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Background: Baricitinib (BARI) or Tofacitinib (TOFA) were the first Janus Kinase Inhibitors (JAKi) to be marketed in rheumatoid arthritis (RA). Concerns regarding venous thromboembolism (VTE) risk have emerged during the past years. The aim of the study was to compare the baseline characteristics of patients initiating BARI or TOFA in RA before versus after European Medicine Agency (EMA)’s VTE warnings and to compare real-world persistence with these two drugs. Methods: In this multicentric cohort study, RA patients initiating BARI or TOFA were included from October 2017, date of BARI marketing authorization in France, to September 2020. Baseline characteristics regarding VTE risk were compared (before vs. after May 2019) by using pre-specified statistical tests. Comparison of persistence was assessed by using propensity-score methods. Results: 232 patients were included; 155 with BARI and 77 with TOFA. Baseline characteristics of patients regarding VTE risk factors were not statistically different when Janus Kinase inhibitor (JAKi) was initiated before vs. after EMA’s warnings although a trend towards a lower proportion of VTE history was observed. Five VTE events occurred, four with BARI, one with TOFA. Cumulative persistence rate at 2 years was similar between BARI and TOFA: HR 0.96; 95% Cl: 0.52 to 1.74; p = 0.89. Conclusions: Our study did not show a significant change in patients characteristics starting a JAKi after the EMA’s warnings, probably due to a lack of power. Though, the lower proportion of VTE history in patients after May 2019 suggests that rheumatologists have taken into account the potential VTE risk. These results need to be confirmed by further evidence.

To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden.Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi.We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p0.001).Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.

Background Anxiety is common in hospitalized patients and can worsen pain or lead to unsuccessful pain relief. Aims The purpose of this study was to evaluate the usefulness of measuring anxiety with a visual analog scale (VAS) in the hospitalized patient experiencing pain. Design We conducted a multiple-center cross-sectional study. Participants/Subjects Adult inpatients experiencing moderate to severe pain defined by a pain VAS score ≥40 of 100 were included. Methods Pain and anxiety data were collected using the following instruments: pain VAS, anxiety VAS, State Anxiety Scale of the Spielberger State-Trait Anxiety Inventory (STAI-YA) and Anxiety Subscale of the Hospital Anxiety and Depression Scale (HAD-A). Results Data were collected from 394 patients. Of those patients, 43.6% (171 of 392) and 36.6% (143 of 391) had significant anxiety according to STAI-Ya and HAD-A, respectively. Correlation was good between anxiety-VAS and STAI-YA (ρ = 0.67 [95% confidence interval 0.61-0.72]) and moderate between anxiety VAS and HAD-D (ρ = 0.48 [0.39-0.56]). The main factor predictive of situational anxiety was history of anxiety-depression symptoms (odds ratio = 2.95 [1.93-4.56]). For anxiety VAS score ≥ 40 of 100, the sensitivity for detecting anxiety was 81% with 70% specificity. Conclusion This study confirmed the high prevalence of anxiety among inpatients experiencing pain, demonstrated the capacity of a VAS to assess this anxiety, determined an anxiety VAS cutoff level to screen for significant anxiety, and identified risk factors of anxiety in this population. Anxiety VAS has been found to be an easy-to-use method familiar to caregivers, with all the advantages needed for an effective screening instrument. An anxiety VAS score ≥40 of 100 would thus warrant particular attention to adapt care to the patient's anxiety-related pain and initiate specific therapeutic interventions.

International audience; Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.

Objectives To evaluate the characteristics of patients (pts) with PsA treated by ustekinumab (UST) or secukinumab (SEK) and to compare real-world persistence of UST and SEK in PsA. Methods In this retrospective, national, multicentre cohort study, pts with PsA (CASPAR criteria or diagnosis confirmed by the rheumatologist) initiating UST or SEK with a follow-up ≥6 months were included from January 2011 to April 2019. The persistence between SEK and UST was assessed after considering the potential confounding factors by using pre-specified propensity-score methods. Causes of discontinuation and tolerance were also collected. Results A total of 406 pts were included: 245 with UST and 161 with SEK. The persistence rate was lower in the UST group compared with the SEK group [median persistence 9.4 vs 14.7 months; 26.4% vs 38.0% at 2 years; weighted hazard ratio (HR) = 1.42; 95% CI: 1.07, 1.92; P =0.015]. In subgroup analysis, the persistence rate of SEK associated with MTX was significantly higher than that of UST associated with MTX: HR = 2.20; 95% CI: 1.30, 3.51; P =0.001, in contrast to SEK vs UST monotherapy: HR = 1.06; 95% CI: 0.74, 1.53; P =0.75. Discontinuation due to inefficacy was reported in 91.7% (SEK) and 82.4% (UST) of pts. Discontinuation due to an adverse event was reported in 12.2% (SEK) and 7.7% (UST) of pts. Conclusion In this first study comparing UST and SEK, the persistence of SEK was higher than that of UST in PsA. In subgroup analysis, this difference was only found in association with MTX.

Introduction Le Tofacitinib (TOFA) et le Baricitinib (BARI) ont ete les premiers JAK inhibiteurs (JAKi) indiques dans la polyarthrite rhumatoide (PR). Ces molecules ont fait l’objet d’alertes concernant un potentiel surrisque thromboembolique veineux (VTE). En mai 2019, l’Agence europeenne du medicament (EMA) a alerte la communaute medicale afin de limiter la prescription de TOFA chez les patients a risque. A ce jour, peu d’etudes ont ete realisees afin d’evaluer si ces alertes avaient eu un impact en pratique rhumatologique courante. Patients et methodes Une etude retrospective multicentrique a ete menee. Les patients inclus devaient etre atteints de PR (criteres ACR/EULAR 2010) et avoir initie un traitement par BARI ou TOFA entre octobre 2017, date de la commercialisation du BARI en France, et septembre 2020. L’objectif principal de cette etude etait la comparaison des caracteristiques des patients debutant un JAKi avant versus apres mai 2019. Le deuxieme objectif etait de comparer la persistance en vraie vie du BARI et du TOFA dans la PR avec recours a un score de propension. Resultats ( Tableau 1 ) Nous avons inclus 232 patients : 155 sous BARI et 77 sous TOFA. Le profil des patients n’est pas statistiquement different selon que le traitement a ete introduit avant ou apres mai 2019, meme si l’on observe une nette diminution de la proportion d’antecedent personnel thromboembolique veineux apres les alertes. La persistance a 2 ans est de 39,3 % pour le BARI et 42,9 % pour le TOFA, sans difference significative entre les deux molecules (p = 0,89). Cinq evenements thromboemboliques sont survenus au cours de l’etude, quatre sous BARI, un sous TOFA. L’analyse des caracteristiques des cinq patients chez qui les evenements sont survenus a revele qu’ils etaient initialement a risque. Deux patients avaient des antecedents personnels thromboemboliques veineux. De maniere interessante, quatre d’entre eux ont debute le JAKi avant mai 2019. Conclusion Les resultats de cette etude suggerent une prise en compte du possible risque VTE des JAKi dans la PR par les rhumatologues apres les alertes de mai 2019. Le risque VTE du BARI et du TOFA reste une preoccupation en vraie vie. La tolerance cardiovasculaire de ces molecules est un sujet d’actualite dans l’attente des resultats detailles de l’etude ORAL surveillance (TOFA) et des premiers resultats de l’etude RA-BRIDGE (BARI). D’autres etudes sont necessaires pour determiner si le risque VTE est un effet classe des JAKi.

Objectives To determine whether the volume of monosodium urate (MSU) crystal deposition measured with dual-energy CT (DECT) is predictive of short-term mortality and development of cardiovascular comorbidities and diabetes mellitus. Methods Patients with a diagnosis of gout having had baseline DECT scans of their knees and feet to measure the volume of MSU crystal deposition were included to undergo a follow-up visit. Risk factors for mortality and a composite variable (onset of any cardio-metabolic event) were examined using multivariable Cox models. Results A total of 128 patients aged 66.1 (14.0) years with gout durations of 11.4 (10.4) years were included; most were naïve of urate lowering therapy (61.7%), with a follow-up visit at 24 (12, 36) months. Baseline serum urate (SU) level was 7.44 (2.29) mg/dl and DECT volume of MSU crystals was 0.2 (0, 0.9) cm3. A total of 14 patients died during follow-up, 6/14 from a cardiovascular cause, and 17 patients presented a new cardio-metabolic comorbidity. Factors associated with mortality risk were baseline DECT volume of MSU crystals [hazard ratio (HR) 1.02, 95% CI: 1.002, 1.03] and baseline SU level (HR 1.04, 95% CI: 1.003, 1.06). DECT volume of MSU crystals was the only factor associated with the onset of cardio-metabolic comorbidities with a HR of 1.014 (95% CI: 1.001, 1.03). Conclusions Volume of MSU crystals measured with DECT is a biomarker for the risk of developing new cardio-metabolic diseases and for all-cause mortality.

(1) Background: To determine which factors are associated with the volume of monosodium urate (MSU) crystal deposition quantified by dual-energy computed tomography (DECT) in urate-lowering therapy (ULT)-naive gout patients. (2) Methods: In this multicenter cross-sectional study, DECT scans of knees and feet/ankles were prospectively obtained from ULT-naive gout patients. Demographic, clinical (including gout history and comorbidities), and biological data were collected, and their association with DECT MSU crystal volume was analyzed using bivariate and multivariate analyses. A second bivariate analysis was performed by splitting the dataset depending on an arbitrary threshold of DECT MSU volume (1 cm3). (3) Results: A total of 91 patients were included. In the bivariate analysis, age (p = 0.03), gout duration (p = 0.003), subcutaneous tophi (p = 0.004), hypertension (p = 0.02), diabetes mellitus (p = 0.05), and chronic heart failure (p = 0.03) were associated with the total DECT volume of MSU crystal deposition. In the multivariate analysis, factors associated with DECT MSU volumes &ge, 1 cm3 were gout duration (odds ratio (OR) for each 10-year increase 3.15 (1.60, 7.63)), diabetes mellitus (OR 4.75 (1.58, 15.63)), and chronic heart failure (OR 7.82 (2.29, 31.38)). (4) Conclusion: Specific comorbidities, particularly chronic heart failure and diabetes mellitus, are more strongly associated with increased MSU crystal deposition in knees and feet/ankles than gout duration, regardless of serum urate level.

Objectives: Data on abatacept (ABA) persistence in routine practice are limited. We aimed to study ABA persistence rates at 12 months, according to the date of initiation, and to analyze the factors associated with persistence at 12 months. Methods: We performed an observational, ambispective, multi-center study from January 2008 to July 2016, based on the French-RIC Network. We defined three groups of patients followed up for rheumatoid arthritis (RA), according to the date of initiation of ABA therapy: Group 1 (from 2007 to 31 July 2010: ABA indicated after anti-TNF failure), Group 2 (from 1 August 2010 to 31 March 2014: ABA indicated after conventional antirheumatic drugs failure), Group 3 (from 1 April 2014 to 1 July 2016: ABA available by the subcutaneous injection). Results: Among 517 patients who initiated ABA, drug persistence at 12 months was 68%. The only factor significantly associated with persistence rate at 12 months was C-reactive protein (CRP) &lt, 10 mg/L at ABA initiation (odds ratio (OR) 0.6, 95% confidence interval 0.3&ndash, 0.9, p = 0.0016). There was no significant difference in drug persistence according to date of initiation, the line of biological disease-modifying antirheumatic drugs (bDMARD) therapy or the route of administration. Conclusions: In routine practice, over time, ABA has come to be initiated earlier in the course of therapy for RA in France. Abatacept persistence is similar to that reported in the Orencia Rheumatoid Arthritis (ORA) registry, and does not differ according to the date of initiation. The only factor found to be associated with the persistence rate at 12 months was CRP &lt, 10 mg/L at ABA initiation.

Introduction La goutte est un facteur de risque bien connu de pathologie cardiovasculaire. L’une des hypotheses reliant ces maladies est le depot de cristaux d’urate monosodique (UMS) au sein des parois vasculaires. Le scanner double-energie thoracique a ete rapporte comme etant capable d’identifier ces depots au sein des arteres coronaires et de l’aorte. Aucune etude n’a ete realisee a ce jour pour determiner si de tels depots de cristaux d’UMS pourraient etre mis en evidence au sein des arteres peripheriques par DECT realises en routine aux membres inferieurs. L’objectif de l’etude VASCURATE etait de caracteriser les plaques vasculaires codees par le DECT comme des depots de cristaux d’UMS et leur association aux stocks de cristaux d’UMS contenus dans les tissus mous. Patients et methodes Il s’agit d’une etude transversale de patients issus d’une cohorte de cas suspects de rhumatismes microcristallins ayant eu un DECT des genoux et des pieds, avec etude prospective d’un sous-groupe de patients ayant des DECT de suivi aux mois 6 et 12 apres initiation d’un traitement hypouricemiant. La frequence de detection de plaque codee UMS a ete comparee entre patients et controle, et correlee au volume de cristaux d’UMS des tissus mous mesures par DECT. Les grades de calcifications arterielles etaient estimes. Les caracteristiques biochimiques (numero atomique effectif Zeff, densite electronique Rho, et index de double-energie DEI) des plaques codees UMS ont ete comparees aux plaques calcifies et a la paroi vasculaire controle sans plaque. Dans le sous-groupe suivi sur 12 mois, l’evolution du statut presence/absence de plaque codee UMS a ete correlee a l’evolution de l’uricemie et du volume de cristaux d’UMS deposes dans les tissus mous. Resultats Au total, 152 patients ont ete inclus dans l’etude transversal entre avril 2016 et juillet 2019, parmi lesquels 126 ont ete classes goutteux et 26 temoins. 17 patients goutteux ont ete inclus dans l’etude de suivi. Des plaques codees UMS ont ete retrouvees chez 31/126 (24,6 %) patients goutteux et 6/26 (23,1 %) temoins. La presence de plaques d’UMS etait correlee au grade de calcification arterielle (p Discussion La presence de plaques vasculaires codees UMS est directement liee au grade de mediacalcose. Nos resultats suggerent que ces plaques codees a tort UMS sont en fait des plaques fibreuses ou faiblement calcifiees. Conclusion L’etude VASCURATE suggere que les plaques vasculaires codees UMS en DECT sont des artefacts et que le DECT n’est pas capable d’identifier dans la goutte les depots vasculaires de cristaux d’UMS dans les arteres peripheriques.

Introduction L’augmentation des evenements cardiovasculaires et de la mortalite chez les patients goutteux sont des phenomenes connus mais le lien avec la goutte reste a eclaircir. La goutte tophacee, en particulier, est associee a une mortalite plus elevee ce qui souleve la question du role potentiel du stock de cristaux d’urate monosodique (UMS). Le scanner double-energie (DECT) permet de mesurer la charge en cristaux d’UMS chez l’ensemble des patients goutteux. L’objectif de cette etude etait de determiner si le volume initial d’UMS mesure en DECT est predictif du risque de mortalite a court terme, du developpement de maladies cardio-vasculaires et de diabete. Materiels et methodes D’avril 2016 a mai 2019, nous avons recrute de facon prospective une cohorte de patients goutteux pour les soumettre a des scanners double energie (DECT) des genoux, chevilles et pieds ; afin de mesurer leur stock uratique initial. Nous avons recueilli la survenue d’evenements cardio-vasculaires majeurs (infarctus du myocarde, accident vasculaire cerebral, arterite obliterante des membres inferieurs symptomatique), mineurs (accident ischemique transitoire, hypertension arterielle), metabolique (diabete) et la mortalite a M12, M24, M36. L’hazard ratio (HR) des facteurs evalues a Baseline pour la mortalite et la survenue d’evenements cardio-metaboliques a ete evalue par modele uni et multivarie de Cox. Resultats Un total de 128 patients ont ete inclus ; l’âge moyen etait de 66,1 ans (± 14) et la duree d’evolution moyenne de la maladie de 11,4 ans (± 10,4). Les patients avaient une uricemie initiale moyenne de 74,4 mg/l (± 22,9), 61,7 % etaient naifs de traitement hypo-uricemiant et 34,6 % avaient une goutte tophacee. Le volume uratique total median a Baseline etait de 0,2 (0-0,9) cm3. Lors de l’evaluation initiale, 26,6 % des patients avaient un diabete, 20,3 % avaient un antecedent d’infarctus du myocarde, 11,7 % d’AVC, et 1,6 % d’AIT. Les donnees de suivi etaient disponibles pour 119 patients a M12, 83 a M24 et 43 patients a M36. L’uricemie moyenne etait de 56 mg/l (± 16,3) a M12, 57,6 mg/l (± 20,1) a M24 et 50,4 mg/l (± 12) a M36. La mortalite globale a ete de 12 % (14 deces ; et statut vital inconnu pour 10 patients) durant le suivi. En analyse univariee, les patients decedes durant le suivi avaient un volume uratique initial moyen aux genoux et pieds de 0,4 cm3 [0,2 ;3,7] et ceux qui ont survecu avaient un volume de depart de 0,2 cm3 [0 ;0,7] ; p = 0,035. Dans le modele Cox multivarie, les facteurs influencant le risque de mortalite globale etaient le volume uratique total mesure en DECT (HR 1,02 (1,002-1,03) ; p = 0,0203 ; pour chaque cm3 additionnel), et l’uricemie a M0 (HR 1,04 (1,012-1,06) ; p = 0,0032). Le seul facteur associe en analyse multivariee a la survenue d’evenements cardio-vasculaires (majeurs, mineurs) et metaboliques etait le volume uratique total (HR 1,014 ; 95 % CI 1,001-1,03 ; p = 0,037). Conclusion Le volume uratique aux genoux et aux chevilles/pieds est un facteur predictif independant de la mortalite et d’evenements cardio-metaboliques a court terme, chez les patients goutteux.

Background: Dual-energy computed tomography (DECT) is being considered as a non-invasive diagnostic and characterization tool in calcium crystal-associated arthropathies. Our objective was to assess the potential of DECT in distinguishing between basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) crystal deposition in and around joints in vivo. Methods: A total of 13 patients with calcific periarthritis and 11 patients with crystal-proven CPPD were recruited prospectively to undergo DECT scans. Samples harvested from BCP and CPP calcification types were analyzed using Raman spectroscopy and validated against synthetic crystals. Regions of interest were placed in BCP and CPP calcifications, and the following DECT attenuation parameters were obtained: CT numbers (HU) at 80 and 140 kV, dual-energy index (DEI), electron density (Rho), and effective atomic number ( Zeff). These DECT attenuation parameters were compared and validated against crystal calibration phantoms at two known equal concentrations. Receiver operating characteristic (ROC) curves were plotted to determine the highest accuracy thresholds for DEI and Zeff. Results: Raman spectroscopy enabled chemical fingerprinting of BCP and CPP crystals both in vitro and in vivo. DECT was able to distinguish between HA and CPP in crystal calibration phantoms at two known equal concentrations, most notably by DEI (200 mg/cm3: 0.037 ± 0 versus 0.034 ± 0, p = 0.008) and Zeff (200 mg /cm3: 9.4 ± 0 versus 9.3 ± 0, p = 0.01) analysis. Likewise, BCP calcifications had significantly higher DEI (0.041 ± 0.005 versus 0.034 ± 0.005, p = 0.008) and Zeff (9.5 ± 0.2 versus 9.3 ± 0.2, p = 0.03) than CPP crystal deposits with comparable CT numbers in patients. With an area under the ROC curve of 0.83 [best threshold value = 0.0 39, sensitivity = 90. 9% (81.8, 97. 7%), specificity = 64.6% (50.0, 64. 6%)], DEI was the best parameter in distinguishing between BCP and CPP crystal depositions. Conclusion: DECT can help distinguish between crystal-proven BCP and CPP calcification types in vivo and, thus, aid in the diagnosis of challenging clinical cases, and in the characterization of CPP and BCP crystal deposition occurring in osteoarthritis.

Resume Les rhumatismes microcristallins sont des pathologies tres frequemment rencontrees chez le sujet âge, essentiellement sous la forme du rhumatisme a depots de cristaux de pyrophosphate de calcium dihydrate (PPCD) et de la goutte. Ces rhumatismes peuvent se presenter comme des arthrites aigues dont le diagnostic se fait sur l’identification microcristalline par analyse du liquide synovial en microscopie en lumiere polarisee. En l’absence de cette preuve, le diagnostic reste un defi que des techniques emergentes d’imagerie peuvent aider a relever. La prise en charge anti-inflammatoire theorique repose sur des traitements conventionnels que sont la colchicine, les anti-inflammatoires non steroidiens et les corticoides. Utilises chez des sujets âges presentant frequemment des comorbidites, ils presentent des precautions d’emploi et des contre-indications, ce qui fait que les therapeutiques anti-interleukine 1 sont parfois envisagees. Seule la goutte possede pour l’heure un traitement de fond mais des strategies peuvent egalement etre envisagees dans le cadre des formes chroniques de PPCD qui peuvent revetir des presentations tres polymorphes.

Background Ustekinumab (UST) and secukinumab (SEK) are new Biologic Disease-modifying antiRheumatic Drugs (bDMARDs) available in psoriatic arthritis (PsA), targeting respectively IL12-23 and IL 17. Real-world data are missing for these drugs, despite the wide use. There is only one previous published study including 160 patients (1) receiving UST, but not SEK. Objectives To evaluate the characteristics of the patients with PsA treated by UST or SEK and to assess real life drug survival and efficacy of UST and SEK in PsA. Methods This is a national, retrospective, multicentric study from patients suffering from PsA (CASPAR criteria) from July 2011 to april 2018. Drug survival was defined as the time from initiation to discontinuation (stop/switch) of bDMARDs. Kaplan-Meier survival curves and Cox-regression analyses [hazard ratios (HR) and 95% confidence intervals (CIs)] were used adjusting for patient demographics, disease characteristics, co-therapy with methotrexate, and line of treatment with ustekinumab. For peripheral involvement, treatment was considered to be effective for patients with a combined favorable expert opinion and/or > 30% clinical improvement of swollen and tender joint counts. For axial involvement, efficacy criteria were: improvement of BASDAI by at least 2 points on a scale from 0 to 10 or 50% improvement and/or expert opinion. Results 186 patients were included with a mean follow-up ≥ 6 months: 111 patients under UST and 75 under SEK. The mean age was 51.5 (12.9) years old, 55% of patients were women and the body mass index was 27.3 (5.8) kg/m². The disease duration was 10.8 (8.1) years. Patients were bDMARDs-naive in 15%. The median drug survivals for UST and SEK were respectively 12 and 14 months (Fig1). A propensity score cannot be used to compare the two bDMARDs, since the number of patients was too small. Smoking was associated with an unfavourable drug survival for SEK (HR= 0.22, 95%CI 0.91), whereas CRP levels were associated with a favorable one for UST (HR=1.009, 95%CI 1.003–1.016). Nine patients under SEK and 2 under UST stopped their treatments due to side effects. Conclusion This is the first real-world study for drug survival on PsA for SEK and one with the largest number of patients for UST. Drug survival of UST and SEK seems similar to TNF inhibitors’ (2). References [1] Iannone F, et al. Drug survival and effectiveness of ustekinumab in patients with psoriatic arthritis. Real-life data from the biologic apulian registry (BIOPURE). Clin Rheumatol. 2018;37:667–75. [2] Walsh JA, et al. Care Spec Pharm. 2018;24:623-631 Disclosure of interests Jean-Guillaume Letarouilly: None declared, Jeremie Sellam: None declared, Pascal Richette Consultant for: Grunenthal, Horizon, Speakers bureau: astraZeneca, Grunenthal, Philippe Dieude: None declared, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Corinne Miceli Richard Grant/research support from: MSD, Pfizer, abbVie, Biogen, UCB, Novartis, Consultant for: abbvie, Novartis, BMS, Eric Houvenagel Speakers bureau: Lilly, Novartis, Janssen, Chi Duc Nguyen: None declared, Marie-Helene Guyot: None declared, Nicolas Segaud: None declared, Laurent Marguerie: None declared, Xavier Deprez Speakers bureau: Novartis Janssen, Jean-Hugues Salmon Speakers bureau: Janssen Novartis, Guy Baudens Grant/research support from: Financial Grant from NordicPharma, Consultant for: Roche SAS, Maeva Kyheng: None declared, Julien Paccou Speakers bureau: Novartis Janssen, Elisabeth Gervais Grant/research support from: Roche, Pfizer, Consultant for: Bristol-Myers Squibb, UCB, Rene-Marc Flipo Consultant for: Honoraria from Novartis as steering committe of this survey

Objective.In psoriatic arthritis (PsA), comorbidities add to the burden of disease, which may lead to poorer quality of life. The purpose of this study was to evaluate the relationship between comorbidities and quality of life (QOL).Methods.Patients from a multicentric, cross-sectional study on comorbidities in PsA were included in the analysis. Data on comorbidities were collected and were subsequently used to compute the modified Rheumatic Disease Comorbidity Index (mRDCI). The Medical Outcomes Study Short Form-36 questionnaire physical (PCS) and mental component summary (MCS) scales were used to assess QOL.Results.In total, 124 recruited patients fulfilled the ClASsification for Psoriatic ARthritis criteria (CASPAR): 62.1% were male; mean age and mean disease duration were 52.6 ± 12.6 years and 11.3 ± 9.6 years, respectively. The number of comorbid conditions was 2.0 ± 1.3, with 30.6% of the sample having currently or a history of 3 or more comorbidities. In the multivariate linear regression analysis, only anxiety remained significantly related to mental health (p < 0.0001). Anxiety alone accounted for 28.7% of the variance in MCS scores. Moreover, MCS was also significantly associated with the mRDCI score, which explained 4.9% of the variance in MCS [β = −1.56 (standard error 0.64), R2 = 0.049, p = 0.0167]. In contrast, PCS was not significantly associated either with type or number of comorbidities.Conclusion.In this study, the type of comorbidity appeared to have a greater effect than the number of comorbidities. Indeed, anxiety in PsA was independently associated with QOL and would thus be an important factor to take into account in daily clinical practice.

Background:In 2017, TOCILIZUMAB (TCZ) obtained marketing authorization for treatment of giant cell arteritis (GCA); however, this doesn’t extend to polymyalgia rheumatica (PMR) therapy. Based on efficacy data for TCZ in GCA, TCZ is sometimes used as a glucocorticoid (GC) sparing agent when PMR is GC dependent or when a rapid steroid withdraw is needed. Currently, there are no available recommendations on the use of this therapeutic class in for this particular indication.Objectives:Here, we present the results of an observational French multicentric study of patients with PMR treated with TCZ.Methods:Thirteen medical centers were included in this study. The data was collected retrospectively between 2015 and 2020. The minimum duration of treatment was 3 months. Patients were included when receiving TCZ for isolated PMR or associated with a non-active GCA (asymptomatic, no vascular fixation on PET scanner).Results:Overall, 34 patients were included (24 women; mean age 70.1 years (+/-10.3)). At TCZ introduction, patients had been treated with GC for a mean duration of 27,9 months (+/-25.9) and the mean GC dose was 16,8mg/d (+/-10). Fifteen patients (44%) had one or more complications from GC therapy. Another immunosuppressant was added before TCZ treatment for 25 (74%); mostly METHOTREXATE (24/25).TCZ was initiated intravenously at 8mg/kg every 4 weeks for 27 patients (79%) and subcutaneously at 162mg/week for 7 patients (21%).The reasons for TCZ introduction included GC dependence (n=30, 88%), and necessity of quick GC sparing (n=4 patients,12%).Of all patients, 76% (26 patients) had stopped GC treatment definitively, with a mean time of 9,4 (0-32) months.The mean TCZ treatment period was 19,2 months (3-66). Fifteen patients (44%) permanently stopped TCZ at the end of the observation period (8 prolonged remissions;1 myocardial infarction; 1 cutaneous lymphoma; 1 primary failure, 3 lost to follow up).Eighteen patients (60%) benefited from an attempted tapering of TCZ (infusion spacing or dose reduction), 6 attempts (1/3) led to a relapse. 1/2 patients had side effects mostly benign (cytopenia n=6, infections n=5).Conclusion:This is the largest cohort presenting results of the use of TCZ in PMR. Despite the small number of participants, our study suggests TCZ is effective as a GC sparing agent in PMR. As there are no official recommendations of use, indications for TCZ use within this population are no defined. Randomized Controlled Trial would be beneficial to validate these first results.References:[1]Toussirot, « Biothérapies, pseudo- polyarthrite rhizomélique et artérite à cellules géantes État des lieux en 2018 ».[2]Devauchelle-Pensec et al., « Efficacy of First-Line Tocilizumab Therapy in Early Polymyalgia Rheumatica ».[3]Genovese et al., « Longterm Safety and Efficacy of Tocilizumab in Patients with Rheumatoid Arthritis ».[4]Stone et al., « Trial of Tocilizumab in Giant-Cell Arteritis ».Disclosure of Interests:None declared

Background:IL17 inhibitors (IL17i) are an alternative for patients with axial spondyloarthritis (axSpA) who did not respond to TNF inhibitors (TNFi). Secukinumab (SEC) is the first human monoclonal antibody that binds to the protein interleukin-17A.Objectives:The objectives of this study were to describe the characteristics of axSpA patients treated with IL17i and TNFi and to assess the persistence with IL17i and TNFi in a real world cohort.Methods:A retrospective multicenter observational study was conducted. axSpA patients (pts) according to ASAS criteria initiating a IL17i or TNFi between June 2016 and December 2019 were included. Demographic features, current and previous use of biologic Disease-modifying antirheumatic drugs (bDMARDs) were collected. Date and reasons of discontinuation – i.e., lack of efficacy, safety issue, sustained remission or others – were collected. Kaplan-Meyer analysis were performed.Results:370 pts were included. Among the 202 patients who received TNFi, 90 (44.6%) were female, mean age was 43.2 +/- 13.2 years, mean body mass index was 26.1 kg/m2 +/- 5.4, 49 pts (46.7%) were smokers. The most common SpA phenotype was axial radiographic (n = 89, 54,9%) and 114 (68.3%) pts were HLA B27 positive, mean BASDAI was 57.5 +/- 14.6, median disease duration was 8.6 years [3.0-10.5]. Among the 168 patients who received SEC, 78 (46.4%) were female, mean age was 47.7 +/- 11.8 years, mean body mass index was 27.2 kg/m2 +/- 5.8, 45 pts (44.1%) were smokers. The most common SpA phenotype was axial radiographic (n = 106, 76,3%) and 114 (78.1%) pts were HLA B27 positive, mean BASDAI was 62.8 +/- 14.8, median disease duration was 9 years [5.0-19.0]. TNFi was the first line bDMARD in 116/202 pts (57.4%) and SEC was the first line bDMARD in 15/168 pts (8.9%). SEC was prescribed at 150mg every month in 121/168 (73.3%) pts. The median persistence with TNFi and SEC were 18.0 months [11.0-27.0] and 12.0 months [6.0-22.0], respectively. During the 3-year follow-up, 130 pts (42 with TNFi and 88 with SEC) discontinued treatment: 80 (22 with TNFi and 58 with SEC) for lack of effectiveness, 41 (16 with TNFi and 25 with SEC) for adverse events. No patient treated with SEC presented a new-onset inflammatory bowel disease.Figure 1.Persistence with SEC after 3 years of follow-upConclusion:In this real world cohort of AxSpA pts, SEC was mostly prescribed at second and third-line, contrary to axSpA pts treated with TNFi. Most reason of discontinuation were related to lack of effectiveness with both therapeutic classes.Disclosure of Interests:Thibaut DELEPINE: None declared., Peggy Philippe Speakers bureau: Abbvie, MSD, Fresenius, Pfizer, UCB Pharma, Novartis, Consultant of: Abbvie, MSD, Fresenius, Pfizer, UCB Pharma, Novartis, Emeline Cailliau: None declared., Eric Houvenagel: None declared., Xavier Deprez Speakers bureau: Pfizer, UCB, Abbvie, Novartis, MSD, Consultant of: Pfizer, UCB, René-Marc Flipo Speakers bureau: Novartis, Lilly, Abbvie, Pfizer, MSD, Consultant of: Novartis, Lilly, Abbvie, Pfizer, MSD, Jean-Guillaume Letarouilly Grant/research support from: Pfizer (research grant).

Aims The aim of this study was to compare the efficacy of tocilizumab, rituximab and abatacept after a non-tumor necrosis factor inhibitor (non-TNFi) failure for the treatment of rheumatoid arthritis (RA). Materials and methods This retrospective multi-centre study included patients treated for RA with abatacept, rituximab or tocilizumab after having received in the previous line the first non-TNFi. Data were collected from patient charts. The primary endpoint was the delta Disease Activity Index of 28 joints – erythrocyte sedimentation rate (DAS28-ESR) and DAS28-CRP (C-reactive protein) at 12 months. The relative change in primary outcome measures from baseline were calculated. Results One hundred patients started a second non-TNFi between 2006 and 2013, including 15 patients treated with rituximab, 36 with tocilizumab and 49 with abatacept. The change of DAS28-ESR was significantly different between the three groups (P = 0.001). In post hoc pairwise comparisons, patients treated with tocilizumab had a higher decrease of the DAS28-ESR than patients treated by abatacept (median [interquartile range: IQR]: 36% [0; 54%] vs. 0% [0; 20%], P = 0.002). A similar non-significant difference was found between tocilizumab and rituximab (median [IQR] decrease: 36% [0; 54%] vs. 0% [−11; 34%], P = 0.07). Similar results were found with the 12 months change in DAS28-CRP. Conclusions This study suggests a better efficacy of tocilizumab compared with abatacept and rituximab in situations of non-TNFi failure.

Introduction Depuis 2017, le TOCILIZUMAB (TCZ) beneficie d’une AMM dans le traitement de l’arterite a cellules geantes (ACG), ce qui n’est pas le cas dans la pseudo polyarthrite rhizomelique (PPR). Sur la base des donnees d’efficacite du TCZ dans l’ACG, certains centres utilisent le TCZ dans les PPR corticodependantes ou en cas de necessite de sevrage rapide en corticoides. Nous presentons ici une etude observationnelle multicentrique de PPR traitees par TCZ, afin d’en etudier les modalites d’utilisation. Materiels et methodes Plusieurs centres ont ete sollicites incluant les CHU de Lille, Paris (Cochin), Brest, Reims, Amiens, Clermont Ferrand, Nantes, ainsi que les CH d’Arras, Lomme, et Valenciennes. Les donnees ont ete collectees de facon retrospective entre 2015 et 2020. La duree minimale de traitement etait de 3 mois. Les donnees ont ete collectees a M0 (date de decision d’initiation du TCZ), M3, M6, puis tous les ans. Resultats 24 patients ont ete inclus issus de 5 centres. Le sex ratio etait de 2/1 pour les femmes. L’âge moyen au diagnostic etait de 67,5 ans (± 8,2). Le delai moyen d’initiation du TCZ par rapport au debut de la maladie etait de 30,7 mois (± 27,2). 11 patients (45,8 %) presentaient une ou plusieurs complications de la corticotherapie (CTC). La CRP moyenne a M0 etait de 30,7 mg/l (1-56,6). La dose de CTC moyenne a M0 etait de 10,35 mg/j (± 6,3). 17 patients (70,8 %) beneficiaient ou avaient beneficie d’un csDMARD, dans 94,1 % des cas, il s’agissait du METHOTREXATE. Chez 20 patients, le TCZ a ete initie par voie IV a 8 mg/kg toutes les 4 semaines, chez 4 patients par voie SC a 162 mg/semaine. Les indications du TCZ etaient chez 18 patients (75 %) une corticodependance, chez 4(16,6 %) une necessite d’epargne cortisonique, chez 2(8,3 %) une cause mixte. La duree de suivi a varie entre 3 et 66 mois. La duree moyenne de sevrage en CTC etait de 9,8mois (0-32), dont 4 arrets a M0. 2 patients sont toujours sous CTC. 10 patients ont beneficie d’une tentative d’espacement du TCZ. Toutes ces tentatives etaient motivees par une remission prolongee, alors que les diminutions de posologie (n = 6) etaient motivees par un probleme de tolerance. 5 patients ont interrompu le TCZ : (1infarctus du myocarde a M7, 1 lymphome cutane a M9, 2 remissions prolongees a M24 et M60, 1 echec primaire). Cote tolerance, 15 patients ont presente un effet indesirable, 66 % des cas (10/15) etait une perturbation du bilan biologique. Conclusion Actuellement, aucune etude en vraie vie ne renseigne sur les modalites d’utilisation et de suivi des patients traites par TCZ pour une PPR. En l’absence de recommandation, ce travail a permis de mettre en lumiere ces differents aspects. Malgre la faiblesse de l’effectif, le TCZ semble etre efficace sur le sevrage de la corticotherapie, en attente d’une etude controlee randomisee.

Background:The reasons explaining why some patients exhibit higher monosodium urate (MSU) crystal burdens than others remain largely unknown. While MSU crystal formation is enhanced by certain factors in vitro such as pH, temperature, and other ion concentrations, it is currently unknown whether comorbidities and clinical features are associated with increased MSU deposition in vivo.Objectives:To determine which factors are associated with the burden of MSU crystal deposition quantified by dual-energy CT (DECT) in urate lowering therapy (ULT)-naive gout patients.Methods:In this multicenter cross-sectional study, DECT scans of knees and feet were prospectively obtained from ULT-naive, or not taking any ULT for more than a year, gout patients. Demographic, clinical (including gout history and comorbidities), and biological data were collected, and their association with DECT MSU crystal volume was analyzed using bivariate and multivariate analyses. A second bivariate analysis was performed by splitting the dataset depending on an arbitrary threshold of DECT MSU volume (1 cm3).Results:A total of 125 gout patients were included, of whom 91 underwent both DECT scans of knees and feet. In bivariate analysis, age (p=0.03), symptom duration (p=0.003), subcutaneous tophi (p=0.004), hypertension (p=0.02), diabetes mellitus (p=0.05), and chronic heart failure (p=0.03) were associated with the total DECT volume of MSU crystal deposition. In multivariate analysis, factors associated with DECT MSU volumes ≥1 cm3 were gout duration (OR for each 10-year increase 3.15 [1.60;7.63]), diabetes mellitus (OR 4.75 [1.58;15.63]), and chronic heart failure (OR 7.82 [2.29;31.38]). The model performance was good with an AUC of 0.816.Conclusion:Specific comorbidities, particularly chronic heart failure, diabetes mellitus, and hypertension, are more strongly associated with increased MSU crystal deposition in knees and feet than gout duration, regardless of serum urate level.Disclosure of Interests: :Tristan Pascart Grant/research support from: Research Grant Horizon Pharma, Consultant of: Novartis, BMS, Sanofi, Pfizer,, Speakers bureau: Novartis, BMS, André Ramon: None declared, Sebastien Ottaviani: None declared, Julie Legrand: None declared, Vincent Ducoulombier: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Laurène Norberciak: None declared, Pascal Richette: None declared, Fabio Becce: None declared, Paul Ornetti: None declared, Jean-François Budzik: None declared

Objectives:Secukinumab (SEC) is an interleukin-17 inhibitor used to treat patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Drug maintenance is often used as a proxy for treatment effectiveness and safety in real life settings. We aim to assess SEC maintenance in routine clinical practice and to identify survival predictors associated.Methods:We conducted a retrospective, longitudinal, observational, multicenter study including all patients (pts) with axSpA or PsA who received at least 1 injection of SEC between July 2016 and October 2019. We collected patient’s demographics and clinic characteristics, SEC date of initiation and dosage and dosage modification of SEC, previous biologic Disease-modifying antirheumatic drugs (bDMARDs) and concomitant treatments. Date and reasons of discontinuation – i.e., lack of efficacy, safety issue, sustained remission or others – were collected. Several potential maintenance predictors were tested: age, gender, disease (axSpA or PsA), smoking status, bDMARDs history and concomitant treatment. Among patients with non-radiographic axSpA (nr-axSpA), evidence of MRI sacroiliitis or elevated CRP were also assessed as potential maintenance predictors. Drug maintenance was analyzed by the Kaplan-Meier method and adjusted for baseline factors were estimated by log rank analysis.Results:The main characteristics of the 561 pts included were the following: 363 (64.7%) axSpA, 198 (35.3%) PsA, 329 (58.6%) female, mean age 45,6 +/- 12 years, 221 (39.4%) smokers, 175 (31.2%) radiographic sacroiliitis, 259 (46.2%) MRI sacroiliitis, 198 (35.3%) elevated CRP, 247 (44.0%) HLA B27 positive, mean BASDAI 48,3 +/- 26.8%. SEC was associated to methotrexate (MTX) in 139 pts (24.8%) and was the first line bDMARD in 55 pts (9.8%). The median drug maintenance (MDM) of SEC was 79 weeks (wk) [73-84]. At 52 wk, 245 pts (60%) SpA were still treated with SEC. During the 3-year follow-up, 264 pts discontinued SEC: 180 (68.2%) pts for lack of effectiveness, 47 (17.8%) for adverse events, 14 (5.3%) for others and 23 (8.7%). SEC prescription as first line bDMARD was associated with longer survival versus second line or more: 111 wk [83-138] vs. 69 wk [57-80] (p=0. 017) (figure 1). MDM was not significantly different depending on gender, MTX combo, elevated CRP, axSpA vs PsA and smoking status. Among the nr-axSpA pts, MRI sacroiliitis or elevated CRP did not modify SEC maintenance (p=0.68) (figure 2).Figure 1.Secukinumab maintenance according to therapeutic lineFigure 2.Secukinumab maintenance in nr-axSpA populationConclusion:In routine clinical practice, SEC median maintenance was 79 weeks. Fist line administration was the only independent factor associated with improved SEC retention. Lack of effectiveness was the most common reason of discontinuation.Disclosure of Interests:Benoît Flachaire: None declared, Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Céline Labadie: None declared, Nicolas Cohen Speakers bureau: Novartis, Janssen, Vincent Pradel: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Guy Baudens: None declared, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Corinne Miceli Richard: None declared, Philippe Dieudé: None declared, Jean-Hugues Salmon Speakers bureau: Novartis, Janssen, Jérémie SELLAM: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Marie-Hélène Guyot: None declared, Chi Duc Nguyen: None declared, Xavier Deprez Speakers bureau: Novartis, Janssen, Isabelle CHARY VALCKENAERE: None declared, Pierre Lafforgue Speakers bureau: Novartis, Janssen, Damien LOEUILLE: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly, Thao Pham Speakers bureau: Novartis, Janssen, Lilly

Background:Real-world data are missing for Ustekinumab (UST) and secukinumab (SEK) in psoriatic arthritis (PsA).Objectives:To evaluate the characteristics of the patients (pts) with PsA treated by UST or SEK and to assess real world persistence of UST and SEK in PsA.Methods:This is a retrospective, multicenter study of pts with PsA (CASPAR criteria or diagnosis confirmed by a rheumatologist) initiating UST or SEK with a follow-up ≥ 6 months from January 2011 to April 2019. The comparison of persistence between UST and SEK was analysed using a Cox model with an inverse probability of treatment weighting propensity score including 11 confounding factors. Subgroup analyses (age>65 years, gender, Body Mass Index (BMI), Charlson score>2, psoriasis, CRP>5mg/L, number (nb) of prior biotherapies, proportion of pts on maximum dose of UST or SEK, combination with methotrexate (MTX), enthesitic and axial forms of PsA) were also performed to test the heterogeneity of UST and SEK persistence. Finally, 2 sensitivity analyses were performed, first excluding the pts treated before the marketing authorization of SEK, and then excluding the pts that underwent a molecule switch. Causes of discontinuation were also collected.Results:406 pts were included: 245 with UST and 161 with SEK. At baseline before propensity score-matching, the UST group has a higher BMI (28.9 ± 6.4 kg/m2vs. 27.4 ± 6.0 kg/m2), more peripheral forms (98% vs. 90.8%), a higher nb of active smokers (27.1% vs. 19.9%), a higher frequency of psoriasis (96.3% vs. 83.2%), less MTX users (38.9% vs. 44.2%), a higher nb of pts with CRP >5mg/L (54.3% vs. 47%), a higher nb of pts naïve to biotherapies (22% vs. 13%) and a higher nb of pts with recommended dosing (97.3% vs 50.9%). The median persistence was 9.4 months and 14.7 months for UST and SEK, respectively. The persistence rate was lower in the UST group compared to the SEK group (40.9% vs. 59.1% % at 1 year; 26.4% vs. 38.0% at 2 years; weighted HR=1.42; 95% CI 1.07 to 1.92; p=0.015) (Fig 1). In subgroup analysis, combination with MTX was associated with a higher persistence rate in the patients with SEK compared to those receiving UST: 43.6% vs. 23.2% (HR=2.20; 95% CI 1.30 to 3.51; p=0.001), whereas no difference was observed in SEK and UST monotherapy: 33.8% vs 28.4%, respectively (HR=1.06; 95% CI 0.74 to 1.53; p=0.75) (Fig 2). A similar difference was found in the sensitivity analyses, with however a difference at the limit of significance for the analysis excluding pts with a molecule switch (adjusted HR=1.35; IC95% 0.96 to 1.92; p=0.085). The causes of discontinuation were due to inefficacy in 85% of cases and an adverse event in 12% of cases (19% in the SEK group and 9% in the UST group).Conclusion:In this first real-world study comparing UST and SEK persistence in PsA, the persistence of SEK was longer than that of UST. Subgroup analysis revealed this difference of persistence was restricted to patients treated in combination with MTX.Disclosure of Interests:Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Benoît Flachaire: None declared, Céline Labadie: None declared, Nicolas Cohen Speakers bureau: Novartis, Janssen, Maeva Kyheng: None declared, Jérémie SELLAM: None declared, Pascal Richette: None declared, Philippe Dieudé: None declared, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Eric Houvenagel Speakers bureau: Janssen, Novartis, Chi Duc Nguyen: None declared, Marie-Hélène Guyot: None declared, Nicolas Segaud: None declared, Frederic Maury: None declared, Laurent Marguerie: None declared, Xavier Deprez Speakers bureau: Novartis, Janssen, Jean-Hugues Salmon Speakers bureau: Novartis, Janssen, Guy Baudens: None declared, Corinne Miceli Richard: None declared, Elisabeth Gervais Speakers bureau: Novartis, Janssen, Roche, Pfizer, BMS, Abbvie, Isabelle CHARY VALCKENAERE: None declared, Pierre Lafforgue Speakers bureau: Novartis, Janssen, Damien LOEUILLE: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Thao Pham Speakers bureau: Novartis, Janssen, Lilly, Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly

Background:The close relationship between gout and cardiovascular diseases is well established. A growing hypothesis explaining this association would be that monosodium urate (MSU) crystals are deposited within vessel walls. Dual-energy computed tomography (DECT) can identify and quantify MSU crystal deposition in soft tissues. It remains unclear whether vascular spots exhibiting DECT attenuation characteristics of MSU are artefacts or true MSU crystal deposits.Objectives:The objectives of this study were to determine whether the presence of peripheral vascular MSU crystal deposition identified with DECT is associated with the extent of MSU deposits in joint soft tissues, and if this association persists over time under urate-lowering therapy.Methods:Patients with a clinical suspicion or established gout diagnosis prospectively underwent DECT for identification and quantification of the MSU crystal burden in their knees and feet. Some of these patients were also enrolled in the GOUT-DECTUS longitudinal study, and thus underwent follow-up DECT scans of their knees and feet at 6, 12 and 24 months. DECT scans were examined for the presence of vascular spots ≥0.01 cm3 classified as MSU crystal deposits according to the default post-processing settings. Multiple linear regressions adjusting on serum urate levels and gout diagnosis were implemented to determine the association between DECT MSU crystal volume in joint soft tissues, and the presence of vascular MSU deposits. Mixed linear models were used to compare DECT volumes of MSU crystal deposition in soft tissues between vascular MSU positive and negative patients during follow-up.Results:A total of 169 patients were included, of which 140 had a final diagnosis of gout, including 15 also included in the longitudinal study. Patients were mostly male (78.8%) and were 65.5 ± 14.6 years old. Among gout patients, disease duration was 9.3 ± 9.9 years and 56.5% were urate lowering therapy-naive. A total of 11/29 (37.9%) controls and 40/140 (28.6%) gout patients presented with a least one vascular spot of DECT MSU deposition, with an average volume of 0.02 ± 0.02 cm3, and all subjects also presented at least one vascular calcification. In the feet, patients positive for vascular DECT MSU crystal deposition had an MSU volume of 3.81 ± 10.06 cm3 in joint soft tissues, compared with 1.85 ± 7.72 cm3 for those without vascular MSU deposition (p=0.018). In the knees, patients with vascular MSU deposition had an MSU crystal volume of 6.03 ± 24.13 cm3 in joint soft tissues, compared with 0.83 ± 2.88 cm3 for those without vascular evidence of MSU deposition. In the longitudinal subgroup analysis, coefficients of the fixed effects for the presence of vascular MSU deposits on the MSU crystal volume in joint soft tissues was 0.4 (p=0.35) in the feet and 1.21 (p=0.03) in the knees. The presence of vascular DECT MSU deposits was associated with a 3.4-fold increase in MSU crystal volume in knee joint soft tissues throughout follow-up.Conclusion:This study suggests that some vascular spots identified with DECT as MSU crystal deposition may be real and not artefacts. This correlation remains throughout follow-up in the knees. However, the comparable prevalence of vascular DECT MSU deposits between gout patients and controls, the systematic co-existence of vascular calcifications and the uneven regression under urate-lowering therapy requires further analysis to determine which DECT spots are artefacts and which are not.References:[1]Dual-Energy Computed Tomography Detection of Cardiovascular Monosodium Urate Deposits in Patients With Gout. Klauser AS, Halpern EJ, Strobl S, Gruber J, Feuchtner G, Bellmann-Weiler R, Weiss G, Stofferin H, Jaschke W.Disclosure of Interests:Tristan Pascart Grant/research support from: Research Grant Horizon Pharma, Consultant of: Novartis, BMS, Sanofi, Pfizer,, Speakers bureau: Novartis, BMS, Paul Carpentier: None declared, Laurène Norberciak: None declared, Julie Legrand: None declared, Eric Houvenagel Speakers bureau: Janssen, Novartis, Fabio Becce: None declared, Jean-François Budzik: None declared

Predicting the risk of flares in patients with gout is a challenge and the link between urate burden and the risk of gout flare is unclear. The objective of this study was to determine if the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT) and ultrasonography (US) is predictive of the risk of gout flares. This prospective observational study recruited patients with gout to undergo MSU burden assessment with DECT (volume of deposits) and US (double contour sign) scans of the knees and feet. Patients attended follow-up visits at 3, 6 and 12 months. Patients having presented with at least one flare at 6 months were compared to those who did not flare. Odds ratios (ORs) (95% confidence interval) for the risk of flare were calculated. Overall, 64/78 patients included attended at least one follow-up visit. In bivariate analysis, the number of joints with the double contour sign was not associated with the risk of flare (p = 0.67). Multivariate analysis retained a unique variable: DECT MSU volume of the feet. For each 1 cm3 increase in DECT MSU volume in foot deposits, the risk of flare increased 2.03-fold during the first 6 months after initial assessment (OR 2.03 (1.15–4.38)). The threshold volume best discriminating patients with and without flare was 0.81 cm3 (specificity 61%, sensitivity 77%). This is the first study showing that the extent of MSU burden measured with DECT but not US is predictive of the risk of flares.

Background For more than 15 years, severe psoriatic arthritis (PsA) has been treated only by TNF inhibitors. Two new Biologic Disease-modifying Antirheumatic Drugs (bDMARDs) have recently arrived on the market with different targets: IL12–23 for ustekinumab and IL 17 for secukinumab. Few studies exist with a large number of patients and with required hindsight. Objectives The objective was to assess drug survival in an observational cohort of 630 PsA depending on the line of treatment and to analyse the reasons of discontinuation. Methods This is a retrospective, multicentric observational study based on the data of the registry RIC Nord de France, from patients suffering from PsA (CASPAR criteria) and treated by bDMARDs from january 2000 to august 2017. Drug survival is defined as the time from initiation to discontinuation (stop/switch) of biologic therapy on the registry. The number of patients who discontinued each treatment and the duration of therapy were recorded. Using Kaplan-Meier survival curves and Cox-regression analyses [hazard ratios (HR) and 95% confidence intervals (CIs)], time to discontinuation was compared across cohorts undergoing first-, second- or third-line treatment. Results Out of 630 PsA, 439 were included with a mean follow up greater than or equal to 6 months. The sex ratio was balanced with 47% of women. The mean age was 54.5 years old and the body mass index (BMI) was 28.7 kg/m². The disease duration was 14.25 years. 51.6% of patients did not smoke. The DAS-28 CRP was 3.99 at the initiation of the biotherapy. The drug survival of the TNF inhibitors was similar at first-line treatment (n=439 patients) (figure 1) and at second-line treatment (n=238 patients). The drug survival of infliximab was statistically longer at third-line treatment (n=209) (p Conclusions The results of the large observational study confirm those of the clinical trials, especially for the patients with failing initial TNF inhibitor therapy. Disclosure of Interest None declared

Background Gout is associated with higher cardiovascular risk and increases with disease severity. It is not clear if the monosodium urate (MSU) crystal burden is associated with traditional cardiovascular risk factors. Objectives The objective of this study was to explore the relationship between the extent of MSU deposition assessed with ultrasonography (US) and dual-energy CT (DECT) and cardiovascular risk. Methods Gout patients naive of urate lowering therapy were included in this cross-sectional study to undergo DECT scans for the assessment of total MSU volume deposition of the knees and feet, and US to evaluate the number of joints with the double contour (DC) sign among the femoro-patellar, talo-crural and first metatarsophalangeal joints. Participants were screened for traditional cardiovascular risk factors and levels of the ACC/AHA 10 year-risk for heart disease or stroke was calculated. The primary endpoint was the Spearman correlation coefficient ρ between DECT MSU volume and cardiovascular risk. Results A total of 50 patients predominantly male (46/50) aged 62.6 years (±14.1) were included. Participants had gout duration of 9.5 years (±11.8), had experienced 4.1 flares (±6.3) over the past year, had serum urate (SU) levels of 8.1 mg/dL (±2.3), and 35/50 had at least one US tophus of 1.5 cm3 (±1.8). The volume of MSU deposits with DECT was 3.9 cm3 (±11.2) for the feet and 2 cm3 (±4.4) for the knees. Overall, 28 patients presented with the metabolic syndrome. Correlations between DECT volumes of MSU deposits of the knees, feet, and knees+feet were poor with ρ respectively of 0.23, 0.03 and 0.21. The was no correlation between the number of joints with the DC sign and cardiovascular risk (ρ of 0) and the correlation was poor with SU levels (ρ=0.09). Patients with the metabolic syndrome had similar DECT volume of MSU deposits than those without (p=0,29). Conclusions This study suggests that the association of gout with traditional cardiovascular risk factors is not related to the extent of the monosodium urate crystal burden. Disclosure of Interest None declared

Objectives Study the therapeutic maintenance, associated factor with maintenance at 12 months and reasons for abatacept (ABA) stop in daily practice. Methods Retrospective multicentric study, from the RIC Nord de France network, of patients treated for rheumatoid arthritis who received at least one ABA treatment between January 2008 and July 2016. We studied the therapeutic maintenance at 12 months, according to the number of previous bDMARDs and according to the date of initiation (group 1: from 2008 until 31/07/2010 (ABA authorised in anti-TNFfailure) and group 2 from 01/08/2010 (ABA authorised in the first line)). Therapeutic maintenance was evaluated using the Kaplan-Meier method. Results Of the 517 patients (74% women) who were included, the mean age was 61.4±13.3 years. There were 76% positive anti-CCP. ABA was used as monotherapy in 176 patients (34%) and 22% of patients were naive to bDMARDs. The mean DAS 28-VS at initiation of ABA was 4.7±1.3. Therapeutic maintenance at 12 months was 68%. Among the 166 patients (32%) stopped ABA, the reason for discontinuation was primary ineffectiveness (n=54, 32.5%), loss of efficacy (n=40, 24%), adverse events (n=43, 26%) and other (n=29, 17.5%). On multivariate analysis CRP No significant difference in therapeutic maintenance was found at 12 months according to the date of initiation and according to the number of previous bDMARDs. Conclusions Therapeutic maintenance at 12 months was 68%, this rate is similar to Pan-European Registry. The rate of CRP at initiation seems to have an impact on the maintenance of ABA at 12 months. Reference [1] Gottenberg JE, Courvoisier DS, Hernandez MV, Iannone F, Lie E, Canhao H, et al. Brief Report: Association of Rheumatoid Factor and Anti-Citrullinated Protein Antibody Positivity With Better Effectiveness of Abatacept: Results From the Pan-European Registry Analysis. Arthritis Rheumatol2016Jun;68(6):1346–52. doi:10.1002/art.39595 Disclosure of Interest None declared

Resume La toxine botulinique est largement utilisee et validee dans le traitement de nombreuses pathologies ou predomine une hyper-activite musculaire. Des travaux recents se sont interesses a son action antalgique articulaire dont les mecanismes commencent a etre mieux identifies. Methodologie d’analyse Une analyse de la litterature internationale a ete realisee en interrogeant les bases de donnees Medline en croisant le mot cle « intra-articular botulinium toxin injection » aux mots cles : « knee, ankle, shoulder, osteoartritis, adhesive capsulitis of shoulder ». Resultats Sur les 16 articles selectionnes consacres aux injections intra-articulaires de toxine botulinique, sept essais cliniques etaient randomises dans les indications suivantes : arthrose, capsulite retractile de l’epaule et douleur chronique post-arthroplastie. Des preuves de l’effet anti-nociceptif de la toxine ont ete apportees pour certaines indications, avec un profil de securite et de tolerance satisfaisant. Les etudes sont heterogenes. Le comparateur le plus frequemment utilise etait un produit corticoide ou un placebo, seule une etude a utilise l’acide hyaluronique. Le critere de jugement principal etait l’intensite de la douleur. Discussion-conclusion Les essais randomises peu nombreux et la taille modeste des echantillons ne permettent pas d’obtenir un niveau de preuve et une puissance statistiques satisfaisants. Des questions demeurent concernant la dose efficace, la dilution et les modalites d’injection de la toxine botulinique.

Tumour necrosis factor alpha (TNFα) is a key cytokine in inflammatory rheumatic diseases but is also implicated in multiple sclerosis (MS) where TNFα is elevated in demyelinating plaques. However, TNFα inhibitors (TNFi) have opposite effects: they have revolutionised the treatment of chronic rheumatic diseases but may cause flares of MS.1 Several studies have suggested an association between TNFi use and occurrence of demyelinating disorders.2 3 Their incidence is estimated up to 4% after 18 months of treatment in a recent prospective study with systematic neurological examination before and after treatment initiation.4 In addition, two TNF receptor superfamily 1 ( TNFRSF1A ) single nucleotide polymorphisms, (SNPs) rs1800693 and rs4149584 (TNFRSF1A R92Q), have been shown to increase the risk of developing MS.5 The rs1800693*G allele leads to a dysfunctional TNFα soluble receptor that inhibits TNFα signalling.6 Rare variants of TNFRSF1A locus have also been implicated …

Background Methotrexate combination therapy improves abatacept efficacy as a first-line biologic agent for the treatment of rheumatoid arthritis, but it is unclear when abatacept is used later on, particularly after non-TNF inhibitor (TNFi) failure. Study question The objective of this study was to determine whether treatment response after non-TNFi inadequate response is different in patients with rheumatoid arthritis (RA) treated with abatacept in combination with or not with methotrexate. Methods Patients treated with abatacept monotherapy or in combination with methotrexate after non-TNFi failure were included. Results Data from 46 patients aged 56 years [49-61] with 12 years [8-16] of disease duration were examined. Rituximab was the treatment used in the previous line for 75.0% of the combination therapy group (15/20) and 34.6% (9/26) in the monotherapy group. At 12 months, 38.5% (10/26) of patients were in good-to-moderate EULAR response in the monotherapy group compared with 25.0% (5/20) in the combination therapy group (P = 0.33). Treatment persistence at 12 months was 61.5% (16/26) in the monotherapy group and 35.0% (7/20) in the combination therapy group (P = 0.07). Conclusions Adding methotrexate to abatacept did not improve treatment response in patients with RA after non-TNFi inadequate response.

Background Ultrasonography (US) and dual-energy computed tomography (DECT) can assess urate burden in gout. The objective of this study was to compare the quantification of urate deposition provided by US to the one provided by DECT. Methods Patients with a diagnosis of gout were prospectively recruited to undergo quantification of urate deposition using US and DECT. US examination for tophi and the double contour (DC) sign was performed on the knees and feet and corresponding DECT scans provided volumes of tophi and of overall urate deposition. The primary endpoint was the intra-class correlation coefficient (ICC) of the volume of the index tophus measured by US and DECT and its 95% confidence interval (CI 95%). Results Of the 64 patients included, 34 presented with at least one tophus on US. DECT inter-reader agreement for urate deposition was perfect with an ICC of 1 (1–1) and good for the measurement of the index tophus with an ICC of 0.69 (0.47–0.83). The ICC for the measurement of the index tophus between the two techniques was poor with a value of 0.45 (0.1–0.71). The average ratio between the index tophi volume as assessed by DECT and US was 0.65. The number of DC-positive joints did not correlate with DECT volume of overall deposits (Spearman correlation coefficient of 0.23). Conclusions DECT measurements of tophi give smaller volumes to the same tophi measured with US, and US signs of urate deposition in joints do not correlate with overall DECT volumes of extra-articular deposition. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1381-2) contains supplementary material, which is available to authorized users.

Background Tumor Necrosis Factor alpha (TNFα) is a key cytokine in inflammatory rheumatic diseases. TNF inhibitors (TNFi) has revolutionized treatment of rheumatic diseases, but may cause flares of multiple sclerosis (MS). Two Single Nucleotide Polymorphisms, (SNPs) rs1800693 and rs4149584, located within TNF receptor superfamilly 1 (TNFRSF1A) locus have been shown to increase the risk of developing MS [1]. The rs1800693*G allele leads to a dysfunctional TNFα soluble receptor that inhibits TNFα signaling while rs4149584 is involved in TNF receptor associated periodic syndrome. Objectives The aim of this study was to look for a possible the association between TNFRSF1A polymorphisms and demyelinating complications occurring during TNFi therapy. Methods Patients who presented with a demyelinating disorder (central or peripheral involvement) while treated with TNFi (cases), were recruited between March 2013 and December 2015, through the physicians involved in the CRI (“Club Rhumatismes et Inflammation”) a nationwide network of the French Society of Rheumatology. Rheumatoid arthritis patients treated with TNFi, from the French ReAct cohort, and who did not develop demyelinating complication constituted the control population (n=294). The frequency of rs1800693 and rs4149584 TNFRSF1A SNPs were compared between cases and controls. Results Twenty-four cases with demyelinating disorders, recruited from 11 centers with a median age of 39.7 years (range 30.4–75.8); of which 16 (67%) were females were included in the study. Neurological symptoms occurred after a median of 18.3 (1–66) months of anti TNFi; 15 (62.5%) had central neurologic involvement and 9 (37.5%) had peripheral involvement. The median follow-up was 26 (4–54) Months. No significant difference in the frequency of the rs1800693 MS risk-alleles (39,5% for cases vs 38,6% for controls) was observed. Similarly no difference was observed between cases (2%) and controls (4%) for rs4149584. Conclusions This study was unable to show an association between MS-associated SNPs within TNFRSF1A locus and the occurrence of demyelination while taking TNFi, suggesting that demyelination might be linked to other genetic factors or other pathways. References De Jager PL, Jia X, Wang J, et al. Meta-analysis of genome scans and replication identify CD6, IRF8 and TNFRSF1A as new multiple sclerosis susceptibility loci. Nat Genet 2009;41:776–82. doi:10.1038/ng.401. Disclosure of Interest None declared

Background Gout is due to monosodium urate (MSU) deposition in joints and soft tissues. Ultrasonography (US) and dual-energy CT (DECT) have been shown to be effective in detecting MSU deposits. Both techniques can examine tophi size. DECT is effective to identify soft-tissue MSU deposits and US can show joint deposition with the double contour (DC) sign. It is unknown if these two techniques provide the same quantification of the extent of urate deposition on a given patient. Objectives The main objective of this study is to compare the tophus size measured by US and by DECT. The secondary objective is to evaluate the correlation between the prevalence of the US DC sign and the global volume of urate deposits measured by DECT. Methods This prospective cross-sectional study included patients fulfilling the 2015 ACR/EUALR criteria for gout. Patients underwent US and DECT examinations of their knees and feet. The largest US tophi was selected as the index tophus. US examination of the DC sign was performed on the femoro-patellar joints, talo-crural joints and 1st metatarsophalangeal joints. Total volume of urate deposits of knees and feet was measured by DECT. The primary endpoint was the intra-class correlation coefficient (ICC) of the volume of the index tophus measured by US and DECT [CI 95%]. Results A total of 64 patients were included in the study, of which 35 patients presented with at least one US tophus. Patients were in average 64.5±16.3 years old, 84.4% were male, had an average ACR/EULAR score of 13.6±2.5, and disease duration was 12±14.7 years. Overall, 44 patients (68.8%) were currently taking urate lowering therapy and 22 patients (34.4%) had clinical tophi. Out of the 35 US selected largest tophi, 6 tophi were not seen in DECT. Of the tophi identified with both techniques, 21 were localized in the feet and 8 in the knees. The ICC of the tophus volume assessment by US and DECT was 0.45 [0.12–0.69]. The average volume of the largest US tophi was 2.7±6.5 cm3 and 1.5±3.3cm3 when measured by DECT. If the index tophus was localized in the knee, the ICC was 0.36 [0–0.82] and was 0.68 [0.37–0.86] if the tophus was in the foot. The Spearman correlation coefficient between the DECT urate volume and the number of joints with a positive DC sign was 0.15. Conclusions US and DECT do not provide the same assessment of tophus size. The correlation is improved when considering tophi localized in the feet. The number of joints with positive DC sign does not correlate to the volume of urate deposition in the soft tissues measured by DECT. Disclosure of Interest None declared

International audience; Choosing the subcutaneous (SC) route of administration of abatacept and tocilizumab is more cost-effective than the intravenous (IV) route. The objective of this study was to examine patients' reasons for choosing to keep with their IV infusions or to switch to subcutaneous SC injections. This study was based upon a self-administered questionnaire given to consecutive rheumatoid arthritis patients treated with abatacept or tocilizumab. Patients were asked to express their opinions concerning reasons explaining why they chose to keep the IV route or switch to the SC route. A total of 201 questionnaires completed by 127 patients treated by tocilizumab and 74 by abatacept were analysed. Overall, 45.8% of the patients chose to keep the IV route of administration. Another ongoing SC treatment was noted more often in patients choosing the SC route (15.9 versus 4.3%, p < 0.05). Reasons guiding the choice of the SC route were concerns about repeated hospital day-care (72%), greater autonomy with SC injections (38.7%) and economic considerations (21.5%). Reasons associated with choosing to maintain the IV route were worries about a lack of follow-up (72.1%), the absence of medical assistance during the SC injection (61.2%), maintaining social relationships with other patients developed at the hospital (40.5%), lower frequency of injection (32.9%), fear of adverse events (27.7%) and fear of SC injections (17.9%). Patients reject the SC switch from the IV route of tocilizumab and abatacept mainly because of fears about the unknown SC route, while those who accept it find it more convenient.

ObjectivesLittle data are available regarding the rate and predicting factors of serious infections in patients with rheumatoid arthritis (RA) treated with abatacept (ABA) in daily practice. We therefore addressed this issue using real-life data from the Orencia and Rheumatoid Arthritis (ORA) registry.MethodsORA is an independent 5-year prospective registry promoted by the French Society of Rheumatology that includes patients with RA treated with ABA. At baseline, 3 months, 6 months and every 6 months or at disease relapse, during 5 years, standardised information is prospectively collected by trained clinical nurses. A serious infection was defined as an infection occurring during treatment with ABA or during the 3 months following withdrawal of ABA without any initiation of a new biologic and requiring hospitalisation and/or intravenous antibiotics and/or resulting in death.ResultsBaseline characteristics and comorbidities: among the 976 patients included with a follow-up of at least 3 months (total follow-up of 1903 patient-years), 78 serious infections occurred in 69 patients (4.1/100 patient-years). Predicting factors of serious infections: on univariate analysis, an older age, history of previous serious or recurrent infections, diabetes and a lower number of previous anti-tumour necrosis factor were associated with a higher risk of serious infections. On multivariate analysis, only age (HR per 10-year increase 1.44, 95% CI 1.17 to 1.76, p=0.001) and history of previous serious or recurrent infections (HR 1.94, 95% CI 1.18 to 3.20, p=0.009) were significantly associated with a higher risk of serious infections.ConclusionsIn common practice, patients treated with ABA had more comorbidities than in clinical trials and serious infections were slightly more frequently observed. In the ORA registry, predictive risk factors of serious infections include age and history of serious infections.

Resume Objectifs Decrire les cas de patients developpant une maladie inflammatoire intestinale (MICI) dans un contexte de rhumatisme inflammatoire (RI) traite par agents anti-TNF-α. Methodes Un appel a participation a ete envoye aux membres du club « rhumatismes et inflammation » francais. Seuls les patients ne presentant pas de symptomes intestinaux avant l’introduction des agents anti-TNF-α etaient inclus. Resultats En deux ans, 16 patients ont ete inclus : neuf hommes et sept femmes, d’âge moyen 41,5 (± 17,4) ans. Douze patients etaient atteints de spondylarthrite ankylosante (SA), un patient de polyarthrite rhumatoide (PR), un patient de rhumatisme psoriasique et deux patients d’arthrite juvenile idiopathique (AJI) avec enthesites liees a l’atteinte articulaire. Globalement 14 patients etaient traites par etanercept et deux par infliximab. Le delai moyen entre le debut du traitement par agents anti-TNF-α et le developpement de la MICI etait de 29,3 ± 20,1 mois. Des analyses endoscopiques et histologiques ont permis de classer la MICI comme maladie de Crohn (MC) typique dans huit cas, une maladie de type Crohn dans six cas, une atteinte indeterminee dans un cas et une rectocolite ulcereuse dans un dernier cas. Pour tous les patients, chaque traitement par agent anti-TNF-α a ete interrompu et remplace par un anticorps monoclonal anti-TNF-α (different du premier le cas echeant). Apres un suivi moyen de 23,4 (± 19,5) mois, le traitement a ete benefique sans recidive ni recrudescence de la MICI. Conclusions Une MICI peut survenir de facon paradoxale au cours du traitement des RI par agents anti-TNF-α, principalement chez les patients ayant une spondylarthropathie traitee par etanerceptLa frequence est estimee a 0,15 % chez les patients francais atteints de spondylarthropathies et traites par des agents anti-TNF-α. La MICI correspond principalement a une MC ou de type Crohn. En revanche, l’apparition de nouvelles MICI est moins frequente dans les autres types de RI chez les patients traites par d’autres agents anti-TNF-α.

Resume Objectif Le rituximab a prouve son efficacite dans le traitement de la polyarthrite rhumatoide (PR) en association avec le methotrexate (MTX). L’objectif de cette etude etait d’analyser la reponse a ce traitement en pratique quotidienne dans les trois situations particulieres suivantes : patients seronegatifs pour le facteur rhumatoide (FR), patients sous rituximab en monotherapie et patients anti-TNFα naifs. Methodes Cette etude observationnelle retrospective constitue une analyse exploratoire de la reponse au rituximab. Mille milligrammes (1000 mg) de rituximab ont ete administres a deux reprises a un intervalle de 15 jours. La reponse therapeutique a ete evaluee 20 semaines en moyenne apres l’injection sur la base des scores DAS28 et des criteres de reponse EULAR. Resultats Cent-huit patients (108) ont ete inclus dans l’etude et 95 d’entre eux ont ete retenus pour l’analyse des reponses. Parmi ces derniers, 75 % etaient repondeurs EULAR. Il n’y avait pas de difference significative dans la reponse EULAR entre les patients traites par rituximab et MTX (73,8 %) et ceux qui avaient recu du rituximab en monotherapie (79,3 %). De la meme maniere, il n’y avait pas de difference dans le nombre de repondeurs EULAR entre les patients ayant recu prealablement des anti-TNFα (74,1 %) et ceux n’en ayant pas recu (78,6 %). Cependant, le delai de retraitement etait significativement plus court chez les patients anti-TNFα naifs. Enfin, une difference significative (p = 0,02) a ete observee dans le taux de reponse EULAR entre les patients FR seropositifs (84,8 %) et ceux FR seronegatifs (57,9 %). Le delai de retraitement etait egalement significativement plus court chez les patients seronegatifs. Conclusion Dans notre experience, tandis que nos resultats d’efficacite du rituximab apparaissent conformes a ceux d’essais controles comparables, que ce soit en association ou non au MTX, ou avec l’utilisation prealable d’un ou plusieurs agents anti-TNF, les patients FR seropositifs presentaient un taux de reponse EULAR plus eleve que les patients seronegatifs.