ce contexte.

Introduction Les recommandations sur la prise en charge de la gonarthrose et de la coxarthrose insistent sur l’utilite des mesures non pharmacologiques, mais ne sont pas graduees selon l’âge et l’etat du patient. Nous presentons une revue extensive des etudes concernant l’exercice physique et la perte de poids dans la coxarthrose et la gonarthrose du sujet âge.

The identification of clinical phenotypes in patients with osteoarthritis could help define different homogeneous groups of patients. Current and future treatments, which can be curative or preventive, could thus be tailored to each sub-groups. Clinical variables to consider are discussed in this article. Osteoarthritis is a severe disease. Associated with numerous comorbidities, it causes a disability that has a significant impact on cardiovascular risk and mortality.

Osteoarthritis is a condition that is found worldwide, and the number of affected patients is set to rise given the ever ageing population and the fact that obesity is becoming increasingly common. The main symptoms are pain and limited joint movement, accompanied by an often significant negative impact on the quality of life of patients. Its mechanism is poorly understood and there is currently no specific treatment for the condition. Treatment is therefore primarily symptomatic: for the pain and any incapacity, often with the surgical introduction of implants being required. As a result, there are significant social and economic costs, both of which are difficult to quantify. In this article, we are attempting to assess around the world in general, and in France in particular, the economic cost and the personal and social burden of osteoarthritis.

Background : Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients. Methods : Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles. Results : We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients. Physical exercise (8 trials): was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation. Aquatic exercise (5 trials): was as effective as land-based exercise. Weight loss (2 trials): only patients under diet + exercise had significant improvement on symptoms. Conclusion : Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.

Objective To assess the ability of avocado–soybean unsaponifiable—Expanscience (ASU-E) to slow radiographic progression in symptomatic hip osteoarthritis (OA). Methods Prospective, randomised, double blind, parallel group, placebo controlled 3 year trial. Patients with symptomatic (painful ≥1 year, Lequesne Index between 3 and 10) hip OA (American College of Rheumatology criteria) and a minimum joint space width (JSW) of the target hip between 1 and 4 mm on a pelvic radiograph were randomly assigned to 300 mg/day ASU-E or placebo. Standing pelvis, target hip anteroposterior (AP) and oblique views were taken annually. The primary outcome was JSW change at year 3, measured at the narrowest point on pelvic or target hip AP view (manual measure using a 0.1 mm graduated magnifying glass). The full analysis dataset (FAS) included all patients having at least two successive radiographs. An analysis of covariance Mixed Model for Repeated Measurements with Missing at Random (for missing data) was performed to compare adjusted 3 year JSW changes (primary outcome) and the percentages of ‘progressors’ (JSW loss≥0.5 mm) between groups. Results 399 patients were randomised (345 kept in the FAS), aged 62 (35–84) years, 54% women, mean body mass index 27 (SD 4) kg/m 2 , mean symptom duration 4 (SD 5) years, 0–100 normalised Lequesne Index 30 (SD 9) and global pain visual analogue scale 37 (SD 23) mm. Mean baseline JSW was 2.8 (0.9) mm. There was no significant difference on mean JSW loss (−0.638 mm vs −0.672 mm, p=0.72, in the ASU-E and placebo groups, respectively) but there were 20% less progressors in the ASU-E than in the placebo group (40% vs 50%, respectively, p=0.040). No difference was observed on clinical outcomes. Safety was excellent. Conclusions 3 year treatment with ASU-E reduces the percentage of JSW progressors, indicating a potential structure modifying effect in hip OA to be confirmed, and the clinical relevance requires further assessment. Trial registration number on ClinicalTrial.gov NCT01062737

Objective To determine whether cardiometabolic factors are associated with hand osteoarthritis (HOA) symptoms, radiographic severity and progression in a post hoc analysis of the phase III Strontium ranelate Efficacy in Knee OsteoarthrItis triAl (SEKOIA) trial, designed to determine the effect of strontium ranelate on knee osteoarthritis (OA). Methods Among the 1683 patients randomised in the SEKOIA study, 869 with radiographic HOA at baseline (rHOA≥2 joints with Kellgren-Lawrence grade ≥2) were included in a cross-sectional analysis. For longitudinal study, we included only the 307 patients with rHOA at baseline from the placebo group. We evaluated whether baseline symptomatic HOA, radiographic severity and clinical and rHOA progression were associated with coronary heart disease and/or metabolic diseases (obesity, diabetes and hypertension, dyslipidaemia) by multivariate regression analysis. Results At baseline, 869 patients (72% women) were included in the cross-sectional analysis; 26% were symptomatic. On multivariate analysis, symptomatic HOA was associated with coronary heart disease (OR 3.59, 95% CI (1.78 to 7.26)) but not metabolic diseases. After a mean follow-up of 2.6 years, for the 307 participants in the placebo group, on multivariate analysis, worse clinical HOA outcome was associated with coronary heart disease (OR 2.91, 95% CI (1.02 to 8.26)). The slow radiographic progression did not allow for revealing any associated factors. Conclusions Symptomatic HOA and worse HOA clinical course are associated with coronary heart disease. These results strengthen the systemic component of HOA and the association between OA pain and cardiac events. Trial registration number ISRCTN41323372.

Resume Le diagnostic d’arthrose, a la hanche, au genou et surtout aux mains peut etre purement clinique. Pour plus de specificite, la majorite des etudes epidemiologiques ou des essais therapeutiques utilisent cependant une definition radiologique : criteres de l’American College of Rheumatology (ACR) ou, surtout, classification de Kellgren-Lawrence (KL). Le grade 2 de cette classification qui est ordinairement retenu comme seuil diagnostique connait cependant des descriptions variables selon les auteurs et privilegie traditionnellement l’osteophytose, signe diagnostique pourtant moins fiable que le pincement de l’interligne articulaire. L’evaluation de la severite et de l’evolution anatomique de l’arthrose repose sur l’imagerie. La radiographie reste la methode de reference. Depuis la description du score de KL et pour pallier a ses imprecisions, de nombreux autres systemes de cotation semi-quantitatifs ont ete decrits. Certains s’appliquent a la plupart des articulations peripheriques, d’autres sont specifiques de certaines regions (Kallman et Verbruggen pour la main, Whole Organ Magnetic Resonance Imaging Score [WORMS] pour le genou, etc.). Les methodes basees sur la mesure de l’interligne articulaire paraissent les plus reproductibles et les plus sensibles au changement a la hanche et au genou. Cette chondrometrie peut etre manuelle ou assistee par ordinateur. Les qualites metrologiques des deux techniques paraissent proches, surtout influencees par la qualite des lecteurs. L’IRM permet d’evaluer l’ensemble des structures articulaires impliquees dans le processus arthrosique. La valeur pronostique de leur atteinte, isolement ou en association, permettant d’etablir un score global de severite reste a preciser. La mesure volumetrique du cartilage, decrite principalement dans la gonarthrose, necessite encore validation.

Objective To evaluate factors influencing orthopedic surgeons' decision in daily practice to recommend or not recommend total hip arthroplasty (THA) in patients with hip osteoarthritis (OA). Methods General practitioners and rheumatologists were asked to prospectively include 1 patient with hip OA for whom a consultation with an orthopedic surgeon was planned to determine whether or not THA was indicated. The following variables were obtained: age, sex, occupational status, body mass index, comorbidities, duration of hip OA, patient's global assessment, Western Ontario and McMaster Universities Osteoarthritis Index pain and functioning subscale scores, New Zealand score, quality of life, and structural parameters on radiographs. The surgeon's decision was obtained by followup questionnaires. Statistical analysis evaluated potential predictors of the surgeon's decision (indication for THA within the next 6 months, yes or no) using univariate and multivariate analysis. Results A total of 558 patients were included (249 men, 300 women, mean age 68.4 years, mean disease duration 4.9 years). The surgeon's decision, available for 486 patients, was to prescribe THA in 60.7% of patients. On multivariate analysis, the variables related to the surgeon's decision were the presence or absence of severe cardiovascular disease, Short Form 12 physical subscale score, and amount of joint space narrowing. Conclusion While the amount of structural degradation is only slightly or not at all taken into account in numerous criteria and/or recommendations on indications for THA, it is an independent predictor of the surgeon's decision in daily practice. Such a discrepancy should be evaluated and understood in further studies.

Background: Osteoarthritis (OA) of the hand could be a relevant model to study the progression of OA in structure-modification trials. Various methods are proposed to assess hand OA and its progression radiologically. Objective: To compare intra-reader and inter-reader precision and sensitivity to change of four radiological scoring methods proposed in hand OA. Methods: 2 trained readers scored separately 105 pairs of radiographs (baseline; year 1), selected from patients enrolled in a randomised controlled trial, for inter-reader reliability and sensitivity to change. They scored twice 60 pairs among the 105 for cross-sectional and longitudinal intra-reader reliability. Radiological hand OA assessment used: global, Kellgren–Lawrence (KL), Kallman and Verbruggen scoring methods. Inter- and intra-reader reliabilities were studied using intraclass coefficient (ICC) and the Bland–Altman method. Sensitivity to change was compared by calculating the standardised response means. Results: Transversal intra-reader reproducibility ICCs ranged from 0.922 to 0.999. Verbruggen ranked the highest, followed by the KL and Kallman methods. Inter-rater reliability was higher for the Verbruggen scores, followed by the KL, global and Kallman scores (ICC 0.706–0.999). Longitudinal intra-reader reliability (baseline; year 1) was better using the Kallman and KL (ICC 0.986 and 0.990), followed by the Verbruggen (0.941) or global methods (0.939). Standardised response means ranged from 0.24 (KL) to 0.29 (Kallman). Conclusion: All four methods compared well with respect to reliabilities. However, the Verbruggen and Kallman methods performed better. The method most sensitive to change was the Kallman method, followed by Verbruggen and global scores. This study also suggests that structural changes could be detected in hand OA over a 1-year period.

To evaluate the structural effect of avocado/soybean unsaponifiables (ASU) in the treatment of patients with symptomatic osteoarthritis (OA) of the hip.Patients with regular painful primary OA of the hip (European League Against Rheumatism 1980 criteria) and a joint space stillor = 1 mm (Kellgren grade 1 to 3, assessed by an independent observer prior to inclusion) entered a prospective, multicenter, randomized, parallel group, double-blind, placebo-controlled trial of 2 years duration. Patients had at least a 6-month history of regular pain and an algofunctional index (AFI)or = 4. The primary assessment criterion was a decrease of the joint space width (JSW) on plain anteroposterior radiographs of the pelvis performed in standing position, measured at the narrowest points by 2 independent readers, previously tested and selected and blinded to both the treatment and the time sequence. Secondary criteria were standard clinical outcome measurements (AFI, pain on a visual analog scale, consumption of nonsteroidal antiinflammatory drugs and patient's and investigator's global assessments).One hundred sixty-three patients were included: 102 men and 61 women (mean age 63.2 +/- 8.7 years). A total of 108 patients (72 men and 36 women; mean age 64 +/- 7.9 years) were radiologically evaluable at 23.7 +/- 2.6 months (ASU group; n = 55) and 23.7 +/- 3.2 months (placebo group; n = 53). Overall comparison of the evolution of JSW showed no difference between the ASU and placebo groups, from 2.35 +/- 0.93 to 1.87 +/- 1.10 mm and from 2.5 +/- 0.94 to 1.9 +/- 1.33 mm, respectively (intergroup P value at end point = 0.9). When patients were divided into 2 subgroups according to the median value of the baseline JSW (2.45 mm), the joint space loss in the most severely affected subgroup of patients (baseline JSWor = median) was significantly greater in the placebo group than in the ASU group: from 1.69 +/- 0.58 to 0.84 +/- 0.77 mm (-0.86 +/- 0.62 mm) and from 1.66 +/- 0.42 to 1.22 +/- 0.7 mm (-0.43 +/- 0.51 mm), respectively (P0.01). The JSW decrease was identical, with no difference in ASU and placebo groups, in the less severely affected subgroup of patients (baseline JSWmedian). Clinical parameters in the 2 groups did not differ significantly throughout the study.This pilot randomized, double-blind, placebo-controlled trial failed to demonstrate a structural effect of ASU in hip OA. However, in a post-hoc analysis, ASU significantly reduced the progression of joint space loss as compared with placebo in the subgroup of patients with advanced joint space narrowing. These results suggest that ASU could have a structural effect but require confirmation in a larger placebo-controlled study in hip OA.

Samson, Maxime | Maillefert, Jean-Francis | Roy, Carine | Cadet, Christian | Ravaud, Philippe; International audience; ''There is no consensus regarding indications for total hip arthroplasty (THA) in hip osteoarthritis (OA). Patients can be referred to surgeons either by a general practitioner (GP) or a rheumatologist. The aim of this study was to determine whether patients referred to orthopedic surgeons by GP and rheumatologists differed. GPs and rheumatologists were asked to include one patient suffering from hip OA for whom a consultation with a surgeon was planned to determine if THA was indicated. Surgeons' decisions were obtained by follow-up questionnaires. Univariate and then multivariate statistical analysis evaluated differences between patients referred by GPs and those referred by rheumatologists. A total of 558 patients were included. THA was prescribed in 71.6 % of patients referred by rheumatologists vs. 57.6 % of patients referred by GPs (p = 0.008). Patients referred by rheumatologists were younger (66.3 vs. 69.3 years; p = 0.006), less frequently retired (72.9 vs. 84.2 %; p = 0.007), and presented with a higher New Zealand score (54.3 vs. 48.1; p = 0.0009). On multivariate analysis, the variables related to patients referred by rheumatologists were the SF-12 mental score, the New Zealand score, and the surgeon's decision. Patients consulting a surgeon to discuss THA were more likely to be operated on when referred by a rheumatologist, which might be due to differences in the rheumatologists' and GPs' opinions on the right time to perform surgery or due to differences in the populations followed by rheumatologists and GPs, those followed by rheumatologists being younger, more active, more urban, with a greater willingness to undergo surgery.''

www.thelancet.com Vol 383 January 11, 2014 121 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ gastrointestinal risks of NSAIDs. However, it does not answer an important question for rheuma tologists and geriatricians: can we prescribe NSAIDs in old and very old patients? Osteoarthritis typically affects elderly people, and management of this disorder includes prescription of NSAIDs. However, international guidelines are unclear about how to manage pain in elderly patients. This patient population is underrepresented in randomised controlled trials, in particular those investigating the use of NSAIDs, with a large diff erence in age between study and clinical populations. The CNT Collaboration report included individual data for more than 88 000 patients (mean age 61 years). Data were stratifi ed into two age groups: younger than 60 years and 60 years or older. Further division could have been done into narrower age groups (eg, 60–69 years, 70–79 years, and ≥80 years), with the number of patients and major side-effects reported for every age category. Similar propor tional eff ects were recorded for every specific safety outcome, accord ing to age. These data are insufficient to allow us to appreciate fully the respective gastrointestinal, cardio vascular, or renal risks in elderly patients and, thus, to guide the best therapeutic decision in this population.

Joint space width (JSW) and narrowing (JSN) measurements on radiographs are currently the best way to assess disease severity or progression in hip osteoarthritis, yet we lack data regarding the most accurate and sensitive measurement technique. This study was conducted to determine the optimal radiograph and number of readers for measuring JSW and JSN. Fifty pairs of radiographs taken three years apart were obtained from patients included in a structure modification trial in hip osteoarthritis. Three radiographs were taken with the patient standing: pelvis, target hip anteroposterior (AP) and oblique views. Two trained readers, blinded to each other's findings, time sequence and treatment, each read the six radiographs gathered for each patient twice (time intervalor = 15 days), using a 0.1 mm graduated magnifying glass. Radiographs were randomly coded for each reading. The interobserver and intraobserver cross-sectional (M0 and M36) and longitudinal (M0-M36) reproducibilities were assessed using the intraclass coefficient (ICC) and Bland-Altman method for readers 1 and 2 and their mean. Sensitivity to change was estimated using the standardized response mean (SRM = change/standard deviation of change) for M0-M36 changes. For interobserver reliability on M0-M36 changes, the ICCs (95% confidence interval [CI]) were 0.79 (0.65-0.88) for pelvic view, 0.87 (0.78-0.93) for hip AP view and 0.86 (0.76-0.92) for oblique view. Intraobserver reliability ICCs were 0.81 (0.69-0.89) for observer 1 and 0.97 (0.95-0.98) for observer 2 for the pelvic view; 0.87 (0.78-0.92) and 0.97 (0.96-0.99) for the hip AP view; and 0.73 (0.57-0.84) and 0.93 (0.88-0.96) for the oblique view. SRMs were 0.61 (observer 1) and 0.82 (observer 2) for pelvic view; 0.64 and 0.75 for hip AP view; and 0.77 and 0.70 for oblique view. All three views yielded accurate JSW and JSN. According to the best reader, the pelvic view performed slightly better. Both readers exhibited high precision, with SRMs of 0.6 or greater for assessing JSN over three years. Selecting a single reader was the most accurate method, with 0.3 mm precision. Using this cutoff, 50% of patients were classified as 'progressors'.

Background When Kellgren and Lawrence proposed their radiologic scoring method to assess OA in 1957, they introduced a grade 1 for doubtful OA, besides the grade 0 for no OA. How to use and consider this grade has been widely discussed. Is a joint at a KL 1 grade a pre-radiographic OA? Is KL 1 the first step to OA? These questions remain an opened issue since no one has looked at what happens to a KL1 joint over time. Objectives To assess what becomes a KL1 joint in hand OA patients over 2.6 years. Methods Data came from an international 3-year, randomized, placebo-controlled phase III trial designed to assess the effect of strontium ranelate compared to placebo on the radiographic progression of knee OA which included symptomatic primary knee OA patients (ACR criteria) at a Kellgren-Lawrence (KL) grade II or III, with a minimal joint space width (JSW) between 2.5-5 mm. Baseline and final postero-anterior radiographs of each hand were performed. Hand symptoms were assessed using the functional index for Hand OA (FIHOA; range 0-30) and the AUSCAN-function (0-900 normalized at 100). Two independent readers scored half of the pairs of radiographs obtained each, blinded to treatment and time sequence, using the KL (range 0-128 for the 32 joints graded), Kallman (0-204) and Verbruggen anatomical phase (0-218) scoring methods with a good inter-rater reproducibility (ICCs >0.8) Hand OA was established if at least 2 joints were scored ≥ KL 2. All the joints scored grade 1 according to KL scoring method identified at baseline were re-assessed on the final hand radiograph. Their evolution over time is described. Results Of 1669 patients included in the SEKOIA trial, 1360 had hand radiographs. 999 ( 73%) had radiologic hand OA at baseline. 297 patients out of 472 in the placebo group had baseline and post-baseline radiographs. 71% were female, mean age 64±7 years, body mass index 29.6±5 kg/m², and initial knee JSW 3.5±0.8 mm. Baseline hand OA radiologic severity was mild: KL score 21.3±13, Kallman score 24.6±22 and Verbruggen score 13.7±15. The level of symptoms was low: FIHOA score was 4±5, Auscan global score was 31.8±28. Mean time interval between baseline and final radiographs was 2.6 years. 1203 joints were scored KL 1 at baseline (mean: 4.1±2.4 per patient). On final radiographs, 42 (4%) were scored KL 0, 779 (65%) remained KL 1, 356 ( 30% ) were scored KL 2, 15 (1%) KL 3 and 6 (0.5%) KL 4. Conclusions In this sample of knee OA patients with mild radiographic hand OA, 32% of the joints at a KL 1 grade progressed to a grade 2 or more, therefore became OA joints, when only 4% evolved to a grade 0 (no OA) after 2.6 years. KL 1 grade appears indeed to be the first step of a radiographic OA in many cases. Disclosure of Interest E. Maheu: None Declared, C. Cadet Grant/research support from: Servier, F. Carrat: None Declared, Y. Barthe: None Declared, F. Berenbaum Grant/research support from: Servier

Background The association between hand (HOA) and knee osteoarthritis (KOA) has been questioned. Current evidence is contradictory. Objectives To study the prevalence of radiographic HOA in a large KOA population, and its cross-sectional association to knee OA radiographic severity. Methods Baseline data were obtained from an international 3-year prospective, multicenter, randomized, controlled trial comparing the structural effect of strontium ranelate to placebo in KOA. Inclusion criteria were: a diagnosis of OA according to ACR criteria, knee pain >40mm on a visual analog scale, OA atmedial compartment witha Kellgren-Lawrence (KL) grade 2 or 3and a minimal joint space width (JSW) of 2.5 to 5mm. Fixed-flexion postero-anterior (PA) radiographs of both knees in standing position every year and PA radiographs of each hand at baseline and endpoint were performed. Minimal JSW was centrally measured using a semi-automated standardized method. Hand radiographs were graded by 2 readers using KL (range 0-128), Kallman (0-204) and Verbruggen scoring methods. Radiographic HOA was defined as 2 or more joints at a KL2 or more. Statistics: Student T test, and Pearson correlation coefficient.Only the 1371 patients having at least 2 knee radiographs were analyzed. Results 1360 patients had hand radiographs at baseline. 999 (73%) had HOA (HOA+). In HOA+, the mean age was 64 years, 71% were female, mean body mass index 29.6. HOA+ were older (5yrs), with a higher percentage of female (p=0.04), with no difference on BMI compared to non HOA patients (p=0.12). Mean knee JSW was 3.44 versus 3.66mm (p Conclusions Our data indicates a very high prevalence of radiographic HOA in a symptomatic KOA population, much more than expected. KOA is radiographically more severe in case of HOA. Conversely, HOA is more severe in the more severe KOA patients (KL3). Disclosure of Interest E. Maheu Grant/Research support from: from Institut de Recherche International Servier, C. Cadet Grant/Research support from: from Institut de Recherche International Servier, F. Berenbaum Grant/Research support from: From Institut de Recherche International Servier

Background Hand OA is a frequent polyarticular disease. Few is known with respect to its radiological progression over time, which in addition is difficult to assess, considering that no radiographic scoring method has, today, proved being superior to another. Objectives To assess hand OA radiological progression over 3 years using three validated scoring methods. Methods Data came from an international 3-year, randomized, placebo-controlled, phase III trial designed to assess the effect of strontium ranelate compared to placebo on the radiographic progression of knee OA which included symptomatic primary knee OA patients (ACR criteria) at a Kellgren-Lawrence (KL) grade II or III, with a minimal joint space width (JSW) between 2.5-5 mm. Baseline and final postero-anterior radiographs of each hand were performed. Hand symptoms were assessed using the functional index for Hand OA (FIHOA; range 0-30) and the AUSCAN-function (0-900 normalized at 100). Two independent readers scored half of the pairs of radiographs obtained each, blinded to treatment and time sequence, using the KL (range 0-128), Kallman (0-204) and Verbruggen anatomical phase (0-218) scoring methods with a good inter-rater reproducibility. Hand OA radiographic progression was studied in the placebo group by looking at 1/ baseline-end changes in global scores, 2/ the numbers of progressors (progression defined for each global score by a change over each reader’s smallest detectable difference (SDD)), 3/ the number of patients with at least 1 new joint affected by OA and 4/ those with at least 1 joint showing a deterioration (worsened joints - improved joints ≥ 1 of at least one grade for KL; of ≥1 phase for Verbruggen score). Results Of 1669 patients included in the SEKOIA trial, 1360 had hand radiographs. 999 had radiologic hand OA at baseline: 73% . 297 patients out of 472 in the placebo group had baseline and post-baseline radiographs. 71% were female, mean age 64±7 years, body mass index 29.6±5 kg/m², initial knee JSW 3.5±0.8 mm. Baseline hand OA radiologic severity was mild: KL score 21.3±13, Kallman score 24.6±22 and Verbruggen score 13.7±15. FIHOA score was 4±5, Auscan function score was 31.8±28. Mean time interval between baseline and final radiographs was 31.5 months. Hand OA radiographic progression over 2.6 years, using global scores, was modest with a mean change of 2.2±3.3 for KL score, 3.7±5.3 for Kallman score and 2.0±4.0 for Verbruggen score. The numbers (%) of progressors (change≥SDD) were 7 (2%), 17 (6%), and 21 (7%) respectively. The numbers (%) of patients with at least 1 new OA joint were 205 (66%) for KL and 127 (41%) for Verbruggen score. The numbers (%) of patients with ≥ 1 worsened joint were 160 (52%) for KL and 158 (51%) for Verbruggen score, with respective means of 3.1±2.5 and 2.1±1.5 deteriorated joints. Conclusions Whatever the radiological scoring method used, and the kind of analysis performed, mild radiographic hand OA patients showed a weak radiological progression over 2.6 years when using global scores. In future structure-modification trials in hand OA, analysing at a joint level the number of patients with at least one new OA joint or one joint worsening could be the most sensitive methods. Disclosure of Interest E. Maheu Grant/research support from: Servier, C. Cadet Grant/research support from: Servier, F. Carrat: None Declared, Y. Barthe: None Declared, F. Berenbaum Grant/research support from: Servier

Joint space width (JSW) and narrowing (JSN) measurements on radiographs are currently the best way to assess disease severity or progression in hip osteoarthritis, yet we lack data regarding the most accurate and sensitive measurement technique. This study was conducted to determine the optimal radiograph and number of readers for measuring JSW and JSN. Fifty pairs of radiographs taken three years apart were obtained from patients included in a structure modification trial in hip osteoarthritis. Three radiographs were taken with the patient standing: pelvis, target hip anteroposterior (AP) and oblique views. Two trained readers, blinded to each other's findings, time sequence and treatment, each read the six radiographs gathered for each patient twice (time interval ≥15 days), using a 0.1 mm graduated magnifying glass. Radiographs were randomly coded for each reading. The interobserver and intraobserver cross-sectional (M0 and M36) and longitudinal (M0–M36) reproducibilities were assessed using the intraclass coefficient (ICC) and Bland–Altman method for readers 1 and 2 and their mean. Sensitivity to change was estimated using the standardized response mean (SRM = change/standard deviation of change) for M0–M36 changes. For interobserver reliability on M0–M36 changes, the ICCs (95% confidence interval [CI]) were 0.79 (0.65–0.88) for pelvic view, 0.87 (0.78–0.93) for hip AP view and 0.86 (0.76–0.92) for oblique view. Intraobserver reliability ICCs were 0.81 (0.69–0.89) for observer 1 and 0.97 (0.95–0.98) for observer 2 for the pelvic view; 0.87 (0.78–0.92) and 0.97 (0.96–0.99) for the hip AP view; and 0.73 (0.57–0.84) and 0.93 (0.88–0.96) for the oblique view. SRMs were 0.61 (observer 1) and 0.82 (observer 2) for pelvic view; 0.64 and 0.75 for hip AP view; and 0.77 and 0.70 for oblique view. All three views yielded accurate JSW and JSN. According to the best reader, the pelvic view performed slightly better. Both readers exhibited high precision, with SRMs of 0.6 or greater for assessing JSN over three years. Selecting a single reader was the most accurate method, with 0.3 mm precision. Using this cutoff, 50% of patients were classified as 'progressors'.