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Matérialisée jadis par le tracé de la ligne verte de 1949, la frontière entre Israéliens et Palestiniens s’avère aujourd’hui flottante à bien des égards, bien qu’elle se manifeste par une séparation catégorique, concrétisée par une gestion particulière du territoire. Le présent article se penche sur l’œuvre autobiographique du chroniqueur palestinien Raja Shehadeh qui, dans le contexte de la colonisation israélienne de la Cisjordanie occupée, observe et commente l’évolution de la frontière depuis la fin des années 1970. Considérant la réalité multiculturelle et multilingue de cet espace de conflit, nous appliquerons à l’analyse certains outils et réflexions empruntés aux théories de la langue et de la traduction, permettant d’éclairer la nature de la relation entre les deux communautés. Abstract The border between Israelis and Palestinians, once marked by the Green Line of 1949, is now floating in many respects, although it manifests itself as a rigid separation, embodied in a particular management of the territory. This article focuses on the autobiographical work of Palestinian chronicler Raja Shehadeh, who, in the context of Israeli colonization of the occupied West Bank, observes and comments on the evolution of the border since the late 1970s. Considering the multicultural and multilingual reality of this space of conflict, we will apply to the analysis some tools and reflections borrowed from the theories of language and translation, allowing to shed light on the nature of the relationship between the two communities.

Objective Digital ulcers (DU) are a burden in systemic sclerosis (SSc). Microangiopathy is a cardinal feature of SSc that plays a critical role in the development of DU. However, whether injury of medium or large vessels also contributes to DU in SSc remains controversial. Methods To measure concomitantly in SSc patients with and without active DU: (i) the Augmentation Index of the reflected wave (Aix_75) by radial applanation tonometry, an index of small and medium arterial function; (II) the aortic pulse wave velocity (PWV), a marker of large vessel injury (aortic stiffness). Results Sixty-three consecutive SSc patients were included (49 females, aged 60 [49–65] years, disease duration of 8.5 [5–13] years), including 10 (15.9%) with active DU. Patients with active DU versus those without had increased Aix_75 (35% [28–38] versus 28% [20–34], P = 0.041) whereas no difference existed in PWV (7.0 m/s [6.7–10.1] versus 7.6 m/s [6.8–8.7], P = 0.887), in systolic, diastolic, as well as aortic pulse pressure ( P = 0.126, 0.592, and 0.161, respectively). When compared to patients in the low tertile, patients having Aix_75 in the highest tertile had 10-fold more DU (OR = 10.23; 95% CI 1.12 to 93.34, P = 0.039). Conclusion The presence of DU is associated with increased Aix_75 whereas there is no relation with PWV. These data suggest that small and medium arteries are involved in the occurrence of DU whether large vessel stiffness does not contribute. Whether Aix_75 is predictive of further DU remained to be studied.

In species that aggregate for reproduction, the social and fitness costs of movement between groups frequently lead to restricted exchange between breeding areas. We report on four individual humpback whales identified in both the Cape Verde Islands and Guadeloupe; locations separated by an ocean basin and >4000 km. This rate of exchange is rarely encountered between such geographically discrete breeding areas. Two individuals returned to the area where they were originally identified. In contrast, no individuals from the Cape Verde Islands were resighted to the much larger sample from the Dominican Republic, though the migratory distances from the feeding areas are comparable between these areas. The social factors driving the stark difference between groups that is observed here are not clear. Effective conservation requires an understanding of the extent and pattern of movement between population units. The findings presented here suggest that there may well be more than one behaviourally distinct group within the West Indies. More broadly, they argue that considerable caution is warranted in assumptions made regarding the number, boundaries and status of population units based solely on spatial separation or proximity.

Campylobacteriosis is the most prevalent bacterial foodborne gastroenteritis affecting humans in the European Union, and ranks second in the United States only behind salmonellosis. In Europe, there are about nine million cases of campylobacteriosis every year, making the disease a major public health issue. Human cases are mainly caused by the zoonotic pathogen Campylobacter jejuni. The main source of contamination is handling or consumption of poultry meat. Poultry constitutes the main reservoir of Campylobacter, substantial quantities of which are found in the intestines following rapid, intense colonization. Reducing Campylobacter levels in the poultry chain would decrease the incidence of human campylobacteriosis. As primary production is a crucial step in Campylobacter poultry contamination, controlling the infection at this level could impact the following links along the food chain (slaughter, retail and consumption). This review describes the control strategies implemented during the past few decades in primary poultry production, including the most recent studies. In fact, the implementation of biosecurity and hygiene measures is described, as well as the immune strategy with passive immunization and vaccination trials and the nutritional strategy with the administration of organic and fatty acids, essential oil and plant-derived compound, probiotics, bacteriocins and bacteriophages.

Campylobacteriosis is the most prevalent bacterial foodborne gastroenteritis affecting humans in the European Union. Human cases are mainly due toCampylobacter jejuniorCampylobacter coli, and contamination is associated with the handling and/or consumption of poultry meat. In fact, poultry constitutes the bacteria’s main reservoir. A promising way of decreasing the incidence of campylobacteriosis in humans would be to decrease avian colonization. Poultry vaccination is of potential for this purpose. However, despite many studies, there is currently no vaccine available on the market to reduce the intestinalCampylobacterload in chickens. It is essential to identify and characterize new vaccine antigens. This study applied the reverse vaccinology approach to detect new vaccine candidates. The main criteria used to select immune proteins were localization, antigenicity, and number of B-epitopes. Fourteen proteins were identified as potential vaccine antigens.In vitroandin vivoexperiments now need to be performed to validate the immune and protective power of these newly identified antigens.

This article examines the work of Niki Marangou, a Greek-language author from Cyprus. Her many stories and anecdotes, whether in poetry or prose, bring in a perspective of cultural geography as they open up places to a spatial imaginary on the crossroad of cartography and testimony. Conceptual tools developed in the field of contemporary Translation Studies may be used to articulate fresh and interesting views on the historical, cultural, political, and ideological contexts of her work, and show the cross-cultural literary dynamic in which her writing emerges.

Highlights • Poultry DNA vaccination studies are regularly being published since 1993. • These studies are mainly, but not only, concerned with vaccination against viruses. • The different strategies of improving DNA vaccine efficacies are presented. • The fate of the vaccine plasmid, immune properties and other applications are described. • Despite the compiling preclinical reports, a poultry DNA vaccine is yet unavailable in the market., DNA vaccination is a promising alternative strategy for developing new human and animal vaccines. The massive efforts made these past 25 years to increase the immunizing potential of this kind of vaccine are still ongoing. A relatively small number of studies concerning poultry have been published. Even though there is a need for new poultry vaccines, five parameters must nevertheless be taken into account for their development: the vaccine has to be very effective, safe, inexpensive, suitable for mass vaccination and able to induce immune responses in the presence of maternal antibodies (when appropriate). DNA vaccination should meet these requirements. This review describes studies in this field performed exclusively on birds (chickens, ducks and turkeys). No evaluations of avian DNA vaccine efficacy performed on mice as preliminary tests have been taken into consideration. The review first describes the state of the art for DNA vaccination in poultry: pathogens targeted, plasmids used and different routes of vaccine administration. Second, it presents strategies designed to improve DNA vaccine efficacy: influence of the route of administration, plasmid dose and age of birds on their first inoculation; increasing plasmid uptake by host cells; addition of immunomodulators; optimization of plasmid backbones and codon usage; association of vaccine antigens and finally, heterologous prime-boost regimens. The final part will indicate additional properties of DNA vaccines in poultry: fate of the plasmids upon inoculation, immunological considerations and the use of DNA vaccines for purposes other than preventing infectious diseases.

Vaccination of broilers is one of the potential ways to decrease Campylobacter intestinal loads and therefore may reduce human disease incidence. Despite many studies, no efficient vaccine is available yet. Using the reverse vaccinology strategy, we recently identified new vaccine candidates whose immune and protective capacities need to be evaluated in vivo. Therefore, the goal of the present study was to develop and evaluate an avian subunit vaccine protocol for poultry against Campylobacter jejuni. For this, flagellin was used as vaccine antigen candidate. A DNA prime/protein boost regimen was effective in inducing a massive protective immune response against C. jejuni in specific pathogen free Leghorn chickens. Contrastingly, the same vaccine regimen stimulated the production of antibodies against Campylobacter in conventional Ross broiler chickens harbouring maternally derived antibodies against Campylobacter, but not the control of C. jejuni colonization. These results highlight the strength of the vaccine protocol in inducing protective immunity and the significance of the avian strain and/or immune status in the induction of this response. Nevertheless, as such the vaccine protocol is not efficient in broilers to induce protection and has to be adapted; this has been done in one of our recent published work.

Cet article est un compte-rendu du livre : Bertrand Westphal, La Cage des méridiens. La littérature et l’art contemporain face à la globalisation, Paris, Les Éditions de Minuit, coll. « Paradoxe », 2016. EAN : 9782707329585.

Current challenges for poultry and poultry meat include traditional (Salmonella and Campylobacter) and emerging (Arcobacter and Helicobacter) biological hazards, as well as the spread of antimicrobial resistance leading to treatment failure against bacterial infections. In recent years, different control strategies have been studied and implemented both on live poultry and on poultry meat. Strategies at farm level, such as biosecurity, vaccination, feed additives, as well as at the slaughterhouse, such as poultry carcass decontamination, are reviewed along with new genomics approaches focused on improving the gut health and the disease resistance of animals. Moreover, new risk-based metrics such as the Appropriate Level of Protection, Food Safety Objective, and Performance Objective, are described as new concepts to increase the food safety for consumers. A holistic approach is envisaged involving all actors of human and veterinary medicine, animal husbandry, agriculture, environment, and legislation to face these risks.

The thymus plays a crucial role in immune system homeostasis. Thymic abnormalities have been reported in many autoimmune diseases, but data for systemic sclerosis (SSc) and rheumatoid arthritis (RA) are sparse. The aim of this study was to evaluate the prevalence and correlates of radiological incomplete involution of the thymus in SSc and RA patients, and in a non-autoimmune group of controls.All patients were at least 40 years old: 96 SSc patients (median age 59 years, 80% women) and 65 RA patients (median age 57 years, 88% women) were compared with 32 control individuals (median age 63 years, 62% women). Pulmonary CT-scans performed for lung assessment were available for all individuals. For the purpose of our study, complete involution of the thymus was defined as the absence of a residual thymus or a gland thickness, corresponding to the short axis on the axial slice, of less than 7 mm. We defined incomplete involution of the thymus as a residual thymic tissue more than 7 mm thick.The frequency of incomplete thymus involution was significantly higher in SSc and RA patients (respectively 15 and 14%) than in the control group (0%; P0.05). Incomplete thymus involution was associated with pulmonary restrictive syndrome in SSc patients, and with biotherapy and an absence of antinuclear antibodies in RA patients.Our findings show that two autoimmune diseases, SSc and RA, are associated with incomplete thymus involution.

Cet article est un compte-rendu du livre : Migrations/translations, sous la direction de Maroussia Ahmed, Corinne Alexandre-Garner, Nicholas Serruys, Iulian Toma et Isabelle Keller-Privat, Nanterre : Presses universitaires de Paris Ouest, coll. « Chemins croisés », 2015, 550 p., EAN 9782840162261.

Resume Objectif Les recommandations de la Haute Autorite de sante (HAS) sur la prise en charge therapeutique de la polyarthrite rhumatoide (PR) ont ete diffusees en 2007. Aucune etude n’a evalue l’impact de ces recommandations en pratique courante. L’objectif de notre etude monocentrique, observationnelle etait d’evaluer leur impact en pratique courante. Methodes Ont ete inclus des patients atteints de PR traites par immunotherapie entre 2006 et 2009. Les criteres choisis pour considerer qu’un patient avait atteint l’objectif therapeutique de la HAS etait un DAS28 inferieur ou egal a 3,2 et une corticotherapie inferieure ou egale a 5 mg/jour. L’impact des recommandations a ete mesure en comparant les pourcentages de patients repondant a l’objectif therapeutique de la HAS avant (periode A) et apres (periode B) leur diffusion. Resultats Les caracteristiques clinico-biologiques des 334 patients inclus (periode A = 279 ; periode B = 253) etaient : âge = 54 ans (18–83) ; anciennete de la PR = sept ans (0–53) ; DAS28 = 5,4 (2–8) ; corticotherapie = 7 mg/j (0–60). La proportion de patients repondant aux recommandations etait plus importante au cours de la periode B qu’au cours de la periode A (56 % versus 44 %, p = 0,007). Les pourcentages de patients pour lesquels les schemas therapeutiques de la HAS avaient ete suivis etaient de 71 % et 61 % respectivement au cours des periodes B et A (p = 0,24). Conclusion Cette etude montre qu’une majorite de patients a atteint l’objectif therapeutique de la HAS. L’augmentation de la proportion de patients remplissant l’objectif therapeutique entre les deux periodes suggere une prise en compte de ces objectifs bien que les schemas therapeutiques fussent deja suivis.

Resume Objectifs Le thymus joue un role crucial dans l’homeostasie du systeme immunitaire. Des anomalies du thymus ont ete rapportees dans de nombreuses maladies auto-immunes mais les donnees sur la sclerodermie systemique (ScS) et la polyarthrite rhumatoide (PR) sont rares. Le but de cette etude etait d’evaluer la prevalence et la correlation entre l’involution radiologique incomplete du thymus chez les patients porteurs de sclerodermie systemique et de polyarthrite rhumatoide compares a un groupe temoin d’affections non auto-immunes. Methode Tous les patients etaient âges d’au moins 40 ans : 96 ScS (âge moyen 59 ans, 80 % de femmes) et 65 PR (âge moyen 57 ans, 88 % de femmes) et ont ete compares a 32 sujets temoins (âge moyen 63 ans, 62 % de femmes). Des tomodensitometries pulmonaires etaient disponibles pour tous les sujets. Dans le but de cette etude, une involution complete du thymus a ete definie par l’absence de thymus residuel ou d’une epaisseur de la glande de moins de 7 mm sur le petit axe de la coupe axiale. Nous avons defini l’involution incomplete du thymus comme un tissu thymique residuel de plus de 7 mm d’epaisseur. Resultats La frequence de l’involution thymique incomplete est significativement plus importante dans la sclerodermie systemique et la polyarthrite rhumatoide (respectivement 15 % et 14 %) que dans le groupe temoin (0 % ; p Conclusion Nos resultats montrent que deux maladies auto-immunes, la sclerodermie systemique et polyarthrite rhumatoide, sont associees a une involution thymique incomplete.

Resume Objectif Le rituximab (RTX) semble bien tolere au cours de la polyarthrite rhumatoide (PR). Il a toutefois ete montre un impact sur le profil des gammaglobulines pouvant modifier le risque infectieux. Determiner l’impact sur les concentrations de gammaglobulines et le risque infectieux de l’utilisation en pratique courante du RTX dans la PR. Methodes Serie prospective monocentrique de 65 patients atteints de PR refractaire (âge median 59 ans [26–83]). Les patients ont recu 1 g de RTX renouvele a 15 jours d’intervalle, puis un re-traitement par 1 g apres un intervalle minimum de six mois, defini selon la reponse apres le premier cycle. Des dosages de gammaglobulines etaient effectues avant chaque perfusion. Resultats La dose mediane de RTX administree a ete de 4 g (1–16), le delai moyen de re-traitement de huit mois (6–16). Le RTX a permis une amelioration significative du score d’activite DAS28. La concentration de gammaglobulines a baisse significativement entre la premiere et la derniere cure de RTX (11,6 g/L (5–26) versus 8,2 g/L (3–20) ; delta = 2,6, p p Conclusion Ces resultats obtenus en pratique courante confortent la bonne tolerance clinique du RTX dans la PR, mais egalement une tendance a une baisse des gammaglobulines avec une influence de la dose cumulee.

Rituximab seems well tolerated in patients with rheumatoid arthritis (RA). However, variations in the gammaglobulin profile that might increase the infection risk have been reported. Here, our objective was to evaluate gammaglobulin concentrations and the infection risk in patients receiving rituximab therapy for RA in everyday practice.Prospective single-center observational study of 65 patients with refractory RA (median age, 59 years; range, 26-83) treated with rituximab 1 g twice 15 days apart, with or without a further 1-g dose at least 6 months later depending on the clinical response. Gammaglobulins were assayed before each rituximab dose.The median cumulative rituximab dose was 4 g (1-16) and the median time to retreatment was 8 months (6-16). Rituximab therapy significantly improved the DAS-28 score. The gammaglobulin concentration decreased significantly between the first and last rituximab dose (from 11.6 g/L [5-26] to 8.2 g/L [3-20], a -2.6 g/L difference; P0.05). The decrease was larger in the 24 patients with cumulative rituximab doses greater than 5 g than in the 41 other patients (difference of -4 vs. -2.7 g/L; P0.05). Three patients experienced severe infections, two in the high-dose group and one in the other group (P=0.5).These data obtained in everyday practice constitute further evidence that rituximab is well-tolerated in patients with RA. Rituximab therapy was associated with a decrease in gammaglobulin concentrations that was greater in patients receiving higher cumulative doses.

Resume Nous rapportons l’observation d’une patiente de 38 ans hospitalisee dans notre service pour le bilan de lesions osteolytiques. Elle presentait des douleurs dorsolombaires et costales apparues dans les suites du diagnostic d’une hyperthyroidie sur goitre multi-heteronodulaire toxique. Les douleurs ont persiste malgre un traitement chirurgical du goitre. L’examen clinique retrouvait des taches cutanees « cafe au lait ». Le bilan phosphocalcique a mis en evidence un diabete phosphate. Les radiographies montraient des lesions lytiques costales ainsi que des fractures vertebrales dorsales. Au scanner, presence de multiples lesions touchant le rachis, les cotes, le sternum, les ailes iliaques et le sacrum avec un aspect typique en verre depoli. Le diagnostic de syndrome de McCune-Albright a ete porte devant cette triade caracteristique. Le traitement a consiste en une supplementation en vitamine D ainsi qu’en de fortes doses de phosphore et de 1–25 OH vitamine D3 pour le diabete phosphate ; un traitement par bisphosphonates intraveineux a ete introduit pour la prise en charge des douleurs osseuses. Nous rapportons une observation inhabituelle de syndrome de McCune-Albright revele tardivement dans les suites d’une hyperthyroidie. Nous pensons que les lesions de dysplasie fibreuse sont devenues symptomatiques du fait de l’hyper remodelage osseux lie a l’hyperthyroidie.

Campylobacter is the leading cause of human bacterial gastroenteritis in the European Union. Birds represent the main reservoir of the bacteria, and human campylobacteriosis mainly occurs after consuming and/or handling poultry meat. Reducing avian intestinal Campylobacter loads should impact the incidence of human diseases. At the primary production level, several measures have been identified to reach this goal, including vaccination of poultry. Despite many studies, however, no efficient vaccine is currently available. We have recently identified new vaccine candidates using the reverse vaccinology strategy. This study assessed the in vivo immune and protective potential of six newly-identified vaccine antigens. Among the candidates tested on Ross broiler chickens, four (YP_001000437.1, YP_001000562.1, YP_999817.1, and YP_999838.1) significantly reduced cecal Campylobacter loads by between 2 and 4.2 log10 CFU/g, with the concomitant development of a specific humoral immune response. In a second trial, cecal load reductions results were not statistically confirmed despite the induction of a strong immune response. These vaccine candidates need to be further investigated since they present promising features.

It is unclear whether bone mineral density (BMD) improves in patients with normocalcemic primary hyperparathyroidism (PHPT) after parathyroidectomy (PTX).The objective of the study was to evaluate and compare the impact of PTX on BMD change at 1 year in normocalcemic vs hypercalcemic PHPT.This was a longitudinal cohort study.The study took place at a referral center.We included 60 PHPT patients (mean age 64.0 ± 10.1 years), successfully treated by PTX by the same surgeon. Two groups were individualized according to baseline serum total (albumin corrected) calcium: 39 patients with normal baseline serum total calcium (normocalcemic group) and 21 patients with hypercalcemia at baseline (hypercalcemic group).BMD changes 1 year after PTX were measured.In the normocalcemic group, BMD increased significantly by +2.3 ± 5.0% at the spine (P = .016) and +1.9 ± 5.7% at the hip (P = .048). In the hypercalcemic group, BMD increased significantly by +4.0 ± 3.8% at the spine (P = .0003) and +3.2 ± 4.2% at the hip (P = .003). There was no difference in these BMD gains between both groups (P.1). The presence of multiple adenomas or hyperplasia was more frequent in the normocalcemic group than in the hypercalcemic group (P = .04).Our results indicate for the first time that successful PTX in normocalcemic PHPT patients with osteoporosis is followed with mild but significant BMD improvement at the spine and hip at 1 year, comparable with that observed in hypercalcemic PHPT, suggesting that PTX may be beneficial in normocalcemic PHPT.

Objective.Whipple disease is a rare infection caused by Tropheryma whipplei. Although patients commonly complain of osteoarticular involvement, musculoskeletal manifestations have been poorly described. We report cases of Whipple disease with rheumatic symptoms and describe their clinical presentation, modes of diagnosis, and outcomes.Methods.This retrospective multicenter study included patients with Whipple disease diagnosed and referenced between 1977 and 2011 in 10 rheumatology centers in France and Italy.Results.Twenty-nine patients were included. The median age was 55 years. The median time to diagnosis from first symptoms was 5 years. Polyarthritis was the most frequent presentation (20/29), and was most often chronic, intermittent (19/29), seronegative (22/23), and nonerosive (22/29). In all cases, the symptoms had led to incorrect diagnosis of inflammatory rheumatic disease and immunosuppressants, including biotherapy, were prescribed in most cases (24/29) without success. The diagnosis of Whipple disease was made by histological analysis, molecular biology tests, or both in 21%, 36%, and 43% of the cases, respectively. Duodenal biopsies were performed in most cases (86%). Synovial biopsies were performed in 18% of cases, but all contributed to diagnosis. The clinical outcomes after antibiotic therapy were good for all patients.Conclusion.Polyarthritis is the main feature observed in cases of Whipple disease; it is seronegative and associated with general and gastrointestinal symptoms. The molecular analysis of duodenal tissue and/or other tissues remains the method of choice to confirm the diagnosis. Reducing the time to diagnosis is important because severe late systemic and fatal forms of the disease may occur.

Introduction The excess of adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetic consequences. The aim of this study was to determine whether body mass index (BMI) affects response to infliximab (IFX) in ankylosing spondylitis (AS) patients. Methods In 155 patients retrospectively included with active AS, the BMI was calculated before initiation of IFX treatment (5 mg/kg intravenously). After 6 months of treatment, changes from baseline in BASDAI, Visual Analogue Scale (VAS) pain, C-reactive protein (CRP) level, and total dose of nonsteroidal antiinflammatory drug (NSAID) were dichotomized with a threshold corresponding to a decrease of 50% of initial level of the measure, into binary variables assessing response to IFX (BASDAI50, VAS50, CRP50, NSAID50). Whether the BMI was predictive of the response to IFX therapy according to these definitions was assessed with logistic regression. Results Multivariate analysis found that a higher BMI was associated with a lower response for BASDAI50 (P = 0.0003; OR, 0.87; 95% CI (0.81 to 0.94)), VAS50 (P < 0.0001; OR, 0.87; 95% CI (0.80 to 0.93)); CRP50 (P = 0.0279; OR, 0.93; 95% CI (0.88 to 0.99)), and NSAID50 (P = 0.0077; OR, 0.91; 95% CI (0.85 to 0.97)), criteria. According to the three WHO BMI categories, similar results were found for BASDAI50 (77.6%, 48.9%, and 26.5%; P < 0.0001), VAS50 (72.6%, 40.4%, and 16.7%; P < 0.0001); CRP50 (87.5%, 65.7%, and 38.5%; P = 0.0001), and NSAID50 (63.2%, 51.5%, and 34.6%; P = 0.06). Conclusions This study provides the first evidence that a high BMI negatively influences the response to IFX in AS. Further prospective studies, including assessment of the fat mass, pharmacokinetics, and adipokines dosages are mandatory to elucidate the role of obesity in AS IFX response.

Objective To investigate whether women with systemic sclerosis (SSc) have an increased risk of osteoporosis (OP) and related fractures compared to a high-risk population with rheumatoid arthritis (RA) and also healthy controls, and to determine putative specific OP and fracture risk factors. Methods We performed a cross-sectional study with successive inclusion of age-matched healthy women and women with SSc and RA. Risk factors for OP and fracture were collected for all patients. Bone mineral density (BMD) was systematically measured at the lumbar spine and total hip region with dual x-ray absorptiometry. Results We included 71 women with SSc, 139 women with RA, and 227 healthy women. The prevalence of OP and fracture was similar in SSc and RA, and was for both diseases higher than in healthy controls (OP: 30% in SSc, 32% in RA, and 11% in controls; fracture: 35% in SSc, 33% in RA, and 10% in controls). Multivariate analysis identified age as a risk factor of OP in SSc. Age and low 25-hydroxyvitamin D (25[OH]D) levels were recognized as risk factors of fracture in SSc. In comparison, age and corticosteroid treatment were associated with OP in RA. Multivariate analysis confirmed age, OP, and low 25(OH)D levels as independent risk factors of fractures in RA. Conclusion The prevalence of OP and fracture in SSc was increased compared to healthy women and reached the high prevalence associated with RA. Age and vitamin D deficiency were identified as risk factors of fracture in SSc. Therefore, increasing the awareness and performance of BMD measurements together with the vitamin D supply in patients with SSc is warranted.

Objectives To investigate whether women with SSc have increased risk of OP and fractures compared to a “high risk” population with rheumatoid arthritis (RA) and also healthy controls. Methods Cross-sectional study with successive inclusion of age-matched healthy, SSc, and RA women on a 18-month period. Risk factors for OP and fractures, including age, menopausal status, calcium/vitamin D intake, family history, comorbidity and steroid use, were collected for all patients. Bone mineral density (BMD) was assessed at AP lumbar spine (L1-L4), femoral neck, and total hip region with DXA Prodigy (GE-Lunar) or QDR4500 (Hologic). We included 71 women with SSc (62±12 years old), 139 with RA (61±11 years old) and 227 healthy controls (60±8 years old). The mean ± standard deviation, SD, disease duration of SSc and RA patients was 10±9 and 18±13 years respectively (p vs. 19392±19333 mg, p vs. 7±7.9 mg/l, p=0.01). Results The point prevalence of OP (T-score vs. SSc and RA). The frequency of lumbar spine and total hip OP did not differ between SSc and RA. The point prevalence of fractures was 35% and 33% in SSc and RA, respectively (p=NS) and 10% in healthy controls (p vs. SSc and RA). The frequency of vertebral (25% and 19%) and non-vertebral fracture (23% and 22%) did not differ between SSc and RA. Multivariate analysis identified disease duration as the only risk factor of OP in SSc (odds ratio, OR: 1.21, 95% confidence interval, CI: 1.02-1.30). There was no association between OP and corticosteroid intake, cumulative dose of corticosteroids, systemic inflammation (CRP >10mg/l) or any SSc feature Age (OR: 1.21, 95% CI 1.03-1.38) and low 25(OH)D levels (OR: 6.02, 95% CI 1.46-24.78) were recognized as risk factors of fracture in SSc. In comparison, age (OR: 1.12, 95% CI 1.02-1.26) and corticosteroid treatment (OR: 3.21, 95% CI: 1.12-10.44) were independently associated with OP in RA. Cumulative dose of corticosteroids negatively correlated with BMD measured at lumbar spine (r=0.38, p=0.01) and total hip (r=0.49, p=0.008) in RA patients. Multivariate analysis confirmed age (OR: 1.09, 95% CI 1.03-1.18), OP (OR: 3.22, 95% CI 1.18-8.75) and low 25(OH)D levels (OR: 4.31, 95% CI 1.29-14.41) as independent risk factors of fractures in RA. Conclusions The prevalence of OP and fracture in SSc was increased compared to healthy women and reached the high prevalence associated with RA. Age and vitamin D deficiency were identified as risk factors of fracture in SSc. Thus, increasing the awareness and performance of BMD measurements together with vitamin D supply in patients with SSc is warranted. Disclosure of Interest None Declared

Background Digital ulcers (DU) are a burden in systemic sclerosis (SSc). Microangiopathy is a cardinal feature of SSc that plays a critical role in the development of DU. However, whether injury of medium or large vessels also contributes to DU in SSc is unknown. Methods To measure concomitantly in SSc patients with and without active DU i) the Augmentation Index of the reflected wave (Aix_75) by radial applanation tonometry, an index of small and medium arterial function, II) the aortic pulse wave velocity (PWV), a marker of large vessel injury (aortic stiffness). Results 63 consecutive SSc patients were included (49 females, aged 57±12 years, disease duration 9.7±7.1 years), including 10 (15.9%) with active DU. Patients with active DU versus those without had increased Aix_75 (35% [28-38] versus 28% [20-34], p=0.041) whereas no difference existed in PWV (7,0m/s [6.7-10.1] versus 7,6m/s [6.8-8.7], p=0.887), in systolic, diastolic, as well as aortic pulse pressure (p=0.126, 0.592, and 0.161 respectively). By multivariate analysis, DU remained independently associated with Aix_75 (p=0.020). Using Aix_75 as a longitudinal variable, and when compared to patients in the low tertile, patients having Aix_75 in the highest tertile had ten-fold more DU (OR=10.23; 95% CI 1.12 to 93.34, p=0.039). Conclusion The presence of DU is independently associated with Aix_75 whereas there is no relation with PWV. These data suggest that small and medium arteries are involved in the occurrence of DU whether large vessel stiffness does not contribute. Whether Aix_75 is predictive of further DU remained to be studied.