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Summary Objective This pragmatic, multicenter, open-label, randomized controlled trial (RCT) aimed to compare the effectiveness, safety, and cost–utility of a custom-made knee brace versus usual care over 1 year in medial knee osteoarthritis (OA). Design 120 patients with medial knee OA (VAS pain at rest >40/100), classified as Kellgren–Lawrence grade II-IV, were randomized into two groups: ODRA plus usual care (ODRA group) and usual care alone (UCA group). The primary effectiveness outcome was the change in VAS pain between M0 and M12. Secondary outcomes included changes over 1 year in KOOS (function) and OAKHQOL (quality of life) scores. Drug consumption, compliance, safety of the knee brace, and cost–utility over 1 year were also assessed. Results The ODRA group was associated with a higher improvement in: VAS pain (adjusted mean difference of −11.8; 95% CI: −21.1 to −2.5); all KOOS subscales (pain: +8.8; 95% CI: 1.4–16.2); other symptoms (+10.4; 95% CI: 2.7–18); function in activities of daily living (+9.2; 95% CI: 1.1–17.2); function in sports and leisure (+12.3; 95% CI: 4.3–20.3); quality of life (+9.9; 95% CI: 0.9–15.9), OAKHQOL subscales (pain: +14.8; 95% CI: 5.0–24.6); and physical activities (+8.2; 95% CI: 0.6–15.8), and with a significant decrease in analgesics consumption at M12 compared with the UCA group. Despite localized side-effects, observance was good at M12 (median: 5.3 h/day). The ODRA group had a more than 85% chance of being cost-effective for a willingness-to-pay threshold of €45 000 per QALY. Conclusions The ERGONOMIE RCT demonstrated significant clinical benefits of an unloader custom-made knee brace in terms of improvements in pain, function, and some aspects of quality of life over 1 year in medial knee OA, as well as its potential cost–utility from a societal perspective.

This study explores changes in the bone homeostasis by testing the N-terminal collagen type I extension propeptide (PINP) marker for osteo-formation and the carboxy-terminal region of collagen type I (CTX-I) marker for osteo-resorption in patients taking tocilizumab for polymyalgia rheumatica (PMR).Twenty patients were included in the prospective open-label TENOR study (Clinicaltrials.gov NCT01713842) and received three monthly tocilizumab infusions, followed by corticosteroids starting at week (W) 12. PINP and CTX-I were tested at inclusion (W0), after tocilizumab but before steroid initiation (W12), at the end of the protocol (W24) and were compared to healthy controls. Information regarding disease activity, bone mineral density using scanographic bone attenuation correlation (SBAC), inflammatory parameters and interleukin (IL)-6 levels were collected during the follow-up of the patients.PMR patients were characterised by a reduction in bone mineral density and a higher level of CTX-I relative to healthy controls matched in age and sex at baseline. PINP levels increased at W12 (P0.001, versus W0) following tocilizumab introduction and CTX-I levels decreased at W24 and after steroid initiation (P=0.001, versus W0). Such modifications explain the altered correlation observed between PINP and CTX-I at W0 (r=0.255 at W0 versus r=0.641 in healthy controls) and its correction after treatment (r=0.760 at W12 and r=0.767 at W24). Finally, greater changes in PINP were observed in patients whose circulating IL-6 levels decreased after tocilizumab therapy.Control of bone turnover, in part through the inhibition of the IL-6 axis, is observed during tocilizumab and subsequent steroid treatment of PMR.

The objective of this study is to assess the prevalence, localization, and severity of bone erosions on radiography (RX) and ultrasonography (US) according to ACPA status in patients with rheumatoid arthritis (RA). 78 patients with ACPA-positive (ACPA+) RA and 30 patients with ACPA-negative (ACPA−) RA fulfilling the ACR 1987 and/or ACR/EULAR 2010 criteria were consecutively included. On RX, a modified Sharp erosion score (SHSe) was evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). On US, erosions were scored on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5) with a four-point scale to calculate the total US score for erosions (USSe). The mean total SHSe and USSe were 3.7 and 4.4 times higher in the ACPA+ group than in the ACPA− group, respectively (P

BackgroundOsteoporosis is a common complication of Rheumatic diseases. The association between osteoporosis and rheumatoid arthritis is clearly demonstrated while this association is still debated as well as for the screening of osteoporosis by Dual-Energy X-Ray Absorptiometry (DEXA) or to demonstrate an increased risk of fracture on radiography in a population of Psoriatic Arthritis (PsA). The prevalence of fragility fractures reported on medical reports ranged between 12% and 40% in PsA patients. Only a few studies evaluated the prevalence of vertebral fracture (VF) on spine radiographs. To our knowledge no study has evaluated the contribution of radiographic or CT assessment of the spine on the prevalence of fragility fracture reported in medical records.ObjectivesTo determine Psoriatic Arthritis patient’s characteristics screened for osteoporosis by DEXA in a population initiating a biologic treatment (bDMARD) and to estimate the prevalence of severe osteoporotic fractures on medical reports and after imaging modalities scoring (X-ray or CT-scan).MethodsPatients with psoriasis should satisfy the CASPAR or ASAS criteria and have been screened during their follow up for a bDMARD. Osteoporotic screening was defined by a BMD testing (DEXA). Vertebral fractures were scored according to Genant’s method on spine X-ray or sagittal CT-scan images. Clinical and demographic data and the presence of previous severe osteoporotic fracture reported in the medical records were collected.ResultsOn 417 PsA patients screened for bDMARDs during 2008-2019, 89 patients (21.3%) were assessed for osteoporosis by DEXA. Increased age, female sex, menopause, previous severe fracture, disease duration, presence of inflammatory bowel disease, current and previous corticosteroid and bDMARDs uses were significantly associated with osteoporotic screening. On DEXA, 7 patients (7.9%) were classified as osteoporotic. The prevalence of severe osteoporotic fracture was 6.7% in medical reports and increased to 23.6% after scoring spine radiographies or TAP-CT images. In univariate analysis the presence of severe osteoporotic fractures was associated with age (p=0.013), scanographic bone attenuation coefficient (p=0.005) and Lumbar T-score (p=0.039).ConclusionLess than a quarter of PsA patients initiating a bDMARD is screened for osteoporosis. The prevalence of osteoporosis on DEXA and severe osteoporotic fractures on medical records are inferior to 10%. After systematic imaging evaluation, this prevalence increases at 23.6%.References[1]Chandran S, Aldei A, Johnson SR, Cheung AM, Salonen D, Gladman DD. Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review. Seminars in Arthritis and Rheumatism. oct 2016[2]Riesco M, Manzano F, Font P, García A, Nolla JM. Osteoporosis in psoriatic arthritis: an assessment of densitometry and fragility fractures. Clinical Rheumatology. déc 2013[3]Pedreira PG, Pinheiro MM, Szejnfeld VL. Bone mineral density and body composition in postmenopausal women with psoriasis and psoriatic arthritis. Arthritis Res Ther. févr 2011[4]Del Puente A, Esposito A, Costa L, Benigno C, Del Puente A, Foglia F, et al. Fragility Fractures in Patients with Psoriatic Arthritis. The Journal of Rheumatology Supplement. 1 nov 2015[5]van der Weijden MAC, van der Horst-Bruinsma IE, van Denderen JC, Dijkmans BAC, Heymans MW, Lems WF. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int. juin 2012[6]Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications. Ann Intern Med. 16 avr 2013[7]Kwok TSH, Sutton M, Yang Ye J, Pereira D, Chandran V, Gladman DD. Prevalence and factors associated with osteoporosis and bone mineral density testing in psoriatic arthritis. Arthritis Care & Research. 16 déc 2020[8]Gulati AM et al. Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population. RMD Open. juin 2018Disclosure of InterestsNone declared

BackgroundOsteoporosis is a common disease whose prognosis can be seriously impacted by the development of fractures that lead to functional limitations and may even have life-threatening sequelae (1). CT is useful for diagnosing vertebral fracture (VF) and measuring the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC- L1). Obesity might be a protective factor against bone loss and osteoporosis (2). Nonetheless, epidemiological studies have reported an association between obesity and an increased risk of fragility fractures (3) and suggested that obesity may be a risk factor for fracture and decreased bone density (4,5). For bariatric surgery, the results are less controversial. According to many studies, malabsorptive procedures lead to a decrease in bone mineral density and sometimes an increased risk of fragility fractures (2,6,7,8). However, the kinetics of bone loss and its physiopathology are unclear.ObjectivesThe primary objective was to evaluate bone fragility on computed tomography (CT) in obese patients before and 2 years after bariatric surgery. The secondary objectives were to identify risk factors for a decrease in the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1).MethodsThis descriptive study included obese patients who underwent bariatric surgery between January 2014 and December 2019 and CT before and two years (±6 months) after bariatric surgery. SBAC-L1 (in Hounsfield units (HU)) was measured on CT, and vertebral fracture (VF) was manually assessed. The SBAC-L1 fracture threshold was defined as below 145 HU.ResultsAmong the 78 included patients, 85.9% were women, with a mean age of 48.5 years (±11.4); the mean body mass index (BMI) was 46.2 kg/m2 (±7) before surgery and 29.8 kg/m2 (±6.7) 2 years after surgery. There was a significant change in SBAC-L1 two years after surgery (p=0.037). In multivariate analysis, the risk factors for having an SBAC-L1 ≤ 145 HU 2 years after bariatric surgery in those with an SBAC-L1 > 145 HU before surgery were age and sex, with men and older patients having a higher risk (OR = 32.6, CI95% = [1.86-568.77], and OR = 0.85, CI95% = [0.74-0.98], respectively).ConclusionSBAC-L1 was significantly lower two years after bariatric surgery than before surgery. When the SBAC-L1 was over 145 HU before bariatric surgery, men sex and older patients were the risk factors for having an SBAC-L1 below the fracture threshold 2 years after surgery.References[1]Toledano E, Candelas G, Rosales Z, Martínez Prada C, León L, Abásolo L, et al. A meta-analysis of mortality in rheumatic diseases. Reumatol Clin. 2012 Dec;8(6):334–41.[2]Lespessailles E, Paccou J, Javier R-M, Thomas T, Cortet B, GRIO Scientific Committee. Obesity, Bariatric Surgery, and Fractures. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4756–68.[3]Gonnelli S, Caffarelli C, Nuti R. Obesity and fracture risk. Clin Cases Miner Bone Metab. 2014 Jan;11(1):9–14.[4]Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, et al. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract. 2010 May;64(6):817–20.[5]Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Silverman S, et al. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res. 2014 Feb;29(2):487–93.[6]Ko B-J, Myung SK, Cho K-H, Park YG, Kim SG, Kim DH, et al. Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis. Obes Surg. 2016 Jul;26(7):1414–21.[7]Paccou J, Martignène N, Lespessailles E, Babykina E, Pattou F, Cortet B, et al. Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study. J Bone Miner Res. 2020 Aug;35(8):1415–23.[8]Lu C-, Chang Y-K, Chang H-H, Kuo C-S, Huang C-T, Hsu C-C, et al. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore). 2015 Dec;94(48):e2087.Disclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease affecting small and medium-sized joints symmetrically, leading to poor functional outcomes and structural damages with time. The RA elementary inflammatory lesions, synovitis and tenosynovitis, have been associated with the development and worsening of bone erosions leading to loss of joint function and pain. The median age at diagnosis of RA patients, ranged between 50-60 years old, age at which degenerative and inflammation lesions relative to osteoarthritis (OA) damages may be present and interfere to establish a diagnosis of inflamed and/or structural RA disease.ObjectivesTo assess prevalence, topography and severity of inflammation and erosion on ultrasound (US) in RA and OA patients and to propose US thresholds to classify RA patients.MethodsPatients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR criteria for hand OA were reprospectively included. Synovitis and tenosynovitis (TS) in B and Power Doppler (PD) modes on seven bilateral joints (carpus, MCP2, 3, 5, MTP2, 3, 5) were scored according to a four-grade scale of severity. Erosive disease was defined by the presence of at least one erosion >2 mm confirmed in 2 perpendicular plans on 30 targeted facet joints. Sensitivity, specificity and OR for the diagnosis of RA were calculated for each elementary (inflammatory and erosive) US lesion.Results153 patients were included: 107 (31 early ConclusionThe combination of PD+ synovitis and erosion in RA and PD+ tenosynovitis alone in early RA offered the best compromise to classify RA versus OA patients.References[1]Scott DL et al. Rheumatoid arthritis. The Lancet.[2]Funck-Brentano et al. Prediction of Radiographic Damage in Early Arthritis by Sonographic Erosions and Power Doppler Signal: A Longitudinal Observational Study. Arthritis Care & Research.[3]Vlychou et al. Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis and Cartilage.[4]Roux et al. Ultrasonographic criteria for the diagnosis of erosive rheumatoid arthritis using osteoarthritic patients as controls compared to validated radiographic criteria. Joint Bone Spine.[5]Sahbudin et al. The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development.Disclosure of InterestsNone declared.

BackgroundRheumatoid arthritis (RA) is the most frequent chronic inflammatory rheumatism. It is characterized by peripheral articular destruction and it is well known that erosions are correlated with the presence and titer of anti-citrullinated peptide antibodies (ACPA)(1). RA is also known to be an independent factor of osteoporosis(2) and it has already been demonstrated that ACPA is associated with bone mineral density (BMD) at the hip and spine(3). The physiopathology of erosion and bone loss in RA is related to osteoclast activation via RANK-L pathway stimulation, that can possibly be lead by ACPA(4).ObjectivesOur aim was to determine if there is an association between local and systemic bone damage in RA, represented respectively by erosion and BMD, and whether it may be driven by ACPA and/or other autoimmunity-related antibodies.MethodsPatients followed in the Department of Rheumatology between January 2008 and May 2019 satisfied the 1987 ACR or 2010 ACR-EULAR criteria. To be included, they had to undergo radiographs and biology at intervals of less than 2 years from DXA. Bone mineral density (BMD) was evaluated in g/cm2 and by T-score at the hip on DXA. Erosions were evaluated by the modified Sharp/van der Heidje erosion score (SHSe) on radiographs and the presence and titers of ACPA, rheumatoid factor (RF) and anti-nuclear antibodies (ANAs) were recorded.ResultsA total of 149 patients met the inclusion criteria, represented by 75.8% of women. They had a mean age of 62 (SD 9.61) and a long median disease duration of 132 [60; 240] months. A total of 61.1% patients were ACPA positive, 79.9% were erosive and 10.7% had a hip or spine T-score ≤-2.5. A higher erosion score was associated with a lower BMD (R2: 0.049 and value: -0.222; p=0.009) and T-score (R2: 0.158 and value -0.397; pvs. 45.5 (44.1) for ACPA – (p= 0.04)). ACPA titers were associated with lower BMD at the hip (value -0.216; p=0.01) but not with T-score. In linear regression, erosion and bone mineral density were still associated but this association does not seem to be driven by ACPA status or titer. RF and ANA did not demonstrate any role in this association.Figure 1.SHSe total score and associated variables in linear regressionConclusionWe have shown that erosions were associated with lower BMD and T-score at hip but also at spine. Nevertheless that relation does not seem to be driven by ACPA or other autoimmunity-related antibodies. However, the presence of ACPA or erosion should lead to osteoporosis assessment.References[1]Maddali Bongi S, Manetti R, Melchiorre D, Turchini S, Boccaccini P, Vanni L, et al. Anti-cyclic Citrullinated Peptide Antibodies are Highly Associated with Severe Bone Lesions in Rheumatoid Arthritis Anti-CCP and Bone Damage in RA. Autoimmunity. sept 2004;37(6‑7):495‑501.[2]Adami G, Saag KG. Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis. Curr Rheumatol Rep. juill 2019;21(7):34.[3]Tomizawa T, Ito H, Murata K, Hashimoto M, Tanaka M, Murakami K, et al. Distinct biomarkers for different bones in osteoporosis with rheumatoid arthritis. Arthritis Res Ther. déc 2019;21(1):174.[4]Harre U, Georgess D, Bang H, Bozec A, Axmann R, Ossipova E, et al. Induction of osteoclastogenesis and bone loss by human autoantibodies against citrullinated vimentin. J Clin Invest. 1 mai 2012;122(5):1791‑802.Disclosure of InterestsNone declared

to determine thresholds and better scenario for the diagnosis of erosive rheumatoid arthritis (RA) by ultrasonography (US) in RA in comparison to osteoarthritic (OA) patients.Patients, prospectively included, fulfilling ACR 1987; ACR/EULAR 2010 criteria for RA or hand OA criteria. Radiographic assessment (RX): Sharp erosion score, evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Definition of eroded RX RA: EULAR 2013 Definition. In US, erosions were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale.A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients have erosive diseases (sensitivity: 34.4%, specificity: 89.1%). On US, 95 RA patients (21 early; 78 late) and 12 OA patients have erosive diseases. Considering at least two joint facets eroded (threshold 1) or at least one joint facet eroded at grade 2 (threshold 2), sensitivities were good (68 and 72.1%), specificities excellent (89.1 and 100%). With only six targeted joint facets examined (6/30), sensitivities and specificities remained good (59.8 and 60.0%) and excellent (95.6 and 100%) with threshold 1 and 2 respectively. For all scenarios, agreement between RX and US for erosive RA was excellent ranged from 88.1% to 92.8%.US erosion assessment of six targeted joint facets detected 1.7 times more erosive RA patients than RX in late and early RA with good sensitivity and excellent specificity.

To determine the correlation between knee synovitis assessed on contrast-enhanced (CE) and non-contrast enhanced (NCE) magnetic resonance imaging (MRI) with histology in patients with knee osteoarthritis.A comprehensive literature search was performed, and related articles published through July 2018 were extracted. Spearman correlation coefficients of MRI-based scores with histology reports were pooled using random effects model. To evaluate presence of publication bias, Egger test was performed.Of 2377 identified records, eight studies consisting of 246 MRI exams were included. Two studies reported results of dynamic CE (DCE)-MRI examinations (81 knees) and two studies reported results of NCE-MRI. There were moderate positive correlations between CE-MRI scores and macroscopic (r = 0.53 (95% Confidence Interval (CI):0.37-0.66), P 0.001) as well as microscopic (r = 0.56 (0.39-0.69), P 0.001) histology. DCE-MRI were strongly correlated (r = 0.71 (0.58-0.80), P-value0.001), with microscopic histology reports, while the correlation for NCE-MRI was low positive (r = 0.44 (0.20-0.63), P 0.001). Meta-regression analysis showed that pooled correlation coefficients of DCE-MRI were significantly higher than CE-MRI (Slope = 0.29, SE = 0.13, P-value = 0.02). CE-MRI were also correlated with inflammatory infiltrate (r = 0.42), while the correlations for cell number of synovial lining (r = 0.27) and level of fibrosis (r = 0.29, P 0.001) were very low.Static and dynamic CE-MRI evaluation of knee synovitis were positively correlated with macroscopic and microscopic features of synovial membrane inflammation. Among the features of synovial tissue inflammation, CE-MRI scores correlated best with the inflammatory infiltrates of synovial tissue. Paucity of current evidence warrants further studies to assess performance of NCE-MRI on determining knee synovitis.

International audience; Objectives: To examine whether trabecular bone texture (TBT) parameters assessed on computed radiographs could predict knee osteoarthritis (OA) progression.Methods: This study was performed using data from the Osteoarthritis Initiative (OAI). 1647 knees in 1124 patients had bilateral fixed flexion radiographs acquired 48 months apart. Images were semiautomatically segmented to extract a patchwork of regions of interest (ROI). A fractal texture analysis was performed using different methods. OA progression was defined as an increase in the joint space narrowing (JSN) over 48 months. The predictive ability of TBT was evaluated using logistic regression and receiver operating characteristic (ROC) curve. An optimization method for features selection was used to reduce the size of models and assess the impact of each ROI.Results: Fractal dimensions (FD's) were predictive of the JSN progression for each method tested with an area under the ROC curve (AUC) up to 0.71. Baseline JSN grade was not correlated with TBT parameters (R < 0.21) but had the same predictive capacity (AUC 0.71). The most predictive model included the clinical covariates (age, gender, body mass index (BMI)), JSN and TBT parameters (AUC 0.77). From a statistical point of view we found higher differences in TBT parameters computed in medial ROI between progressors and non-progressors. However, the integration of TBT results from the whole patchwork including the lateral ROIs in the model provided the best predictive model.Conclusions: Our findings indicate that TBT parameters assessed in different locations in the joint provided a good predictive ability to detect knee OA progression.

Background:Ultrasonography (US) can detect more erosions than radiography (RX) at the joint level in rheumatoid arthritis (RA), especially at an early stage of the disease.Objectives:The aim of the study is to determine the ability of ultrasonography to detect erosion progression by the US Score for erosions (USSe), in early (less than 2 years disease duration (DD)) and late stage (more than 2 years DD) RA over two years of follow-up.Methods:Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA were prospectively included. Clinical and demographic informations were recorded at baseline and hands and feet RX were scored according to the Sharp erosion score (SHSe). Erosive RA on RX was defined by the presence of at least three eroded joints (1). US examinations were performed at baseline and during the two years of follow-up. Erosions were scored by US on six bilateral joints (MCP 2, 3, 5 and MTP 2, 3, 5) with a four grade-scale to calculate total USSe. Erosive RA on US was defined by presence of one erosion ≥ 2mm (2). Inter-examiner reproducibility was performed on 14 patients in order to calculate the smallest detectable change (SDC), which was 2.3. Ultrasonographic progression was defined as a change in USSe > 2 (erosion change > SDC).Results:A total of 71 patients were included, 22 patients (31.0%) had early RA and 49 (69.0%) patients had late RA diseases. On RX, 30 (42.3%) patients were erosive at baseline with a mean SHSe at 29.4 (SD at 24.7). On US, 63 patients (88.7%) were classified as eroded. On US, erosions prevailed at baseline in MTP5 joints, then MCP2 and MCP5 joints on their lateral facets. During follow-up, 28 patients (39.4%) were classified as US progressors, 30 (42.3%) were stable and 13 (18.3%) considered as regressors (figure 1). In early RA disease, three of the four non eroded patients became eroded. USSe progressed in 11 patients (50%) while regression was observed in only one patient. In late RA disease, 17 patients (34.7%) progressed and 12 patients (24.5%) decreased significantly their USSe. Erosion progression prevailed on MTP 5 joints followed by MCP2 and finally MCP5 joints (figure 2).Figure 1.USSe progression plots (n=71)Figure 2.Differences of USSe by joints during follow-up in early and late RAConclusion:US structural examination is a highly reproducible method to assess erosion in RA disease. The USSe is able to detect structural changes (progression, stabilization and regression) in RA patients during a follow-up of two years especially in RA patients with short disease duration.References:[1]Van der Heijde D, van der Helm-van Mil AHM, Aletaha D, Bingham CO, Burmester GR, Dougados M, et al. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Ann Rheum Dis. avr 2013;72(4):479‑81.[2]Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, et al. Optimization of ultrasonographic examination for the diagnosis of erosive Rheumatoid Arthritis in comparison to erosive hand Osteoarthritis. Eur J Radiol. sept 2019;118:10‑8.Disclosure of Interests:None declared

Background:Clinical assessment of swollen joint count (SJC) in rheumatoid arthritis (RA) might be affected by obesity in terms of obesity-related excess adipose tissue.Objectives:To compare the level of agreement between synovitis evaluated by Power Doppler ultrasound (PDUS) and clinical examination (SJC as component of SDAI) in obese (O) (i.e. Body Mass Index (BMI) >30) versus non-obese (NO) (BMI≤30) RA patients.Methods:RA patients ≥18 years fulfilling 2010 ACR-EULAR criteria were included in the cross-sectional multicentre (13 centres) French observational RABODI study (ClinicalTrials.gov Identifier:NCT03004651). Clinical synovitis was evaluated on 44 joints. ESR and CRP were collected and SDAI, DAS28, DAS were calculated. A standard US examination on 44 joints was performed by an independent investigator blinded to clinical data. US synovitis was defined by a synovial hypertrophy ≥1 and PD signal≥1 on a semi-quantitative scale according to the EULAR-OMERACT scoring system. Levels of agreement between number of synovitis defined by PDUS and clinical examination were compared in O versus NO patients using Chi2 test, and Kappas (k) and ORs were calculated. A patient was considered “discordant” if ≥1 joint was discordantly classified by PDUS and clinical examination. SDAI was calculated and compared, with SJC defined either by clinical examination or PDUS.Results:121 patients were included: mean (SD) age of 58.5 (12.7) years, mean disease duration of 11.1 (9.7) years. 81% were female, 84.3% anti-CCP positive, 63.6% had erosive disease. Mean SDAI was 12.6 (±10.2). 53 (43.8%) had a BMI >30 and 68 (56.2%) ≤30. 59 (48.7%) and 62 (51.2%) had a SDAI≤11 and >11, respectively. The 2 groups were comparable, except for weight (mean (SD) 65.4 (13.5) vs 96.7 (14.7) kg, p< 0.001), some comorbidities (diabetes, asthma and fibromyalgia more frequent in O patients), tender joint count (mean 4.04 (±5.23) in NO vs 7.38 (±8.64) in O, p=0.021). Mean number of SJC was 2.4 (3.3), and PDUS 6.7 (±6.3). Levels of agreement between clinical and PDUS findings were comparable in O vs. NO patients regarding SDAI and other scores (Table). Patients with ≥3 discordant joints were numerically higher in O patients compared to NO (26/53 (49.1%) vs 22/68 (32.4%), p=0.062). At the joint level, discordance was higher in O patients in MCP4 (p=0.057), wrist (p=0.089).Table.Level of agreement between PDUS synovitis and SJC in obese versus normally weighted RA patientsScore with PDUS vs. SJCBMI ≤ 30N=68BMI > 30N=53OR(95%CI)P*SDAINon-Discordant (ND)63461.92(0.57-6.42)0.28Discordant (D)57Kappa0.850.73DAS28ND62471.32(0.4-4.35)0.64D66Kappa0.810.77DAS44ND63520.24(0.03-2.14)0.23D51Kappa0.830.96≥1 synovitisND51351.54(0.7-3.4)0.28D1718Kappa0.500.32Conclusion:In RA patients, despite a perceived higher difficulty to clinically detect SJ in O patients, the discrepancy between clinically- and PDUS defined synovitis was not significantly higher than in NO patients, and did not impact the extend of the definition of disease activity level.Disclosure of Interests:Gael Mouterde: None declared, Federico Manna: None declared, Benoit Le Goff: None declared, Jean-David Albert: None declared, Sandrine Jousse-Joulin: None declared, Frederique Gandjbakhch: None declared, Damien LOEUILLE: None declared, Philippe Gaudin Speakers bureau: Lilly, Muriel PIPERNO: None declared, BANAL Frédéric: None declared, Bénédicte Jamard: None declared, Carine Salliot: None declared, Nicolas Molinari: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Maria-Antonietta D’Agostino: None declared, Cédric Lukas: None declared

The aims of this study were to compare characteristics of radiography (RX) and ultrasound (US) erosive lesions in rheumatoid arthritis (RA) and osteoarthritis (OA) patients (prevalence, topography and severity), to determine thresholds for the diagnosis of erosive RA based on US and to evaluate the performance of US and RX to establish a diagnosis of erosive RA differentiated from hand OA.Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Erosions in US were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale to calculate total US score for erosions (USSe).A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients were eroded according to EULAR 2013 definition criteria with sensitivity at 34.4% and specificity at 89.1%. On US, 95 RA patients (21 early; 74 late) and 12 OA patients were eroded. Considering at least two joint facets eroded or at least one joint facet eroded at grade 2 on US, sensitivities were good (68-72.1%) and specificities excellent (89.1-100%). Agreement between RX and US was excellent (90-92%). The positive and negative likehood ratios were respectively 3.16 and 0.73 for radiography and 6.64 and 0.31 for US (for two facets eroded).USSe can differentiate RA from OA in erosive disease and detect two times more patients with erosive RA than RX with excellent specificity and agreement.

Background Evaluation of imaging is important in spondyloarthritis (SpA) research, but loss to follow up often jeopardises interpretation of the evaluation. The Interpretation may further be challenged by the fact that often different readers have contributed to scores, in multiple read ‘waves’. A common approach is to evaluate patients (pts) with complete follow up (completers analysis), and aggregate scores of individual readers (eg. agreement ≥2 out of 3 readers). These approaches are not assumption-free, may cause non-random data loss, and may as such provide spurious estimates and loss of external validity. Objectives We aimed to investigate if the use of all data in an assumption-free manner (a so called ‘integrated analysis’) affects the precision of estimates for imaging outcomes in pts with axial SpA (axSpA), with completers analysis as reference standard. Methods Pts from the DESIR cohort fulfilling the ASAS axSpA criteria were included. Radiographs and MRIs of the SIJ and spine were obtained at baseline (BL), 1, 2 and 5 years. Each film was scored by 2 or 3 readers in 3 ‘reading-waves’ (wave 1: BL only; wave 2: BL, 1, 2 years; wave 3: BL, 2, 5 years). Each outcome was analysed in two ways: i. according to a ‘combination algorithm’ (‘2 out of 3’ for binary and mean of 3 readers for continuous variables); and ii. per individual reader. The change of each outcome was analysed by generalised estimating equations (GEE)) with ‘time’ as explanatory variable. Three analytical approaches were pursued: i) ‘integrated-analysis’ (including all pts with ≥1 score from ≥1 reader from all waves); ii) completers-only analysis (including only pts with complete 5 year follow-up, using scores from individual readers from wave 3); iii) aggregated completers analysis using a combination algorithm (the same as ii but using combined scores). Results In total, 413 pts were included (mean (SD) symptom duration: 1.6 (0.9) years) and 366 completed the 5 year follow up. An analysis with all data from different readers and ‘waves’ (‘integrated analysis’) was more inclusive, but did not result in a meaningful loss of precision (width of 95%CIs) of the change-estimates as compared to both completers analyses (table 1). In fact, for low-incident outcomes (e.g.% of mNY-positive over 5 years), a similar incidence was ‘captured’, with more precision, by the ‘integrated analysis’ compared to the completers analysis with combined scores (% change/year (95% CI): 1.1 (0.7; 1.5) vs 1.2 (0.5; 1.8), respectively). The same results were seen using continuous outcomes. Conclusions An efficient and entirely assumption-free usage of all data from different readers and ‘read-waves’ does not compromise precision of the estimates of change in imaging parameters, and may yield increased statistical power for detecting changes with low incidence. In addition, integrated analysis may protect against attrition bias and avoid bias by ‘convenient choices’. Disclosure of Interest None declared

Background Lumbosacral transitional vertebra (LSTV) is a congenital anomaly of the lumbosacral transition reported in 16% to 36% of the general population. One study reported low clinical relevance of LSTV in the early diagnosis of axial spondyloarthritis (axSpA), but data remains scarce. Objectives Our objectives were to evaluate the association of LSTV with sacroiliitis on conventional radiographs (CR) and magnetic resonance imaging (MRI) in a population with inflammatory back pain (IBP) suspected of axSpA. Methods Baseline pelvic and lumbar CR of DESIR cohort patients (18–50 years, IBP≥3 months but Results 688 patients with available CR enabling LSTV analysis were studied, 47% were men, mean age was 33 years, 64% fulfilled ASAS criteria. Among the 688 patients 29.1% presented LSTV. Number and percentages of patients with different classes of LSTV are presented in Table I. Patients with LSTV had more often sacroiliitis on CR than patients without, respectively 27% and 19% (p=0.013). Patients with LSTV had more often sacroiliitis on MRI (figure 1) than patients without, respectively 39% and 29% (p=0.019). Presence of fusion on the right transverse process was associated with both right (p=0.001) and left (p=0.001) sacroiliitis on CR. Presence of fusion on the left transverse process was associated with sacroiliitis in CR on both right (p=0.006) and left (p=0.001) sides. Conclusions LSTV is observed in 29.1% of patients from the DESIR cohort, as reported in the literature and is associated with sacroiliitis on conventional radiography and MRI. Further study is mandatory to understand if this is based on mechanical stress or AxSpA and to assess the potential bias of LSTV in axSpA diagnosis. Disclosure of Interest None declared

To examine whether trabecular bone texture (TBT) parameters assessed on computed radiographs could predict knee osteoarthritis (OA) progression.This study was performed using data from the Osteoarthritis Initiative (OAI). 1647 knees in 1124 patients had bilateral fixed flexion radiographs acquired 48 months apart. Images were semi-automatically segmented to extract a patchwork of regions of interest (ROI). A fractal texture analysis was performed using different methods. OA progression was defined as an increase in the joint space narrowing (JSN) over 48 months. The predictive ability of TBT was evaluated using logistic regression and receiver operating characteristic (ROC) curve. An optimization method for features selection was used to reduce the size of models and assess the impact of each ROI.Fractal dimensions (FD's) were predictive of the JSN progression for each method tested with an area under the ROC curve (AUC) up to 0.71. Baseline JSN grade was not correlated with TBT parameters (R 0.21) but had the same predictive capacity (AUC 0.71). The most predictive model included the clinical covariates (age, gender, body mass index (BMI)), JSN and TBT parameters (AUC 0.77). From a statistical point of view we found higher differences in TBT parameters computed in medial ROI between progressors and non-progressors. However, the integration of TBT results from the whole patchwork including the lateral ROIs in the model provided the best predictive model.Our findings indicate that TBT parameters assessed in different locations in the joint provided a good predictive ability to detect knee OA progression.

La artrosis asocia una sintomatologia clinica que evoluciona sobre un fondo mecanico, mas o menos caracterizado por episodios inflamatorios, y anomalias radiologicas de aparicion mas tardia aunque indispensables para el diagnostico (criterios). A pesar de que la radiologia es parte integral de los criterios diagnosticos actuales y es la referencia para el seguimiento de la enfermedad, hay estudios recientes que subrayan las limitaciones de la tecnica, sobre todo para el diagnostico precoz y el seguimiento de la evolucion de la enfermedad. Las tecnicas de imagen modernas permiten de forma incontestable una mejor identificacion de los pacientes artrosicos. La artrotomografia computarizada (artro-TC) muestra las lesiones condrales de superficie y la perdida cartilaginosa en la rodilla y otras articulaciones (cadera u hombro). La gammagrafia osea ofrece una cartografia de las destrucciones articulares y predice, en la rodilla, el pinzamiento de la interlinea articular. La ecografia es un complemento indispensable en el examen radiografico de las articulaciones profundas (cadera) al precisar la existencia de un derrame y/o una sinovitis no descubiertos con la exploracion fisica. Ademas, esta prueba ofrece informacion complementaria sobre las lesiones yuxtaarticulares (meniscos, rodete, quiste, etc.). En los ultimos anos, se ha impuesto la resonancia magnetica (RM) como la tecnica de imagen de referencia para la artrosis; permite la aproximacion fisiopatologica, diagnostica, pronostica y terapeutica mas precisa de la enfermedad; al visualizar directamente la perdida cartilaginosa, la RM permite establecer un diagnostico mas precoz que la radiografia, delimitar los diferentes factores de riesgo de la perdida condral y determinar las estructuras articulares o yuxtaarticulares responsables de las manifestaciones dolorosas. En el futuro, esta tecnica de imagen deberia posibilitar una mejor clasificacion de las poblaciones artrosicas y, con ello, optimizar el plan terapeutico y, tambien, evaluar de forma mas exacta la eficacia de los medicamentos con efecto condroprotector.

In contrast to radiography, magnetic resonance imaging permits visualization of all articular structures affected by osteoarthritis. Many studies have demonstrated its potential to elucidate the pathophysiological phenomena that lead to joint destruction, quantify cartilage damage, and establish risk factors for chondrolysis. Bone marrow lesion is a well-recognized process localized just beneath the subchondral bone that is responsible for clinical symptoms and structural changes not only to bone but also to cartilage.

To compare radiation dose and image quality for CT of the lumbar spine between helical CT and wide volume mode scanning with a 320-detector row CT.Monocenter prospective study on 20 consecutive patients divided into two groups. All 20 patients underwent lumbar spine CT on the 320-detector row scanner (Aquilion One, Toshiba). The CT examinations for group 1 were performed using the wide volume mode with 320 detector rows while the CT examinations for group 2 were performed using a 64-detector row helical CT mode. The acquisition length and delivered dose corresponding to the DLPe (extended dose length product) as well as qualitative and quantitative image quality were compared between both groups.The mean acquisition length was comparable between both groups. There was a significant dose reduction of about 35% for group 1 compared to group 2 (mean DLPe of 970 mGy.cm for group 1 compared to 1503 mGy.cm for group 2, p0.028) when using the wide volume mode acquisition at 320-detector row CT compared to the 64-detector row helical CT mode. No significant difference was noted for image quality between both groups.The acquisition of lumbar CT using the wide volume mode at 320-detector row CT allows significant dose reduction to patients compared to the 64-detector row helical CT mode while preserving image quality.

Bone marrow edema is easily identified on MRI. The terminology suggests that the water content of bone marrow is increased when it is T1W hypointense and T2W hyperintense. It is a misnomer since, histologically, the abnormality does not correspond to marrow edema. The histological findings vary based on the underlying etiology and the presence of fibrosis or inflammatory infiltrate is frequent and often predominant. In France, this terminology is used routinely to describe such lesions. The term osteitis is preferred to describe these marrow signal changes in the setting of rheumatic joint diseases. The detection of bone marrow edema is important because of its diagnostic and prognostic value. It occurs in isolation and is reversible in patients with bone contusion and complex regional pain syndrome. It indicates underlying structural damage and may modify management in patients with rheumatoid arthritis or spondylarthropathies. MR scores for disease activity rely mainly on the presence of marrow edema. Finally, diffusion weighted MR allows quantification of marrow edema and could be more sensitive than conventional MRI to detect inflammation. The purpose of this article is to review the imaging features of marrow edema, review the underlying etiologies and its diagnostic and prognostic value.

To study synovial membrane (SM) inflammation near the patella with different magnetic resonance imaging (MRI) approaches performed using a T1-injected sequence in knee osteoarthritis (OA), and to compare MRI results with macroscopic, microscopic and clinical findings.Fifteen patients fulfilling American College of Rheumatology (ACR) criteria for knee OA and requiring joint lavage completed a functional index (Lequesne's functional index) and a pain visual analog scale (VAS). SM inflammation near the patella was assessed on axial fat saturation post-injected T1 MRI images using three different methods: (1) semi-quantitative score=MRI synovitis score; (2) synovial membrane volume (SMV) analysis; (3) SMV with low (SMVL) (0.3%/s(-1)), intermediate (SMVI) (0.3%/s(-1) to 1%/s(-1)) and high (SMVH) (or =1%/s(-1)) speed of enhancement. Chondral lesions and SM inflammation were macroscopically graded and SM biopsies performed for microscopic scoring.All MRI approaches exhibited excellent intra- and inter-observer reproducibility. MRI synovitis score correlated well with macroscopic (r=0.61, P=0.003) and total microscopic scores (r=0.55, P=0.03). Correlations between SMV and macroscopic (r=0.60, P=0.02) and microscopic congestion (r=0.63, P=0.01) were good. SMVH was correlated only with microscopic congestion (r=0.79, P=0.01). Low SMV was associated with neither macroscopic nor microscopic scores. However, it did correlate well with pain-VAS score (r=0.61, P=0.03) and moderately with a functional index (r=0.46, P=0.10).The three MRI approaches used here provided highly reproducible information on SM inflammation near the patella in knee OA. Compared to SMV, MRI synovitis score seems sufficient to assess synovial inflammation but high SMV is an appropriate indicator of vascular congestion, and low SMV reflects pain in knee OA.

The contribution of leptin, as a possible link between osteoarthritis (OA) and obesity, was studied in cartilage and synovial fluid samples obtained from osteoarthritic patients. Its effect on cartilage was evaluated in rats after intraarticular injections of leptin. Leptin levels were measured in the synovial fluid samples by enzyme linked immunosorbent assay; leptin concentrations were correlated with the body mass index. Leptin was strongly expressed in osteophytes and OA cartilage, while, in normal cartilage, few chondrocytes produced leptin. The level of leptin expression was related to the grade of cartilage destruction and was in good relation with those of growth factors as IGF1 and TGFb. Studies in rats showed that intraarticular leptin injection stimulated anabolic functions of chondrocytes and induced the synthesis of leptin, IGF1 and TGFB in cartilage at both the chondrocytes and induced the synthesis of leptin, IGF1 and TGFB in cartilage at both the mRNA and protein levels. In conclusion, leptin may be a link between osteoarthritis and obesity, and may play a key role in cartilage metabolism. Leptin may contribute to the pathophysiology of OA.

The recent approval by the French Ministry of Health of the use of intra-articular Gadolinium could promote the increasing use of MR-arthrography in France. Although useful in specific pathologies, it should not be overly prescribed and should be considered only if it provides a more accurate diagnosis than other less invasive techniques. The technical aspects and medico-legal implications of MR-arthrography as well as its various indications are reviewed in this article. There are three possible techniques: indirect MR-arthrography with IV Gadolinium injection, direct MR-arthrography with intra-articular Gadolinium injection and lastly, direct MR-arthrography with intra-articular injection of iodinated contrast media (or saline solution). Indirect MR-arthrography cannot be recommended because of insufficient contrast enhancement and the absence of joint filling. Conversely, direct MR-arthrography allows joint expansion which smooths out capsule and ligaments, better delineates articular surfaces and yields a homogeneous high intensity signal of the entire joint. Direct MR-arthrography with iodinated contrast media combines standard arthrography with conventional MRI. Direct MR-arthrography with intra-articular injection of dilute Gadolinium is associated with T1WI, usually of higher quality than T2WI, even though the latter remains part of the protocol. Although, the last two techniques yield higher image quality and are often performed for various articular pathologies, they should not be randomly carried out in the evaluation of joint pathology. However, they should be recommended as the first step in the diagnosis of painful shoulders or hips in young adults and athletes.

To evaluate the ability of T2 mapping on an 8.5 T imager to characterize morphologically and quantitatively spontaneous repair of rat patellar cartilage following full thickness defect.Patellar cartilage defects were created in 24 rats knees on D0. Eight rats per time-point were killed on D20, D40 and D60 after surgery. T2 maps of repair tissue in patellar defects were obtained from eight different axial spin echo images on an 8.5 T imager. Global, superficial and deep T2 values were evaluated in spontaneous repair tissues (3x8 right patellae) vs the opposite patellae (3x8 left patellae) of the same animals. MR data were compared with macroscopic and histological studies.T2 map was able to identify morphologically three types of repair tissue observed macroscopically and histologically: 'total', 'partial' and 'hypertrophic' repair tissue. 'Total' and 'partial' repair tissues were characterized by global T2 values almost similar to controls, whereas 'hypertrophic' repair tissues were characterized by T2 global values higher than controls. Zonal variation between superficial and deep T2 values observed in controls was not depicted in repair tissue before D60.T2 map is able to characterize quantitatively and qualitatively rat patellar cartilage repair, and thus can be promoted, as a non invasive technique, in clinical longitudinal studies of articular cartilage repair.

To determine whether routine magnetic resonance imaging (MRI) techniques can detect age-related structural modifications of bovine articular cartilage.The cartilage of 3-month-old, 3-year-old, and 13-year-old animals was studied. T1- and T2-weighted MR sequences were performed using a 1.5T clinical imager and a 3-inch surface coil. Histologic slices (5 microm) of cartilage specimens were stained with picrosirius red (for collagen) and toluidine blue (for glycosaminoglycans [GAGs]). A polarized light study was performed to determine the collagen network organization. Except for the 13-year-old animal cartilage, the biochemical content was studied on slices cut parallel to the surface to determine GAG and hydroxyproline (collagen) content. Cartilage profiles were performed to determine the MR pixel intensity and the histologic color intensity.On T1-weighted images, the cartilage was homogeneous, with pixel intensity profiles presenting low variations. On T2-weighted images, the cartilage was laminar in the 3-month-old animals and became homogeneous thereafter. The pixel intensity varied through the cartilage depth with a profile that depended on the age of the animal. The collagen and GAG staining showed abrupt transitions in the 3-month-old animal, while in older animals the cartilage became more homogeneous with a mild gradient of matrix constituents with depth. These results were confirmed by findings of a biochemical study. In addition to these matrix content variations, the bovine cartilage presented modifications of its collagen network organization with aging.The MR T2-weighted sequences depicted signal variations with age in bovine cartilage concomitant with modifications in its structure. If confirmed in clinics, these observations will reinforce the place of MRI in characterizing cartilage with aging and pathologic processes.

Intravesical BCG therapy remains the first-line prophylactic treatment for recurrences of superficial bladder tumours. However, necessary the safety of this medicinal product, for which a potential risk of complications was demonstrated during development, needs to be evaluated.Based on spontaneous notifications of adverse events reported according to good pharmacovigilance practice and in the context of a survey conducted jointly with Health Authorities, the authors present an analysis of adverse event notifications received by the manufacturer over a three-year period. A summary of serious adverse events (SAE) was established and hypotheses concerning factors predisposing to these adverse events were discussed. Finally, practice guidelines were formulated.During this period, 97 SAEs were reported spontaneously, including 12 local SAEs, 12 regional SAEs and 73 systemic SAEs. 46 of the 73 systemic SAEs were suspected to be due to BCG infection, 18 were related to immune disorders and the cause of 9 SAEs could not be determined. Several hypotheses are formulated concerning the circumstances leading to the onset of these SAEs and practice guidelines are proposed.Pharmacovigilance has allowed a better understanding of the qualitative and quantitative safety of BCG-IT in France. Hypotheses concerning factors predisposing to adverse effects were formulated and practice guidelines were proposed. It is essential to continue this collaboration between practitioners, Health Authorities and the manufacturer to ensure optimal use of this medicinal product.

Familial articular chondrocalcinosis is a chronic articular disease characterized by acute intermittent attacks of arthritis, presence of calcium pyrophosphate dihydrate crystal in synovial fluid, cartilage and periarticular soft tissue and by x rays calcium deposition in articular cartilage. A family originating from Alsace, with an autosomal dominant transmission has been studied. As in English and Argentinean families, a linkage to the short arm of chromosome 5p has been found. These results suggest that a defective gene at this location may be related to the chondrocalcinosis in these families.

To determine which signs are the most accurate in the diagnosis of sacroiliitis with MRI.40 consecutive patients with inflammatory low back pain underwent MRI at 1.5 T with FSE T2 and SE T1 weighted-images before and after Gadolinium-DOTA injection. 22 patients were suffering from spondylarthropathy while the other 18 patients constituted the control group. Each examination was interpreted by two independent observers who analysed 11 different signs.Intra and inter observer reproducibility were high (respectively 76% and 70%). Inter observer reproducibility was excellent for bone marrow edema (89%) but low for bone productions (38%). Three lesions displayed a high positive predictive value: ligamentous contrast enhancement (86%), bone marrow edema (80%) and bone erosions (70%). Intra articular enhancement of the sacro-iliac joint was a less sensitive sign than bone marrow edema.This study confirms the excellent positive predictive value of MRI for an early diagnosis of active sacroiliitis. Bone marrow edema seems to be a more pertinent sign than intra articular enhancement.

Septic sacroiliitis is an uncommon condition that is often diagnosed late. Two cases in the immediate postpartal period are reported. Magnetic resonance imaging contributed decisively to the early diagnosis.

To visualize articular changes during iodoacetate induced osteoarthritis (OA) of the rat knee using high resolution magnetic resonance imaging (MRI).All images were acquired on a 8.5T microimager on ex vivo rat knees. After optimization studies, 3D spin echo sequences were used with TR 1200 ms and TE 15 ms; 40 sagittal images were obtained with a resolution of 400 x 60 x 60 microns. OA lesions were achieved by injecting 3 mg iodoacetate in the right knee joint (Day 0). Progression of OA changes was studied at Days 5, 10, 15, 20, 30, 90 and corresponding radiographs and histological sections were obtained.Spin echo images of the normal rat knee clearly visualized cortical bone, calcified menisci, patella, and cruciate ligaments as dark regions. Cartilage and muscles appeared as intermediate signal. In some cases a trilaminar appearance of cartilage and growth plate was depicted. This appearance persisted at Day 5, although cartilage presented a marked loss of proteoglycans. After Day 10 the menisci appeared irregular and inhomogeneous. After Day 15, MRI showed important alterations of articular cartilage, predominant on weight bearing areas of femoral condyles. Osteophytic remodeling was also seen around the patella. From Day 20 to Day 90 anatomical changes progressively affected epiphyseal bone, leading to subchondral cysts and loss of its regular trabecular structure.High field MRI provides a sensitive method for investigating ex vivo focal erosions of cartilage and established osteochondral remodeling in experimental OA in the rat. In this model, microimaging provides more information about early modifications of cartilage and soft tissue than radiographic exploration, in good correlation with histological data.

Objectifs Comparer la dose delivree et la qualite d’image entre le mode volumique et le mode helicoidal sur un scanner 320 detecteurs lors de l’acquisition d’un scanner lombaire. Materiels et methodes Etude prospective chez 20 patients de plus de 45 ans (moyenne d’âge de 63 ans) ayant un scanner lombaire avec deux acquisitions successives sur un scanner 320 detecteurs (Aquilion One®, Toshiba) en mode volumique (320 detecteurs) puis en mode helicoidal (64 detecteurs) avec modulation automatique de la dose. La dose delivree etait fournie par le Produit-Dose-Longueur en mGy. cm. La qualite d’image a ete evaluee par la mesure de la deviation standard d’une region d’interet placee dans le muscle psoas a hauteur de L5. Les longueurs d’acquisition ont egalement ete comparees. Resultats II existe une reduction significative de la dose delivree de 29,5% (p Conclusion L’acquisition en mode volumique sur le scanner 320 detecteurs permet de reduire la dose delivree de facon significative par rapport a l’acquisition heliocoidale, tout en preservant une qualite d’image equivalente.