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BackgroundAlthough it prevents severe forms of the disease, vaccination does not completely protect against the occurrence of COVID19 disease. If, DMARDs used have been associated with variable humoral response to SARS-CoV-2 vaccination, the impact of their use after SARS-CoV-2 natural infection have been poorly studied.ObjectivesTo characterize humoral response after SARS-CoV-2 infection and viral persistence in the nasopharyngeal sphere (NP), stools and blood of patients with rheumatic disease under DMARDs, and compared to healthy controls.MethodsProspective monocentric longitudinal study including patients with rheumatoid arthritis or spondyloarthritis under DMARDs and with a confirmed SARS-CoV-2 infection (positive NP PCR and/or positive serology and/or pathognomonic thoracic tomography (CT)) during the first or second wave of the COVID pandemic. Patients were followed up until one year after infection and humoral response was assessed before vaccination. Serum IgG and IgA antibodies against spike (S) and nucleocapsid (N) proteins were measured at every visit. Viral persistence was assessed at the early visit in the NP and stools using conventional RT-PCR and in the blood using a high sensitive technique (droplet digital PCR).ResultsBetween June 2020 and July 2021, we include 96 patients (50 SpA and 46 RA) with a mean age of 53 +/- 14 years and 20 healthy controls (mean age 49 ± 16 years) corresponding to relatives of patients (spouses, children) living together and infected at the same time. The immune responses were analyzed according to 6 treatment groups: methotrexate (MTX)/salazopyrine (SLZ) monotherapy (n=17/2); anti-TNF monotherapy (n=24), anti-TNF + MTX (n=23); rituximab (RTX) (n=11); anti-IL17 or -23 (n=8); others (n=11). Visits were made at 1 month (29 ±13 days; n=18), 3 months (110 ±23 days; n=67), 6 months (231 ±35 days; n=48) and 12 months (368 ± 19 days; n=19) after infection. The anti-S and anti-N IgG Ab titers were not significantly different in the 6 treatment groups and the control population at 3 months. A significant decrease in anti-S IgA Ab titers was noted in the group treated with RTX (p=0.007) and with molecules targeting the IL17/23 pathway (p=0.007). A similar but non-significant trend was observed in these same treatment groups for anti-N IgA Ab (p=0.07). The titers of anti-SARS-CoV-2 antibodies at M3, was not associated with a severe COVID disease. Detection of SARS-Cov-2 RNA in stools and serum was negative for all samples taken at 1 month or 3 months. 4 patients (2 RA treated with abatacept/RTX and 2 SpA treated with anti-TNF/secukinumab) had a positive RT-PCR NP with low to very low viral load at the 1-month visit (mean Ct 36). None of these 4 patients had had a severe form of COVID19 infection.ConclusionDMARDs - treated patients with previous proven COVID-19 did not seem to alter IgG Ab response but RTX and anti-IL17/-IL-23 might alter IgA humoral response. This lower immune response was not associated with a more severe disease. In these patients, new infection may not be considered as a full boost for the immune system. DMARDs did not induce viral persistence in the serum, the NP or in the stool.Acknowledgementsfinancial support from Société Française de Rhumatologie and ANR RA COVIDDisclosure of InterestsNone declared

BackgroundCarpal tunnel syndrome (CTS) and hand osteoarthritis (HOA) are common diseases that can coexist in the same patient. Only one recent study showed that CTS was associated with a significant decrease in strength and performance of the OA-affected hand [1]. This observation suggested that CTS-induced neuropathic disorders may have effects on the surrounding joints symptomatically supporting the role of nerve-joint axis in OA pain.ObjectivesOur work aimed to study the impact of CTS on the symptoms and structural severity of HOA in the DIGICOD (DIGItal Cohort Design) cohort.MethodsDIGICOD is a single-center prospective hospital cohort which includes 426 patients over 35 years of age with symptomatic HOA [2]. Patients in our study were those in the DIGICOD cohort at inclusion for whom the dominant hand and laterality in case of CTS involvement were known. The analysis was based on the study of the dominant hand. We compared the demographic, clinical and radiographic characteristics (notably by the sum of the Kellgren Lawrence (KL) score) between patients with CTS and those without CTS. In case of comparison test, Chi-square or Fisher exact test were performed. Then, we investigated whether CTS was associated with grips strength, pinch strength and KL score by linear regression model and with number of joints painful pressure with negative-binomial model, after adjustment for age and sex.Results417 patients including 39 with CTS were included in our study. Obesity and metabolic syndrome were more frequent in patients with CTS than in those without CTS (obesity: 29.7% vs 10.2%, pConclusionThe risk factors for CTS in HOA are those known in the general population (hypothyroidism, obesity and metabolic syndrome). However, our study did not find any impact of CTS on the clinical signs and structural severity of HOA.References[1]Kim YH, Han EY, Kim J, Seo K-B, Jeon YT, Im SH. Associations between hand function and electrophysiological measurements in hand osteoarthritis patients of different ages with or without carpal tunnel syndrome. Sci Rep 2020;10:19278. https://doi.org/10.1038/s41598-020-74795-2.[2]Sellam J, Maheu E, Crema MD, Touati A, Courties A, Tuffet S, et al. The DIGICOD cohort: A hospital-based observational prospective cohort of patients with hand osteoarthritis - methodology and baseline characteristics of the population. Jt Bone Spine 2021;88:105171. https://doi.org/10.1016/j.jbspin.2021.105171.AcknowledgementsAll the patients who have accepted to participate to the DIGICOD cohort. All the investigators who manage or have managed patients’ recruitments, and the monitoring the clinical visits (Dr. Camille Deprouw, Dr. Sandra Desouches, Dr. Ariane Do, Dr. Emeline Gaigneux, Dr. Camille Glanowski, Dr. Karine Louati, Dr. Stéphanie Malbos, Dr. Sabine Trellu, Dr. Houda Ajlani, Dr. Juliette-Louise Petit and Dr. Clémence Gorlier all from the Rheumatology Department of AP–HP Saint-Antoine Hospital), the staff members of the URCEST and of the Centre des Ressources Biologiques from AP–HP Saint-Antoine Hospital.Funding of the DIGICOD cohortTRB Chemedica unrestricted research grantDisclosure of InterestsNone declared

BackgroundAmong the general population over 60 years-old, the decrease in grip strength is a marker of morbidity and mortality: its measurement during follow-up consultations is considered as a predictive marker of good health status or the patient’s overall fragility (1). However, hand osteoarthritis (HOA), which can modulate grip strength and is also associated with comorbidities is never taken into account, while it is a very common disease.ObjectivesThe objectives of this study are to describe grip strength in a symptomatic HOA population, to investigate painful osteoarthritic joints associated with decreased grip strength, and to determine whether decreased grip strength is independently associated with comorbidities in this population.MethodsDIGICOD is a hospital-based observational cohort including patients with radiographic features of HOA of at least 2 joints or radiographic thumb base OA. Inflammatory rheumatism or crystal arthropathy were excluded. The data at baseline were used for the analysis. Grip strength was the higher score of 3 repeated measures using a Jamar dynamometer. Baseline grip strength of the dominant hand was compared in the cohort between men and women (Student’s T test) and was described by age (by 10-year age groups using Kruskal-Wallis test). In this cross-sectional study, factors associated with a decreased grip strength were investigated using univariate and then multivariate linear regression analysis (with adjustment on age, BMI and variables with p ≤ 0.2 in univariate analysis) with stratification by sex. Results were presented by beta coefficients and their 95% confidence intervals. A first analysis focused on the association of grip strength with local factors: painful locations in the dominant hand by row and radiographic severity according to the total Kellgren-Lawrence (KL) score. The second analysis assessed the patient-level association between decreased grip strength and general characteristics, including cumulative comorbidities and markers of radio-clinical severity of hand OA, namely the AUSCAN pain score and total KL score. A sensitivity analysis was performed to look for association between grip strength and each comorbidity.Results394 patients were analyzed, including 329 women (mean ± SD of the dominant hand’s grip strength of 21.6 ± 6.9 kg) and 65 men (34.9 ± 9.8 kg) with a mean age of 66.9 ± 7.3 years. Grip strength decreased with age (pAmong women, locally, decreased grip strength was independently associated with painful involvement of at least 2 metacarpophalangeal joints (MCPs) (estimated coefficient [95% CI] -3.6 [-6.2; -1.0] kg versus no painful MCPs) but not with proximal and distal interphalangeal joints, and with a high KL total sum score (-0.06 [-0.10; -0.01] kg per additional point). At the patient-level, decreased grip strength was not associated with comorbidities but with radio-clinical severity (pAmong men, neither radiographic severity nor painful locations were independently associated with a decrease of grip strength. Conversely, decreased grip strength was associated with at least 3 comorbidities (-8.5 [-15.5; -1.43] kg versus a single comorbidity being OA), independently of radiographic severity. The study of comorbidities individually did not show any particular association with grip strength.ConclusionIn this cohort of symptomatic HOA, the decrease of grip strength reflects the radio-clinical severity of hand OA among women, whereas among men, it is independently associated with the accumulation of comorbidities. The presence of hand OA should be considered for further studies investigation the relationship between grip strength and morbi-mortality.References[1]Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. CIA. oct 2019;Volume 14:1681‑91.Graph 1.Grip strength according to the number of comorbidities among men and womenDisclosure of InterestsNone declared

BackgroundPatients with autoimmune/inflammatory rheumatic diseases (AIRD) were suspected to be an at-risk population of severe COVID-19. However, whether this higher risk is linked to the disease or to its treatment is difficult to determine.ObjectivesTo identify, among AIRD patients, factors associated with occurrence of moderate-to-severe COVID19 infection and to evaluate if having an AIRD was associated with an increased risk of severe form of COVID19 infection (defined by hospitalization in ICU or death), compared to general population.MethodsData source: The “Entrepôt des Données de Santé (EDS)” collect data from electronic health records of all patients hospitalized or followed in the AP-HP (39 hospitals in Paris area, France). The French RMD COVID19 cohort is a national multi-center cohort that included patients with confirmed AIRD and diagnosed with COVID-19. All AIRD patients diagnosed with COVID-19 before September 2020 from both cohorts were included.-We Identified factors associated with severe COVID-19 was made in a combined analysis of the 2 cohorts.-Then, we compared COVID-19 infection severity in the EDS-COVID database in AIRD patients and controls, by a propensity score (PS)-matched case-control (1:4) studyResultsAmong 1213 patients (334 in EDS and 879 in RMD cohort), 195 (16.1%) experienced a severe COVID19. In multivariate analysis, greater age, history of interstitial lung disease, arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory disease and treatment with corticosteroids or rituximab were associated with severe COVID-19 (Table 1).Table 1.AIRD patient’s characteristics associated with severity of COVID-19Patients with mild or moderate infectionPatients with severe infectionOR ajustés 95%CIp-value(N = 1018)(N = 195)Patients characteristics Age55.9 (16.7%)70.3 (14.3%)1.05 [1.03;1.07] Gender: Female695 (68.3%)105 (54.1%)0.59 [0.38;0.94]0.025 Interstitial pneumonia38 (3.7%)20 (10.3%)2.94 [1.34;6.34]0.008 Obesity143 (17.8%)38 (27.7%)2.09 [1.26;3.43]0.004 Hypertension268 (26.3%)114 (58.5%)1.81 [1.13;2.89]0.013Underlying Disease: Chronic inflammatory arthritis618 (60.8%)72 (36.9%)Ref. Auto-inflammatory disease29 (2.9%)5 (2.6%)3.91 [1.2;11.32]0.025 Other29 (2.9%)4 (2.1%)0.35 [0.06;1.41]0.15 Connectivitis190 (18.7%)34 (17.4%)1.13 [0.62;2.01]0.69 Sarcoidosis40 (3.9%)24 (12.3%)5.19 [2.15;12.3] Vasculitis111 (10.9%)56 (28.7%)1.8 [1.02;3.16]0.044Treatments Corticosteroid318 (31.2%)117 (60.0%)2.47 [1.58;3.87] Leflunomide44 (4.3%)2 (1.0%)0.13 [0;0.97]0.045 Rituximab37 (3.7%)22 (11.5%)4.05 [1.96;8.27]Not significant in multivariate analysisCOPD, Asthma, Coronary heart diseases, stroke, diabetes, smoking, cancer, non-steroidal anti-inflammatory drugs, colchicine, hydroxychloroquine, methotrexate, salazopyrine, mycophenolate mofetil, azathioprine, intravenous immunoglobulins, anti-TNFα, anti-IL1, -IL6, -IL17, Abatacept, JAK inhibitorAmong 35741 COVID-19 patients in EDS, 316 with AIRD were compared to 1264 PS-matched controls. Severe form occurred in 118 (37,3%) AIRD cases and 384 (30.4%) controls (Adjusted OR (aOR) for severe form= 1.43 [1.1;1.9], p=0,01). In analysis restricted to rheumatoid arthritis (RA) and spondylarthritis (SpA), no increased risk of severe form (aOR=1.11 [0.68;1.81]) form or death (aOR=1.00 [0.55;1.81]) was observed.ConclusionIn this multicenter study we confirmed that AIRD patients treated with rituximab or corticosteroids were at increased risk of severe COVID-19, as were those with vasculitis, auto-inflammatory disease, and sarcoidosis. Also, when compared to controls from the same cohort of hospitalized patients, AIRD patients had, overall, an increased risk of severe COVID-19, increased risk not observed in an analysis restricted to patients with RA or SpA.AcknowledgementsFAI2R /SFR/SNFMI/SOFREMIP/CRI/IMIDIATE consortium and contributorsPatricia MartelAll clinicians/physicians implicated in COVID-19 patient care in APHP hospital and generated EDS patient dataDisclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases and regularly affects women of childbearing age1. However, there is limited knowledge about the impact of the disease and its treatment on fertility.ObjectivesThe aim of the study was to determine factors associated with time-to-conception in women with RA.MethodsAll RA patients (diagnosis according to the Rheumatologist) included in the national multicenter GR2 cohort from 2015 to June 2021 were included in the analysis. Patients could be included either with a pregnancy wish (i.e., preconceptional period) or because of a clinical pregnancy (12 months or non-achievement of pregnancy), as well as the number exposed to csDMARDs and biologics in the preconception period. We performed survival analyses, using a Cox model including a random effect for the center to account for heterogeneity of practices among participating centers. We used a multiple imputation to address missing data among the explanatory variables. Results are presented as a hazard ratio (HR) with confidence interval (CI) to assess associations between the factors studied and time-to-conception.ResultsAmong the 167 patients with RA included in the GR2 cohort, 78 were selected for the main analysis of time-to-conception. Of these, 40 (51.3%) had a clinical pregnancy during follow-up. Subfertility was observed in 33 (42.3%) women and median time-to-conception was 19.1 months; mean preconception DAS28-CRP score was 2.3 (+/- 1.2).Patients were treated during the preconceptional period with NSAIDs, corticosteroids, csDMARDs and biotherapy in 10 (12.8%), 35 (44.9%), 24 (30.8%), and 32 (41.0%) cases, respectively. The multivariate model adjusted for age, BMI, DAS28-CRP, disease duration, ACPA positivity, and exposure to corticosteroids and biologics in the preconception period found an association between increased preconception delay and age (HR (per year) 1. 12 95% CI [1.04-1.16] p = 0.01) as well as disease duration (HR (per year) 1.06 95% CI [1.02-1.15] p = 0.03).ConclusionThis study provides original results on fertility in women with RA. It found a median time-to-conception of 19.1 months, with a subfertility rate of 42.3%, which is significantly higher than the general population2. In this context, it seems essential to discuss this topic from the beginning of the disease in women of childbearing age.References[1]Van den Brandt S. Arthritis Res Ther. 2017;19(1):64.[2]Junul S. Hum Reprod. 1999;14(5):1250-4.Table 1.Survival analyses (Cox model): factors associated with time-to-conception in women with RA.Univariate analysesMultivariate analysesCrude HR 95% CIpAdjusted HR 95% CIpAge1.11 [1.04-1.18]0.0021.12 [1.04-1.16]0.015BMI1.06 [0.99-1.16]0.1031.08 [0.99-1.16]0.062ACPA positivity1.75 [0.90-3.39]0.1071.44 [0.65-2.86]0.310Disease duration1.03 [0.98-1.08]0.2671.06 [1.02-1.15]0.032DAS28-CRP score1.08 [0.81-1.45]0.5921.08 [0.92-1.32]0.170Corticosteroids0.91 [0.51-1.65]0.7690.86 [0.42-1.68]0.620Biologics1.52 [0.82-2.81]0.1891.30 [0.62-2.78]0.630Figure 1.Cumulative incidence curves for pregnancies in women with RA.AcknowledgementsThe GR2 Cohort is supported by the French Society of Rheumatology, the French Internal Medicine Society, and unrestricted grants from UCB.Disclosure of InterestsSABRINA HAMROUN: None declared, Marion Couderc: None declared, Laure Gossec: None declared, Rene-Marc Flipo: None declared, Hubert MAROTTE: None declared, Christophe Richez Speakers bureau: CR has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this manuscript., Aline Frazier-Mironer: None declared, Jérémie SELLAM: None declared, Elisabeth Gervais: None declared, Valerie Devauchelle-Pensec: None declared, Alban Deroux: None declared, Rakiba Belkhir: None declared, AZEDDINE DELLAL: None declared, Laëtitia Dunogeant: None declared, Cédric Lukas: None declared, Emmanuel Chatelus: None declared, Nathalie Costedoat-Chalumeau: None declared, Anna Moltó: None declared

BackgroundCervical involvement in ankylosing spondylitis (AS) is particularly disabling and has been poorly studied yet. Actual radiologic scoring design to assess disease progression does not provide a comprehensive picture of the cervical involvement in AS. [1] Association with clinical features such as psoriasis are discussed.ObjectivesWe aimed to assess radiographic features of cervical involvement in AS and clinico-biological parameters associated with this specific radiographic location.MethodsCross-sectional study based on radiographic analysis of a subgroup of patients included in the French BambooSpine cohort, originally designed to study the genetic risk factors of AS structural severity. The analysis was based on patients included in Parisian hospitals to have access to images of the entire spine on the Picture Archiving and Communication System (PACS) shared by all University Hospitals in Paris. A double reading of the images was performed by a rheumatologist/radiologist pair until consensus was reached, to identify syndesmophytes, zygapophyseal joint (ZJ) involvement and posterior ligament structures (PLS) at each cervical level, syndesmophytes in the thoracic region, and ZJ and PLS involvement in the lumbar region.ResultsOf the 113 assessed patients, 101 were men, mean age 53 years (+/- 11 years) with 27 years (+/- 13 years) of disease duration (Table 1). Of those whose HLA B27 status was known, 85% (70/82) were carriers. Among 86 patients with radiological cervical involvement, 83% had syndesmophytes, 86% had ZJ involvement and 24% had PLS involvement. In the cervical region, 13 patients (15%) had zygapophyseal fusion without syndesmophytes. 26/113 patients were completely free of any cervical involvement while 30/113 had a maximal cervical involvement (anterior and posterior). In univariate analyses, HLA-B27 was significantly associated with ZJ involvement at the cervical and lumbar level (p=0.016). Cervical involvement of any type was not associated with psoriasis. Low educational level (not beyond secondary school) was significantly associated with syndesmophytic involvement (p=0.035). There was a non-significant trend for an association between arthritis and ZJ involvement.Table 1.Clinical featuresMen (n,%)101/11389,4%Age at diagnosis (mean, SD)31,211,68Duration of evolution (mean, SD)27,013,0Smoking ever (n,%)65/11258,0 %Chronic Back Pain (for > 3 months) (n,%)109/11396,5%Chest pain45/11040,9%Buttock pain78/10971,6%Arthritis36/11132,4%Enthesitis38/11233,9%Dactylitis6/1115,4%HLA B2770/8285,4%CRP87/10384,5%X ray sacro-iliitis112/112100%Personnal history -Uveitis41/11336,3% -Inflammatory bowel disease13/11311,5% -Reactive arthritis2/1121,8% -Psoriasis19/11117,1%ConclusionCervical involvement was very frequent (76% of this severe AS population) but not associated with psoriasis, as usually thought. Zygapophyseal involvement was present in 86 % of cases and exclusive in 15 % of cases. This latter radiological form of the disease, i.e. without syndesmophytes, is usually more difficult to diagnose, and should be systematically assessed among AS patients with cervical pain and/or patients with reduced cervical mobility.References[1]Wanders AJB, Landewé RBM, Spoorenberg A, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? Arthritis & Rheumatism 2004Disclosure of InterestsNone declared

BackgroundSpondyloarthritis (SpA) is one of the most common chronic inflammatory diseases and regularly affects women of childbearing age1. However, there is limited knowledge about the impact of the disease and its treatment on fertility2.ObjectivesThe aim of the study was to determine factors associated with time-to-conception in women with SpA.MethodsWe performed an analysis of SpA patients (diagnosis according to the rheumatologist) included in the national multicenter cohort GR2 from 2015 to June 2021. Patients could be included either with a pregnancy wish (i.e., preconceptional period) or because of a clinical pregnancy (12 months or non-achievement of pregnancy), as well as the number exposed to csDMARDs and biologics in the preconception period. We performed survival analyses, using a Cox model including a random effect for the center to account for heterogeneity of practices among participating centers. We used a multiple imputation to address missing data among the explanatory variables. Results are presented as a hazard ratio (HR) with confidence interval (CI) to assess associations between the factors studied and time-to-conception.ResultsAmong the 207 patients with SpA included in the GR2 cohort, 88 were selected for analysis of time-to-conception (i.e., include preconceptionally). Of these, 56 (63.6%) had a clinical pregnancy during follow-up. Subfertility was observed in 40 (45.4%) women and the median time-to-conception was 16.1 months. The mean preconceptional BASDAI score was 2.9 (+/- 2.1). Patients were treated with NSAIDs, corticosteroids, csDMARDs and biotherapy in 23 (26.1%), 8 (9.1%), 12 (13.6%), and 61 (69.3%) cases, respectively. The multivariate model adjusted for age, BMI, nulligestity, BASDAI, disease duration, smoking, form of spondyloarthritis (axial, peripheral, or both), and exposure to NSAIDs, csDMARDs, and biotherapy in the preconception period found an association between longer time-to-conception and age (HR 1. 22 95% CI [1.08-1.40] p < 0.001), as well as the use of NSAIDs during preconception (HR 3.01 95% CI [2.15-3.85] p = 0.01).ConclusionThis study provides original results on fertility in women with SpA. The factors associated with a longer time-to-conception were age and the NSAIDs use during the preconception period, which argues for their cautious use in case of pregnancy wish in patients needing continuous NSAID intake for the management of their disease.References[1]Van den Brandt S. Arthritis Res Ther. 2017;19(1):64.[2]Hamroun S. Rheumatology. 2021; Jul 23: keab589.Figure 1.Cumulative incidence curves for pregnancies in women with SpA according to NSAIDs use in preconception period.AcknowledgementsThe GR2 Cohort is supported by the French Society of Rheumatology, the French Internal Medicine Society, and unrestricted grants from UCB.Disclosure of InterestsSABRINA HAMROUN: None declared, Marion Couderc: None declared, Rene-Marc Flipo: None declared, Jérémie SELLAM: None declared, Christophe Richez Speakers bureau: CR has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this manuscript., Emmanuelle Dernis: None declared, Aline Frazier-Mironer: None declared, Laure Gossec: None declared, Elisabeth Gervais: None declared, Hubert MAROTTE: None declared, Laëtitia Dunogeant: None declared, Cédric Lukas: None declared, Alban Deroux: None declared, Nathalie Costedoat-Chalumeau: None declared, Anna Moltó: None declared

BackgroundSpondyloarthritis (SpA) is one of the most common chronic inflammatory diseases and regularly affects women of childbearing age1. However, there is limited knowledge about the impact of the disease and its treatment on pregnancy.ObjectivesThe aim of the study was to determine the factors associated with adverse pregnancy outcome in women with SpA.MethodsAll SpA patients (diagnosis according to the Rheumatologist) included in the national multicenter GR2 cohort from 2015 to June 2021 were included in the analysis. Patients could be included either with a pregnancy wish (i.e., preconceptional period) or because of a clinical pregnancy (ResultsAmong the 207 pregnancies in women with SpA included in the GR2 cohort, 126 were retained for analysis of obstetrical outcome. Of these, 29 (23.0%), 14 (11.1%), 69 (54.8%) were exposed to corticosteroid, NSAID and biologics at least once during pregnancy, respectively. An active disease at least once during pregnancy was found in 47 (37.3%) pregnancies. A live birth was found in 116 (92.1%) women, including 110 (87.3%) full-term births. Early miscarriages and stillbirths were observed in 7 (0.06%) and 3 (0.02%) women, respectively. A caesarean section was performed in 20 (17.2%) cases.A favorable pregnancy outcome was found in 80 (63.5%) of the women. Unfavorable pregnancy outcome was most frequently due to small for gestational age, observed in 22 (19%) pregnancies. The multivariate model adjusted for age, BMI, nulliparity, active disease during pregnancy, smoking, and exposure to NSAIDs and corticosteroids during pregnancy found an association between unfavorable pregnancy outcome with nulliparity (OR 2.63 95% CI [1.01-6.81] p = 0.05).ConclusionThis study provides original results on pregnancy in women with SpA. It found a favorable pregnancy outcome in 63.5% of women. Unfavorable pregnancy outcome was most frequently due to small for gestational age, which should lead to a coordinated management with obstetricians for the follow-up of pregnancy in women with SpA.References[1]Van den Brandt S. Arthritis Res Ther. 2017;19(1):64.Table 1.Multilevel logistic regression model: factors associated with unfavorable pregnancy outcome in women with SpA.Univariate analysesMultivariate analysesCrude OR 95% CIpAdjusted OR 95% CIpAge1.01 [0.92-1.10]0.8591.05 [0.95-1.17]0.297BMI0.99 [0.91-1.07]0.7960.99 [0.90-1.08]0.747Nulliparity2.16 [0.94-4.94]0.0712.63 [1.01-6.81]0.049Smoking0.84 [0.23-3.03]0.8050.84 [0.22-3.21]0.805Disease activity*0.98 [0.40-2.43]0.9641.15 [0.43-3.07]0.778Corticosteroids**1.09 [0.45-2.65]0.8761.15 [0.51-2.71]0.902NSAIDs**0.65 [0.18-2.33]0.1960.67 [0.18-2.56]0.565* BASDAI score ≥ 4 at least once during pregnancy.** Use at least once during pregnancyAcknowledgementsThe GR2 Cohort is supported by the French Society of Rheumatology, the French Internal Medicine Society, and unrestricted grants from UCB.Disclosure of InterestsSABRINA HAMROUN: None declared, Marion Couderc: None declared, Rene-Marc Flipo: None declared, Jérémie SELLAM: None declared, Christophe Richez Speakers bureau: CR has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this manuscript., Rakiba Belkhir: None declared, Laure Gossec: None declared, Hubert MAROTTE: None declared, Emmanuelle Dernis: None declared, Aline Frazier-Mironer: None declared, Elisabeth Gervais: None declared, Cédric Lukas: None declared, Valerie Devauchelle-Pensec: None declared, Laëtitia Dunogeant: None declared, Alban Deroux: None declared, Nathalie Costedoat-Chalumeau: None declared, Anna Moltó: None declared

BackgroundArtificial intelligence techniques, in particular machine learning (ML), are increasingly used in rheumatology and especially in osteoarthritis (OA). ML studies in OA are very heterogeneous, hence the need to have an overview of their field of application.ObjectivesThe aim of this systematic literature review is to provide a comprehensive and exhaustive landscape of the use of ML in the clinical care of OA.MethodsA systematic review of the literature was performed in July 2021 using the Medline database with key words and MeSH terms referring to ML methods in OA. Only original articles in English were considered. Articles related to replacement surgery, theorical imaging, rehabilitation, molecular biology, and spinal or temporomandibular OA were excluded. For each selected article, the number of patients, the ML algorithms used, the type of data analyzed, the validation methods, and the data availability were collected.ResultsFrom 1,148 screened articles, 46 were selected and analyzed, most of which were published after 2017 (Figure 1). Twelve articles were related to diagnosis, 7 to prediction, 4 to phenotyping, 12 to severity and 11 to progression. The number of patients included ranged from 18 to 5,749. Deep learning (DL) was used in 35% of the cases. Imaging analyses represented 74% of the studies. Knee OA was studied in 85% of these articles while 15% investigated hip OA. None were on hand OA. Most of the studies were done on the same cohort with data from the Osteoarthritis Initiative (OAI) used in 46% of the articles whereas the Multi-Center Osteoarthritis Study (MOST) and the Cohort Hip and Cohort Knee Study (CHECK) cohort were respectively used in 11 % and 7 % of the articles. Data and source code were publicly available in 54% and 22% of the articles. External validation was provided in only 7 % of the articles.Figure 1.Article selection flow chartConclusionThis review provides a comprehensive update of ML in OA research. The number of ML articles in OA has increased exponentially over the last 5 years with applications across all major research themes. However, there is methodological heterogeneity, with articles based mainly on radiological data, but also on knee OA. To date, there is no ML article on digital osteoarthritis. This work also shows the need to develop clinical cohorts to bring more diversity in ML work and to allow external validation This article is the first systemic review of the literature in OA and provides an overview of ML in OA, its applications, limitations and perspectives.Disclosure of InterestsMarie Binvignat: None declared, Valentina Pedoia: None declared, Atul Butte Shareholder of: a minor shareholder in Apple, Facebook, Alphabet (Google), Microsoft, Amazon, Snap, 10x Genomics, Illumina, CVS, Nuna Health, Assay Depot, Vet24seven, Regeneron, Sanofi, Royalty Pharma, AstraZeneca, Moderna, Biogen, Paraxel, and Sutro, and several other non-health related companies and mutual funds, Speakers bureau: invited talks from Johnson and Johnson, Roche, Genentech, Pfizer, Merck, Lilly, Takeda, Varian, Mars, Siemens, Optum, Abbott, Celgene, AstraZeneca, AbbVie, Westat, and many academic institutions, medical or disease specific foundations and associations, and health systems, Paid instructor for: boards for Geisinger Health, Regenstrief Institute, Gerson Lehman Group, AlphaSights, Covance, Novartis, Genentech, and Merck, and Roche, Consultant of: Personalis and NuMedii; consultant to Samsung, Mango Tree Corporation, and in the recent past, 10x Genomics, Helix, Pathway Genomics, and Verinata (Illumina), Grant/research support from: NIH, Northrup Grumman (as the prime on an NIH contract), Genentech, Johnson and Johnson, FDA, Robert Wood Johnson Foundation, Leon Lowenstein Foundation, Intervalien Foundation, Priscilla Chan and Mark Zuckerberg, the Barbara and Gerson Bakar Foundation, and in the recent past, the March of Dimes, Juvenile Diabetes Research Foundation, California Governor’s Office of Planning and Research, California Institute for Regenerative Medicine, L’Oreal, and Progenity., Karine Louati: None declared, David Klatzmann: None declared, Francis Berenbaum: None declared, Encarnita Mariotti-Ferrandiz: None declared, Jérémie SELLAM Consultant of: MSD, Pfizer, Abbvie, Fresenius Kabi, BMS, Roche Chugai, Sandoz, Lilly, Gilead, Novartis, Janssen and grant research from Pfizer, MSD, Schwa Medico, BMS.

BackgroundThe study of associations between body composition and osteoarthritis is still incomplete. While fat-related components are associated with pain in cross-sectional studies, longitudinal studies are rare and the impact on other quality of life (QOL) dimensions is not known.ObjectivesThe main objective of the study was to analyze the impact of body composition on the evolution of the perceived health of patients followed for hip and knee osteoarthritis (OA).MethodsLongitudinal data from the Knee and Hip Osteo Arthritis Long-term Assessment (KHOALA) cohort, a multicenter cohort of 878 patients with symptomatic knee and/or hip OA, were used. Body composition measures were obtained from DXA scans at year 3. Only 3 of the 6 investigating centers with Lunar Prodigy Advance DXA equipment recruited patients for this study. The main outcome criteria were the changes in Patient-Reported Outcomes Measures (PROms) (physical functioning, pain, mental health and vitality of the SF-36 0=worst,100=best) between 3 and 7 years of follow up. Body composition variables were as follows: fat mass index (FMI (kg/m2)), percentage of fat mass and trunk to leg fat mass ratio (TFM/LFM), skeletal muscle Mass Index (SMI (kg/m2)) and low lean mass if SMI 2 for men and 2 for women. To account for the correlation of repeated measurements of the same individual, generalized estimating equation (GEE) models were used to assess the associations between body composition measurements and the 4 SF-36 scores. The GEE models were adjusted for potential confusion covariates (age, sex, education level, occupation, smoking, comorbidity, hand OA, number of painful joints, joint of inclusion and Kellgren grade (KL)) showing a significant association at the 0.2 threshold in the bivariate analysis.Results290 patients with knee and 114 patients with hip OA have been included in the analysis: women 254 (66.7%), mean age 60.3 (SD 8.4) years old, IMC 29.5 (5.7), KL grade2 135 (46.6%) for knee OA, 79 (69.3%) for hip OA.The results of the multivariate analysis of associations between anthropometric measures and quality of life dimensions are presented in Table 1.Table 1.Physical functionningBodily painMental healthVitalityβCI* 95%pβCI* 95%pβCI* 95%pβCI* 95%pFMI*-0.02(-0.03;-0.01)-0.007(-0.02;0.002)0.140.0012(-0.006;0.008)0.76-0.01(-0.02;0.002)0.02TLF/LFM*0.06(-0.02;0.14)0.120.03(-0.06;0.12)0.530.09(0.02;0.15)0.0080.08(0.002;0.17)0.04SMI*0.01(0.006;0.02)0.02(0.01;0.02)Low LM-0.21(-0.02;0.02)0.02Positive coefficients indicate that the outcome variable increased more for the observed group than for other participants.*The estimator expresses the variation of risk for an increase of 1 units of the variable.Analyses were adjusted on age, sex, education level, occupation, smoking, comorbidity, hand OA, number of painful jointsConclusionIncreased FMI and the presence of low muscle mass (SMI) were associated with impaired functional ability, but not with pain, the associations of which disappeared after adjustment. Increased TFM/LFM and SMI were associated with improved mental health and vitality over timeDisclosure of InterestsAnne-Christine Rat Speakers bureau: Pfizer, Lilly, Abbvie, Galapagos, novartis, Consultant of: Pfizer, Lilly, Sanofi Genzyme, Abbvie, BMS, Jérémie SELLAM: None declared, Bernard Mazières: None declared, Willy Ngueyon Sime: None declared, PATRICE FARDELLONE: None declared, Francis Guillemin: None declared

BackgroundRheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases and regularly affects women of childbearing age1. However, there is limited knowledge about the impact of the disease and its treatment on pregnancy.ObjectivesThe aim of the study was to determine the factors associated with adverse pregnancy outcome in women with RA.MethodsAll RA patients (diagnosis according to the Rheumatologist) included in the national multicenter GR2 cohort from 2015 to June 2021 were included in the analysis. Patients could be included either with a pregnancy wish (i.e., preconceptional period) or because of a clinical pregnancy ( 3.2 at least once during pregnancy. We performed a multilevel logistic regression model, in which we considered patient and center random effects (patient random effect for some women included in the cohort two times). We used a multiple imputation procedure to address missing data among the explanatory variables. Results are presented as an odds ratio (OR) with confidence interval (CI).ResultsAmong the 167 pregnancies in women with RA included in the GR2 cohort, 92 were retained for analysis of obstetrical outcome. Of these, 43 (46.2%), 8 (7.9%), 40 (43.5%) were exposed to corticosteroid, NSAID and biologics at least once during pregnancy, respectively. A moderate or severe disease activity at least once during pregnancy was found in 20 (21.8%) pregnancies. A live birth was found in 83 (90.2%) women, including 69 (83.1%) full-term births. Early miscarriages were observed in 9 (0.1%) women. A caesarean section was performed in 22 (23.9%) cases.A favorable pregnancy outcome was found in 52 (56.5%) of the women. Unfavorable pregnancy outcome was mainly due to prematurity and small for gestational age, observed in 14 (16.9%) and 17 (20.5%), respectively. The multivariate model adjusted for age, BMI, nulliparity, active disease during pregnancy, smoking, and exposure to biologics and corticosteroids during pregnancy found an association between an unfavorable pregnancy outcome and nulliparity (OR 6.2 95% CI [2.1-17.8] p = 0.002), age (OR (per year) 1.1 95% CI [1.0-1.3] p = 0.02) and exposition to corticosteroids during pregnancy (OR 3.2 95% CI [1.1-9.6] p = 0.04).ConclusionThis study provides original results on pregnancy in women with RA. It found a favorable pregnancy outcome in 56.5% of women. Unfavorable pregnancy outcome was associated with age, nulliparity and corticosteroids use during pregnancy, which argues for their careful use during pregnancy.References[1]Van den Brandt S. Arthritis Res Ther. 2017;19(1):64.Table 1.Multilevel logistic regression model: factors associated with unfavorable pregnancy outcome in women with RA.Univariate analysesMultivariate analysesCrude OR 95% CIpAdjusted OR 95% CIpAge1.09 [1.01-1.19]0.0361.14 [1.02-1.28]0.019BMI0.93 [0.83-1.04]0.1960.91 [0.77-1.08]0.204Nulliparity4.18 [1.66-10.53]0.0036.16 [2.13-17.76]0.002Smoking1.08 [0.29-3.36]0.9961.65 [0.37-7.22]0.141Disease activity*1.06 [0.40-2.81]0.9110.98 [0.21-2.28]0.753Corticosteroids**2.45 [1.05-5.68]0.0393.22 [1.09-9.57]0.038Biologics**1.05 [0.11-3.54]0.5892.02 [0.70-4.12]0.194* Moderate or severe disease activity at least once during pregnancy.** Use at least once during pregnancyAcknowledgementsThe GR2 Cohort is supported by the French Society of Rheumatology, the French Internal Medicine Society, and unrestricted grants from UCB.Disclosure of InterestsSABRINA HAMROUN: None declared, Marion Couderc: None declared, Rene-Marc Flipo: None declared, Laure Gossec: None declared, Christophe Richez Speakers bureau: CR has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this manuscript., Rakiba Belkhir: None declared, Aline Frazier-Mironer: None declared, Valerie Devauchelle-Pensec: None declared, Hubert MAROTTE: None declared, Jérémie SELLAM: None declared, Elisabeth Gervais: None declared, Alban Deroux: None declared, Cédric Lukas: None declared, Emmanuelle Dernis: None declared, Emmanuel Chatelus: None declared, Nathalie Costedoat-Chalumeau: None declared, Anna Moltó: None declared

BackgroundTNF inhibitor (TNFi) treatment is standard for RA patients even though many reasons may lead to TNFi therapy failures such as lack of effectiveness, patient dissatisfaction or limited therapy adherence, or even safety. As a consequence, patients may switch to a different TNFi. The efficacy of golimumab (GLM) in RA patients with inadequate response to TNFi was demonstrated in the Go-AFTER phase III clinical trial.ObjectivesThe objectives of the present Go-BEYOND study were to provide real-world data to evaluate disease activity and treatment persistence with GLM as a second line TNFi therapy in RA patients over a one-year follow-up.MethodsGo-BEYOND is an observational French multicenter prospective cohort study. All consecutive patients over 18 years of age with a diagnosis of active RA were eligible at the time of initial GLM prescription. To be included, patients had to be previously treated with only 1 TNFi (discontinued for any reason) other than GLM. Patients were ineligible if they had been previously treated with other “non-TNFi” biologics or more than one TNFi.The study’s primary outcome was the percentage of RA patients with a Disease Activity Score (DAS28-CRP score) ≤ 3.2 at the 6-month visit (M6 visit). Patients who permanently discontinued their treatment over the 1-year follow-up were considered as non-responders. The secondary outcomes were analyzed descriptively and included (but not limited to) DAS28-CRP score at 12-month visit (M12 visit), EULAR criteria assessment, treatment persistence analysis, HAQ score, RAPID3 score, and patient acceptable symptom state and satisfaction with the injection. The study was approved by a French Ethics Committee in July 2017.ResultsA total of 128 patients (72.7% female, median age 58.2 years, and duration of RA 13.2 ± 11.4 years) met the inclusion criteria. Anti-CPP antibodies and rheumatoid factors were present in 80 (62.5%) and 81 (63.3%) patients, respectively. In the majority, the initial TNFi was etanercept (n=88, 68.8%), then adalimumab (n=25, 19.5%). The reasons for switching to GLM were secondary non-response (i.e., lack of effectiveness after an initial response to the treatment) for 75 (58.6%) patients, then safety (n=22, 17.2%), primary non-response (n=21, 16.4%), and other personal or medical reasons (n=10, 7.8%).At the M6 and M12 visits, a small number of patients, 27 (21.1%) and 48 (37.5%) had respectively permanently discontinued their GLM treatment and were considered as non-responders. At the M6 visit, 48 patients over the 128 included (37.5%) had a DAS28-CRP ≤ 3.2 and 32 (25%) < 2.6. At M12 visit, 41 (32%) patients had a DAS28-CRP ≤ 3.2 and 31 (24.2%) < 2.6. According to EULAR response criteria thresholds, 49 (38.3%) and 45 (35.2%) patients had a good or moderate response to GLM at the M6 and M12 visits.ConclusionThe Go-BEYOND study confirms that in RA, a non-response to a first TNFi does not exclude a response to GLM as a second-line biologic in a substantial proportion of patients in real-life settings.ReferencesNoneAcknowledgementsWe would like to thank the investigators and the entire Go-BEYOND team for their involvement in the study.Disclosure of InterestsCécile Gaujoux-Viala Consultant of: AbbVie; Amgen; Boehringer Ingelheim; Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB, Jérémie SELLAM Consultant of: Abbvie; Biogen; BMS; Fresenius Kabi; Janssen; MSD; Novartis; Pfizer; Roche, Florence Tubach: None declared, Naoual HARID Employee of: MSD France - Medical advisor, Bernard Combe Consultant of: AbbVie; Bristol-Myers Squibb; Celltrion; Eli Lilly; Gilead/Galapagos; Janssen; Merck; Novartis; Pfizer; Roche/Chugai; Sanofi; UCB, René-Marc Flipo Consultant of: Abbvie; BMS; Janssen; MSD; Pfizer; Roche-Chugai

Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).

L’obesite favorise l’arthrose de la hanche ou du genou par les exces de contraintes mecaniques appliquees aux articulations portantes qui activent les chondrocytes et favorisent la degradation du cartilage. Fait original, l’obesite et le surpoids favorisent aussi l’arthrose digitale par un effet systemique impliquant les adipokines, synthetisees par le tissu adipeux mais aussi par certaines cellules de l’articulation, et responsables d’un effet pro-inflammatoire et prodegradatif sur le cartilage. Cette arthrose liee a l’obesite s’integre desormais dans un phenotype plus large d’arthrose « metabolique » du fait de l’association de l’arthrose avec les differents parametres du syndrome metabolique et de la surmortalite cardiovasculaire dans cette maladie. Des donnees recentes soulignent la frequence plus elevee de l’arthrose chez les patients ayant un diabete de type 2, et l’association de ces deux maladies. Une arthrose d’apparition precoce doit alerter sur la possibilite d’un syndrome metabolique. La perte de poids et l’activite physique demeurent essentielles pour prevenir l’arthrose ou en diminuer ses symptomes.

L’arthrose est la maladie articulaire la plus frequente, caracterisee par un manque de traitements pharmacologiques efficaces. Ce constat necessite d’avoir une approche neuve de cette affection. Les etudes recentes relatives a l’arthrose mettent en avant la vision pluritissulaire de cette maladie qui affecte non seulement le cartilage mais aussi la membrane synoviale, siege d’une inflammation, et l’os souschondral, implique precocement dans la maladie. L’ensemble des trois tissus participent a la degradation de l’articulation et aux symptomes par le biais de mediateurs inflammatoires et d’enzymes proteolytiques. Cette vision de la maladie pourrait inciter a cibler specifiquement ces tissus de maniere pharmacologique. Par ailleurs, il n’y a pas une arthrose mais des arthroses directement en rapport avec les mecanismes initiateurs : ainsi differencie-t-on l’arthrose lie a l’obesite, l’arthrose post-traumatique et l’arthrose liee au vieillissement. Ces trois phenotypes sont caracterises par une degradation articulaire, mais les mecanismes y aboutissant sont certainement propres a chacun d’entre eux. L’arthrose liee a l’obesite est maintenant integree au sein d’un phenotype plus vaste, l’arthrose metabolique, compte tenu des associations epidemiologiques entre arthrose et syndrome metabolique. Les liens entre arthrose et diabete sont aussi particulierement probants tant au plan clinique qu’au plan fondamental. Cette nouvelle vision de la maladie devrait aboutir a des traitements specifiques de chacun de ces phenotypes.

Diagnostic work-up of uveitis involves many uncertainties. Search for an etiology should take into account the epidemiology of uveitis and focus on the most severe diseases or those, which can be treated. This work was undertaken to establish recommendations for the diagnosis work-up of uveitis.Recommendations were developed by a multidisciplinary panel of 15 experts, including internists, ophthalmologists and a rheumatologist and are based on a review of the literature with regard to effectiveness of investigations and the results of the ULISSE study, which is the first prospective study assessing the efficiency of a standardized strategy for the etiological diagnosis of uveitis. Children, immunocompromised patients, severe retinal vasculitis and specific ophthalmological entities are excluded from these recommendations.Investigations should be first guided by the history and physical examination. Serological screening for syphilis is the only test appropriate in all forms of uveitis. If no diagnosis is made after this stage, we propose investigations guided by the anatomic characteristics of uveitis. It includes HLA B27 testing (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin converting enzyme, interferon-gamma release assay and chest CT (chronic uveitis), cerebral MRI and anterior chamber tap with IL10 analysis (intermediate or posterior uveitis in patients over 40 years). Investigations ordered in the absence of orientation are almost always unhelpful.We propose a strategy for the etiologic diagnosis of uveitis. The recommendations should be updated regularly. The efficiency of more invasive investigations has yet to be evaluated.

Osteoarthritis (OA) is the main musculoskeletal disease leading to articular pain and stiffness. It is one of the leading causes of disability after 65 years of age. Longtime set aside and associated with inevitable aging, OA is also associated with obesity, female gender, joint injury, and trauma as well as metabolic diseases such as type 2 diabetes. Furthermore, OA has been associated with excess cardiovascular diseases and mortality raising many assumptions.

I dolori dell’arto superiore sono un motivo frequente di visita, modalita di espressione o di rivelazione di un campo molto vasto di malattie, che richiedono un iter incentrato su tre obiettivi: qual e il tipo di dolore? Qual e la topografia della lesione? Qual e la sua natura? L’esame clinico e essenziale, in quanto solo esso permette di distinguere i dolori di origine neurologica, articolare, ossea, muscolotendinea o vascolare.

Los dolores del miembro superior son un motivo de consulta frecuente y un modo de expresion o de revelacion de un amplio grupo de enfermedades que necesitan un enfoque centrado en tres objetivos: tipo de dolor, topografia de la lesion y naturaleza de la lesion. La exploracion fisica es fundamental para distinguir los dolores de origen neurologico, articular, oseo, musculotendinoso o vascular.

Ľarthrose est la pathologie articulaire la plus frequente touchant aussi bien les genoux, les hanches que les mains. Outre le vieillissement et les antecedents de traumatisme articulaire, ľobesite est un facteur de risque majeur ďarthrose des articulations portantes (hanches, genoux). Ceci s’explique par la transduction au niveau des chondrocytes de contraintes mecaniques excessives en un processus ďinflammation articulaire et de degradation enzymatique du cartilage. Il existe egalement un lien systemique entre arthrose et obesite, illustre par une augmentation du risque ďarthrose des mains (articulations non portantes) chez les sujets obeses, possiblement expliquee par les adipokines. Au-dela de ľarthrose liee a ľobesite, on definit desormais ľarthrose associee au syndrome metabolique (ou arthrose metabolique) englobant le lien avec ľobesite mais egalement ľassociation de ľarthrose avec les autres composantes du syndrome metabolique (hypertension arterielle, diabete ou insulino-resistance et dyslipidemie). De nombreux mecanismes physiopathologiques sont communs a ces pathologies telles que ľinflammation chronique de bas grade et le stress oxydant. Cette nouvelle approche de ľarthrose en fonction des phenotypes (metabolique, lie a ľâge ou post-traumatique) devrait permettre ďenvisager de nouvelles perspectives therapeutiques et de personnaliser la prise en charge des patients.

International audience; Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration

We used data from the AutoImmunity and Rituximab (AIR) registry to investigate the safety of surgery for patients with rheumatoid arthritis receiving rituximab (RTX) in routine care.Data for patients included in the AIR registry and undergoing surgery during the year following an infusion of RTX were reviewed to describe the frequency of postsurgical complications, compare patients with and without complications, and identify factors associated with complications.We examined data for 133 patients with a known date of surgery and at least 1 followup visit, corresponding to 140 procedures, including 94 orthopedic surgeries (67%) and 23 abdominal surgeries (16.5%). The median delay between surgery and the last RTX infusion was 6.4 months (interquartile range 4.3– 8.7 months), without any difference between patients with and without complications. Nine patients (6.7%) experienced 12 complications (8.5%), including 8 surgical site infections (5.7%) and 1 death due to septic shock. Postoperative complications occurred after 4.3% of abdominal surgeries (1 of 23) and 7.4% of orthopedic surgeries (7 of 95). On univariate analysis, spine surgery was associated with postoperative complications (P = 0.048).In common practice, the risk of complications may be more important in case of spine surgery, but does not seem to be linked to the time between the last RTX infusion and surgery.