Search

International audience; To develop and validate a questionnaire assessing patient knowledge in rheumatoid arthritis (RA). Knowledge considered essential for patients with RA was identified through a series of Delphi rounds among rheumatologists, health professionals (HPs), patients, and then reformulated to construct the knowledge questionnaire. Cross-sectional multicenter validation was performed in 12 rheumatology departments to assess internal validity (Kuder\textendash Richardson coefficient), external validity, acceptability, reproducibility (Lin's concordance correlation coefficient) and sensitivity to change (difference in total score before and after patient education sessions). Associations between patient variables and knowledge levels were evaluated. RAKE (RA Knowledge questionnairE) is a self-administered 45-item questionnaire scored 0\textendash 100, with a 32-item short-form survey assessing knowledge of disease, comorbidity, pharmacological treatments, non-pharmacological treatments, self-care and adaptative skills. Of 130 patients included in the validation study, 108 were women. Acceptability was good with\

Resumen Objectifs: Si l’on considere le vaste perimetre que couvre la rhumatologie et la prevalence de la douleur au cœur de cette specialite, il nous a semble necessaire de mener une etude sur les habitudes de prescription dans le contexte de l’epidemie internationale des opioides et compte tenu de l’efficacite moderee des opioides forts dans le traitement des affections osteo-articulaires chroniques. Nous avons compare les pratiques de prescription d’opioides en rhumatologie francaise dans la douleur chronique non cancereuse et propose des recommandations de bonne pratique clinique. Methodes: Nous avons realise une etude transversale de la base de donnees de l’assurance maladie en France, incluant tous les patients âges de 16 ans ou plus ayant recu au moins un opioide fort sur prescription d’un rhumatologue en 2015. Une enquete nationale aupres de tous les rhumatologues francais a ete realisee en juin 2015 a l’aide d’un questionnaire en 47 items. Resultats: Seuls 2,4 % des patients ayant recu un opioide fort en 2015 (n = 700 946) avaient au moins une prescription d’un rhumatologue. Les rhumatologues prescrivaient davantage de morphine et significativement moins d’oxycodone et de fentanyl (p Conclusions: Pour soulager la douleur chronique non cancereuse, les rhumatologues prescrivaient generalement des opioides pour une courte duree, a des doses reduites, majoritairement en adequation avec les recommandations nationales. La formation a la prise en charge de la douleur influencait la prescription d’opioides par les rhumatologues.

Post-operative pain is a common symptom of ambulatory surgery. The objective of this study was to evaluate a pain management protocol integrating a pharmacist consultation. We conducted a quasi-experimental, single center, before-after study. The control group was recruited between 1 March and 31 May 2018 and the intervention group between 1 March and 31 May 2019. Outpatients in the intervention group received a pharmacist consultation, in addition to the usual anesthesiologist and nurse consultations. Pharmacist consultations were conducted in two steps: the first step consisted of general open-ended questions and the second step of a specific and individualized pharmaceutical interview. A total of 125 outpatients were included in each group. There were 17% (95% CI 5 to 27%, p = 0.022) fewer patients with moderate to severe pain in the pharmaceutical intervention group compared with the control group, which corresponded to a decrease in the mean pain level of 0.9/10 (95% CI −1.5/10; −0.3/10; p = 0.002). The multivariate analysis did not reveal any confounding factors, showing that only the pharmaceutical intervention could explain this result. This study demonstrates a positive impact of pharmacist consultations on postoperative pain in ambulatory surgery.

Non-cancer pain of the locomotor apparatus is the main symptom justifying referral to a rheumatologist with potential introduction of opioids, leading to addiction if misused. The objective was to evaluate the impact of a personalized pharmaceutical plan on patients' knowledge of their opioid treatment and its duration. This prospective non-randomized pilot study was conducted during 7 months with standardized data collected in a French rheumatology department. Patients with rheumatic diseases and non-cancer pain requiring opioid treatment were included. The intervention group had a 30-min opioid-targeted pharmaceutical interview and received a full medication plan and the control group received usual care. A total of 17 patients were included in the intervention group and 18 in the control group. Among patients in the intervention group, only 6 (35%) knew that immediate-release opioids have a rapid and short action, 9 (53%) were worried about taking opioids, and 13 (76%) reported that they would refer to the information document provided if side effects occurred. A trend toward a shorter duration of treatment was observed in the study group (HR = 1.87, 95% CI 0.93 to 3.76, p = 0.08), but this trend was attenuated when adjusting on hospital duration (HR = 1.53, 95% CI 0.74 to 3.15, p = 0.25). This pilot study provides preliminary evidence on the role of the clinical pharmacist in the management of non-cancer pain with strong opioids. Clinical benefits will be assessed in a randomized study. Key Points • Knowledge of opioids is insufficient in rheumatology patients with non-cancer pain. • Pharmaceutical interviews may improve patients' knowledge of opioids.

Resume Objectif Proposer une liste de variables a collecter des le diagnostic et tout au long du suivi des patients atteints de spondyloarthrite axiale (SpA axiale) pour optimiser leur prise en charge en routine. Methodes Le processus s’est deroule en plusieurs etapes : (1) estimation de l’interet de 51 variables proposees pour l’evaluation de la SpA axiale via une recherche systematique dans la litterature ; (2) consensus de 78 rhumatologues hospitaliers ou de ville notant chaque variable selon un bareme de 4 points de « Peu utile/Inutile » a « Indispensable » ; (3) consensus sur la frequence minimale d’evaluation des variables selectionnees selon un bareme de 5 points allant de « A chaque consultation » a « Jamais systematiquement ». Resultats La recherche systematique a identifie 14 133 resumes dont 213 ont ete inclus dans la synthese qualitative finale. Les donnees a collecter lors du bilan systematique initial comprenaient cinq questionnaires patient auto-administres, trois variables de l’entretien avec le medecin, deux variables de l’examen physique, deux variables de l’imagerie specifique a la SpA axiale et deux autres examens. La collecte systematique a ete recommandee a chaque visite pour deux variables, deux fois par an pour une variable, une fois par an pour six variables et tous les deux ans pour une variable. Conclusions Cette initiative a utilise des approches fondees sur des preuves et sur un consensus d’experts pour definir un ensemble de base de variables a collecter et a consigner immediatement apres le diagnostic et pendant le suivi de routine des patients atteints de SpA axiale.

To determine a potential window of opportunity for retreatment with rituximab in patients with rheumatoid arthritis (RA) from a multicentre longitudinal real-life study based on tight monitoring with ultrasonography (US).Thirty RA patients treated with rituximab were included. US parameters were collected at each time (8 visits) of the 18-month follow-up, notably the global score of power Doppler (PD) activity. Clinical relapse was defined as a DAS28 ESR of3.2 after 6 months in responders while US relapse was defined as an increase of ≥20% of the global score of PD activity. The decision of retreatment was based exclusively on clinical findings.A total of 29 patients were analysed (mean (SD) age: 57.2 (12.2) years; female gender: 66%). The mean (SD) PD score decreased from 8.8 (5.2) at baseline to 4.9 (4.3) at 6 months (p0.0001). A clinical response was observed at Month 4 or Month 6 for 93% of patients. A total of 19 patients had a first clinical relapse (with or without US relapse) after Month 6 (18 of them were retreated with rituximab). Among 10 patients without clinical relapse, 3 had US relapse (only one was retreated) and 7 had no US relapse (but 4 were retreated).This study highlights a great heterogeneity in terms of sequence of clinical relapse, US relapse and retreatment in RA patients receiving rituximab. Therefore, US monitoring does not seem to be relevant to determine the best time for retreatment with rituximab.

This study aims to evaluate in patients hospitalized for vertebral osteomyelitis (VO) the effectiveness of bacteriological diagnosis and the yield of percutaneous needle biopsy (PNB) and to identify factors associated with the result of PNB. This retrospective, two-centre study was conducted between 2000 and 2009. Data on patients with VO were retrieved from the diagnosis database and confirmed by checking medical records. A total of 300 patients with VO were identified; 31 received antibiotics without bacteriological diagnosis, and 269 patients with spondylodiscitis imaging were included. Eighty-three (30.9%) and 18 (6.7%) infections were documented by blood cultures and by bacteriological samples other than PNB, respectively; 168 patients with no bacteriological diagnosis had PNB. Of these, 92 (54.8%) were positive and identified the pathogen and 76 (45.2%) were negative. The most common bacteria were Staphylococcus aureus (34.3%), Streptococcus spp. (20.6%) and coagulase-negative staphylococcus (14.8%). After multivariate analysis, the only factor associated with negative PNB was previous antibiotic intake (OR: 2.31 [1.07-5.00]). When VO was suspected on imaging, bacteriological investigation identified the microorganism in 209/300 (70%) of the cases. The yield of PNB was 54.8%. The only predictor of PNB negativity was previous antibiotic intake. Therefore, we believe that a second PNB should be done after a sufficient delay withdrawal of antibiotics if the first sample was negative. The study was retrospectively registered by the local ethics committee (N°E2019-61).

Background Pain remains a prevalent symptom for rheumatoid arthritis (RA) patients despite a wide therapeutic choice. The objective of this study was to provide a multidimensional evaluation of pain. Methods A total of 295 RA patients from 7 French rheumatology centres were enrolled in a cross‐sectional study. Patients completed a chronic pain assessment questionnaire approved by the French National Authority for Health, the health assessment questionnaire (HAQ) as well as depression and anxiety scales (HAD, Beck Depression Inventory, STAI). Disease activity (DAS28) and ESR were recorded. A multivariate descriptive analysis was undertaken using principal component analysis (PCA). Results 38.4% of patients had a pain score > 40 mm/100, although 83% were on biological treatment and 38.7% were in remission based on the RA activity score. The PCA analysis found four axes representing 70% of total variance. The axes, per cent of variance and variables represented were as follows: (a) axis 1, 41% variance, anxiety and depression scores, sensory and affective qualifier score, HAQ and pain impact on daily life; (b) axis 2, 13% variance, disease activity score (DAS28) and pain relief with current treatment; (c) axis 3, 9% of variance, RA duration and radiographic score and (d) axis 4, 6% of variance, DAS28 and ESR. Moderate to severe pain was significantly associated with axes 1 and 2. Conclusions Despite a high proportion of patients on biological treatments, 38.4% of patients continue to experience moderate to severe pain. Pain is associated with the RA activity score, but also with the depression and anxiety scores. Significance Substantial proportion of rheumatoid arthritis (RA) patients still experiences relevant pain, although more than 80% on biological treatment. Pain is primarily associated with anxiety and depression scores and with disease activity score. These findings highlight the need to assess patients’ mental well‐being alongside. Clinical measures of disease activity to better manage pain and guide treatment decisions.

To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities.Prospective, randomized, controlled, open, 12-month trial (NCT02374749).consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) THE PROGRAM: A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. TREATMENT ALLOCATION: random allocation (i.e. either this program or an educational program not presented here and considered here as the control group).change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management).502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p0.01).This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.

This work aimed to assess treatment adherence in rheumatoid arthritis patients with several tools and to identify factors associated with poor adherence.Between February and December 2015, 183 patients were included in this cross-sectional study. A homemade 23-item self-questionnaire was filled by patients during an outpatient consultation or a day hospitalization stay. Morisky Medication Adherence Scale (MMAS)-4, MMAS-8 and Girerd scores were extracted from this homemade questionnaire. Medication possession ratio (MPR) was then calculated. For identification of factors associated with nonadherence, patients were divided in two groups according to MMAS-8 results differentiating patients with good or bad adherence to treatments.Of the 183 patients, 59% received a combination of biologic and conventional synthetic disease-modifying drugs, 22% a biological treatment alone, and 19% a conventional DMARD alone. Respectively, 3%, 10%, and 7% were considered as low adherent according to MMAS-4, MMAS-8, and Girerd scores. MPR was calculated for 84/183 patients; 23% were low adherent. The need for a help in preparing the drugs (p = 0.05; OR = 6.12; 95% CI: 0.86 to 268.90) and concomitant diabetes (p0.001; OR = 0.045, 95% CI: 0.001 to 0.299) was higher in patients with good adherence. Presence of a patient's relative reminding to take medications was associated with low adherence (p = 0.002; OR = 4.32, 95% CI: 1.41 to 13.11).This study highlighted the difficulty of assessing treatment adherence in rheumatoid arthritis patients despite four different tools. Objective measures by MPR indicated a higher proportion of poor adherent patients than self-questionnaires.Key Points• Proportion of patients considered as low adherent ranged from 3 to 27% according to the method of evaluation.• The use of a pillbox and/or the preparation of drugs by a patient's relative was associated with good adherence.• The presence of a patient's relative reminding to take medication was associated with low adherence.

Background Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. Objective We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. Methods We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. Results Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. Conclusions This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. Trial Registration ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694

BACKGROUND Chronic pain affects approximately 30% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. OBJECTIVE We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. METHODS We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. RESULTS Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3%), and a low rate of completion of the follow-up questionnaires and assessments (63.8% (67/105) and 61.9% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. CLINICALTRIAL ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694

Objective To propose a list of variables to be collected right after the diagnosis has been made and during the follow-up of patients with axial spondyloarthritis (ax-SpA) for an optimal management in daily practice. Methods The process comprised (1) the evaluation of the interest of 51 variables proposed for the assessment of ax-SpA by means of a systematic literature research; (2) a consensus process involving 78 hospital-based or office-based rheumatologists, considering the collection of each variable in a 4 grade scale from “not very useful/useless” to “mandatory”; (3) a consensus on the minimum interval of time for periodic assessment of the selected variables on a 5 grade scale from “at each visit” to “never to be re-collected”. Results The systematic literature research retrieved a total of 14,133 abstracts, of which 213 were included in the final qualitative synthesis. Data to be collected at the initial systematic review comprised 5 patient's self-administered questionnaires, 3 variables of the physician's interview, 2 variables of the physical examination, 2 variables of the specific ax-SpA imaging and 2 other investigations. Two variables were recommended to be systematically collected at each visit, 1 variable twice a year, 6 variables yearly and 1 variable every 2 years. Conclusions Using an evidence-based and an expert consensus approaches, this initiative defined a core set of variables to be collected and reported right after the diagnosis and during follow-up of patients with ax-SpA in daily practice.

Resume Contexte L’information et l’education (ETP) du patient sont recommandees pour les patients atteints de rhumatisme inflammatoire chronique (RIC) : polyarthrite rhumatoide (PR) et spondyloarthrite (SpA). Cependant, il n’y a pas de consensus sur les connaissances essentielles destinees a ameliorer l’autogestion par les patients de leur maladie. Le but de cette etude etait de determiner ces connaissances. Methodes A partir des questionnaires de connaissances patients (QC) publies et selectionnes par une revue de la litterature, une liste d’elements de connaissances a ete etablie, classes par domaines et sous-domaines. Un processus Delphi conduit aupres de rhumatologues, professionnels de sante et des patients en 2014-2015, a selectionne les elements juges utiles. Resultats Trois QC publies ont ete analyses : 2 pour la PR, 1 pour la SpA ; 5 QC non publies ont egalement ete recueillis. Dans les QC, 90 items de connaissances etaient mentionnes pour la PR et 67 pour la SpA. Le processus Delphi a implique de 18 a 32 participants a chaque tour. Le premier tour Delphi a elargi la liste a 322 items pour PR et 265 items pour SpA. Le deuxieme tour a selectionne 69 et 59 items pour la PR et la SpA respectivement, dont 36 (52 %) et 34 (57 %) n’etaient pas presents ou ont ete modifies par rapport aux QC publies. Les domaines cles concernaient les traitements pharmacologiques, la gestion de la fatigue, les competences d’adaptation tels que les aspects socioprofessionnels, la communication patient-soignant et la prise de decision partagee. Conclusion Cette etude a permis d’obtenir un corpus de connaissances considerees comme essentielles pour les patients pour faciliter la gestion de leur rhumatisme inflammatoire. Le choix de nombreux elements reflete l’accent mis recemment sur les recommandations professionnelles et le point de vue des patients. Cette etude permettra de developper de nouveaux QC actualises pour les patients.

Objective To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis. Methods Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group). Results A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ). Conclusion This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.

ObjectiveTo evaluate the effect of a nurse-led patient education on safety skills of patients with inflammatory arthritis treated with biologic disease-modifying antirheumatic drugs (bDMARDs).MethodsThis is a multicentre, open-labelled, randomised controlled trial comparing an intervention group (face-to-face education by a nurse at baseline and 3 months later) with a control group (usual care) at the introduction of a first subcutaneous bDMARD. The primary outcome was score on the BioSecure questionnaire at 6 months (0–100 scale), a validated questionnaire assessing competencies in dealing with fever, infections, vaccination and daily situations. The secondary outcomes were disease activity, coping, psychological well-being, beliefs about medication, self-efficacy and severe infection rate.Results129 patients with rheumatoid arthritis and spondyloarthritis were enrolled in nine rheumatology departments; 122 completed the study; 127 were analysed; and 64 received the intervention (mean duration: 65 min at baseline and 44 min at 3 months). The primary outcome was met: the BioSecure score was 81.2±13.1 and 75.6±13.0 in the education and usual care groups (difference: +6.2, 95% CI 1.3 to 11.1, p=0.015), demonstrating higher safety skills in the education group. Exploratory analyses showed better skills regarding infections, greater willingness for vaccinations and greater adherence-related behaviours in the education group. Coping was significantly more improved by education; other secondary outcomes were improved in both groups, with no difference.ConclusionsEducating patients was effective in promoting patient behaviours for preventing adverse events with bDMARDs. An education session delivered to patients starting a first bDMARD can be useful to help them self-manage safety issues.Trial registration numberNCT02855320.

Resume Objectifs Evaluer l’efficacite de la rTMS « a large champ » dans la fibromyalgie. Une evaluation multidimensionnelle a ete realisee avec pour critere de jugement principal l’echelle numerique de la douleur et criteres secondaires les scores FIQ, MFI-20, HAD et WPI - SSS. Methodologie Essai clinique monocentrique ouvert, realise en neurophysiologie chez des patients atteints de fibromyalgie consultant au Centre d’evaluation et traitement de la douleur du CHU de Rouen entre novembre 2014 et juin 2016. Les patients etaient inclus sur la base du FIRST, des criteres ACR 1990 et ACR 2010. Les donnees etaient recueillies sur autoquestionnaires a j1, j7, j15 et j30 (EN douleur, scores FIQ, HAD, MFI-20 et WPI–SSS). Un examen clinique avec recherche des points de Yunus etait realise a j1 et j30. Trois seances de stimulations magnetiques transcrâniennes, espacees sur 5 a 8 jours, ont ete realisees pour chaque patient. Les seances comprenaient 30 stimulations, renouvelees 3 fois, soit 90 stimulations par seances. Resultats Vingt-et-un patients ont ete inclus. L’EN douleur, le FIQ et le HAD anxiete etaient significativement ameliores a j7 (respectivement p = 0,004, p = 0,007 et p = 0,049) et cette efficacite persistait jusqu’a j30. L’amelioration de la douleur portait a la fois sur les caracteristiques affectives et sensorielles au QDSA evalue a j30 ( p = 0,02). Le WPI etait significativement ameliore a j7 ( p = 0,049) mais cette efficacite disparaissait au cours du suivi. L’amelioration du MFI etait retardee par rapport aux stimulations (j30, p = 0,04) ainsi que l’amelioration du score HAD depression (j15, p = 0,007 et j30, p = 0,049). Conclusion La rTMS « a large champ » permet une amelioration des patients fibromyalgiques dans les multiples dimensions etudiees. Un essai clinique randomise controle devrait etre realise pour confirmer les resultats preliminaires.

ObjectiveTo determine predictive/predictable factors of relapse in rheumatoid arthritis (RA) patients undergoing biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) dose reduction/discontinuation.Patients and methodsRA patients receiving the same bDMARD for more than 1 year, in Simplified Disease Activity Index (SDAI) remission, were selected in an observational monocentric real-life study. The 18-month follow-up included spacing (6 months) and withdrawal (12 months) periods of bDMARD. Clinical, biological and ultrasonographic (US) parameters were collected regularly. Relapse was defined by SDAI>11.ResultsFifty-three RA patients (mean age: 58 years; 72% women; median duration: 11 years) were enrolled. Forty-two received anti-cytokinic bDMARD targeting tumour necrosis factor (n=39) or interleukin-6R (n=3) and 11 were treated by abatacept. The number of relapses during the spacing and discontinuation periods were 19 and 20, respectively. After 18 months of follow-up, among the 53 patients, 12 maintained bDMARD-free remission, 39 had relapsed and 2 were lost of follow-up. Median time to relapse was 11.8 months. In multivariate analysis, baseline factors predictive of relapse were corticosteroid intake, female gender, longer disease duration and no methotrexate intake with bDMARD. Concerning the survival analysis, also taking into account the factors of predictability, the main risk factor of relapse after discontinuation was an increase of SDAI >0 during the spacing period (p=0.03). US findings were not contributive.ConclusionIn the context of RA in remission under bDMARDs, variation of SDAI during the dose-reduction phase is more relevant than baseline parameters to predict success of drug withdrawal.

Background Despite a wide range of biological treatments (bDMARDs) in the management of rheumatoid arthritis (RA), some patients fail in different lines of treatment. Currently, there is no consensual definition of multiresistance to bDMARDs in RA. Objectives The aim of our study was to describe the characteristics of « multiresistant » patients and to establish associated factors with multiresistance to bDMARDs in RA. Methods In this observational and retrospective study were identified patients with RA admitted for administration of a bDMARD at Rouen University Hospital (France) between January 2007 and July 2017 (sources : diagnostic coding using International Classification of Diseases 10th revision and traceability of intra-hospital pharmacy). In the absence of a consensual definition, multiresistance to bDMARD was defined in this study by failure, primary and/or secondary, to at least 2 bDMARDs. The clinical and paraclinical characteristics of these patients at the initiation of the first bDMARD were collected using data from their standardized monitoring, then compared to those of patients who received a single bDMARD effective for 10 years or more, constituting the “responder” group. Results We identified 794 patients: 385 constituted our active RA file under bDMARD, 192 patients excluded for different reasons (6 patients not fulfilling the ACR/EULAR 2010 criteria, 18 followed in another department, 45 for missing data at bDMARD’s initiation, 50 not found in computerized file, 73 for whom the expected bDMARD was never started) and 217 lost to follow-up. Among our active RA file under bDMARD (385 patients), 53 were « multiresistant » (at least 2 bDMARDs failed), and 50 patients received a single and effective bDMARD for 10 years or more, after excluding some patients for missing data (Figure 1). The mean age of « multiresistant » patients at initiation of bDMARD was 50.3 years (±13.2 years), and the sex ratio was 2.8 women/1 man. They presented erosive RA (77.4%), rheumatoid factor and anti-citrullinated peptide antibodies positive (73.6%), highly active (median number of tender and swollen joints 8/28, median visual analog scale disease activity 70/100, median C-reactive protein (CRP) 21 mg/L, mean Disease Activity Score 28 CRP mean 5.36±1.28), and with high functional impact (Health Questionnaire Median Assessment: 1,500/3). The age of disease onset was significantly later in « multiresistant » patients than in « responder » patients (43±14.2 years versus 37.9±10.7 years, p = 0.042). No demographic, anamnestic, clinical and paraclinical characteristics differed significantly between « multiresistant » and « responder » patients. Conclusion It is an original work, counting in the literature as a single similar study [1], with nevertheless significant methodological differences. There is no consensual definition of multiresistance to bDMARD in RA, and its mechanisms remain misunderstood. Identifying predictive factors would make it possible to early identified patients with a refractory profile, in order to adapt the therapeutic strategy. Multidrug resistance in RA remains one of the challenges in the management of this pathology. Reference [1] Kearsley-Fleet L, Davies R, De Cock D, Watson KD, Lunt M, Buch MH, et al. Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum DisEpub ahead of print : 8 July 2018 Disclosure of Interests None declared

Background Improving knowledge and skills is recommended for patients with rheumatoid arthritis (RA) to enhance self-management. Measuring knowledge is also part of the educative approach. However, the available Knowledge questionnaires (KQs) (ref 1,2) needed to be updated according to recent recommendations for RA management and the patients’ needs (ref 3). Objectives To develop and a validate a new KQ in RA. Methods 4 steps. Step1. Selection of knowledge considered essential for patients with RA through Delphi rounds by a working group of rheumatologists, health professionals (HPs) and patients leading to a list of consensual items (ref3). Step2. Two rheumatologists and a rheumatology nurse constructed the first version of the KQ, each question of the KQ referring to a selected item on the list. The formulation was then amended by the working group. A new version was elaborated during a face-to-face meeting of 3 HPs and one patient. Step 3. The KQ was submitted to ten patients for cognitive debriefing, comments were analysed and a the final version was elabored. Step 4. Multicentric validation in 11 rheumatology departments: acceptability was measured by the rates of missing data per item, reproducibility and sensitivity to change were assessed respectively by test/retest at a 2 weeks interval (Lin’s concordance correlation coefficient) and by testing the KQ before and after patient education sessions. The sample size estimation and statistical analyses were conducted according to COSMIN recommendations, especially concerning thresholds of metrological indexes. Results Step1 obtained 45 knowledge items, 32 considered essential and 13 considered useful, selected respectively by more than 2/3 and more than 50% of participants to the Delphi rounds, leading to the RAKE: a 45-items questionnaire, with a 32-items short form. The RAKE contains 6 knowledge domains: disease knowledge (10 items), pharmacological treatment (14), non -pharmacological treatment (7), comorbidities (1), self-care for pain and fatigue (5), adaptative skills to psychosocial and professional issues and health care system (8). The validation included 130 patients, 108 (83%) women, mean age 56.4±12.10 years, median disease duration 9 years [4; 23]. The missing data rate per item was 1.1 [0.7; 1.6]. The RAKE’s external validity was confirmed by correlation with the RAID score of 0.16 (p=0.08). Conclusion This study enabled the development and the validation of the RAKE, a Knowledge questionnaire for patients with RA, with a good acceptability, reproducibility and sensitivity to change. This KQ will be helpful to assess the process of knowledge acquisition in patient education approaches. References [1] Hill and al., Br J Rheumatol. 1991,30 :45-9. Lineker and al., J Rheumatol. 1997, 24(4):647-53. Beauvais C, et al. ARD 2015; 74, suppl 2. Disclosure of Interests Malory RODERE: None declared, Bruno Pereira: None declared, Martin SOUBRIER: None declared, Sonia Trope: None declared, Francoise Fayet: None declared, Jean David COHEN: None declared, Muriel PIPERNO: None declared, Beatrice Pallot Prades: None declared, Sophie Pouplin: None declared, Pascal COQUERELLE: None declared, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Christelle Sordet: None declared, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Catherine Beauvais: None declared

Background: Biologic disease modifying drugs (bDMARDs) are highly effective treatments of IA such as rheumatoid arthritis (RA) and axial or peripheral spondyloarthritis (SpA). However, they lead to risks of infections and other side effects. Some of these adverse events may be prevented by patient education (PE) aimed at promoting patients’ safety skills. Objectives: To investigate the effect of a nurse-led PE on safety skills of patients with IA at the introduction of a first subcutaneous bDMARD. Methods: Multicentric randomized controlled trial comparing an intervention group (IG) to usual care (UC) at the time of the introduction of a first bDMARD. Inclusion criteria: patients with RA or SpA, biologic naive, eligible for a subcutaneous bDMARD according to the rheumatologist’s opinion. Intervention: a face-to-face nurse-led PE at baseline (BL) and 3 months later, ie, assessment by the nurse of the patients’ health beliefs and educational needs, education focused on safety skills, self-injections and motivation. The primary outcome was the acquisition of safety skills at 6 months measured by the Biosecure Questionnaire (0-100 scale), a 55 item validated questionnaire assessing competences to deal with fever, infections, vaccination, and other daily life situations (ref). The secondary outcomes were quality of life, severe infections rate, coping, psychological well-being and disease activity. Data were anaysed as intent-to-treat using multiple imputations. Results: 128 patients were included from 9 rheumatology departments between January 2017 and April 2018, 39 (30.7%) with RA, 72 (56.7%) with axial SpA, 16 (12.6%) with peripheral SpA; mean age 47.0 ±12.8 years, mean disease duration 6.1 ±7.5 years, 120 (94%) completed the study. BL mean self- reported information on RA treatments (0-10 numeric scale) was similar: 7.1±2.0 in IG; 6.8±2.1 in CG. The mean duration of the intervention was 65.5 ±17.9 minutes. The primary outcome was met: the Biosecure score at 6 months was 81.2 ±13.1 versus 75.6±13.0 in the IG and CG respectively (p =0.016), showing better skills in the IG. Secondary outcomes were also favorable. Conclusion: Safety is an important issue in the management of IA treated with bDMARDs. In this trial, a nurse-led patient education was shown for the first time to be effective in teaching patients the essential safety skills. References [1] Gossec, et al. Joint Bone Spine 2013;80:471-6. Acknowledgement: Grants : The “France Rhumatisme” Foundation and the therapeutic patient education Section of the French Society of Rheumatology. Disclosure of Interests: Catherine Beauvais: None declared, Francoise Fayet: None declared, Alexandra Rousseau: None declared, Christelle Sordet: None declared, Sophie Pouplin: None declared, Yves Maugars: None declared, Rose Marie Poilverd: None declared, Carine SAVEL: None declared, Veronique Segard: None declared, Beatrice Godon: None declared, Christian L’amour: None declared, Aleth Perdriger: None declared, Fabienne Brin: None declared, Patricia Peyrard: None declared, Fabienne Chalier: None declared, Beatrice Pallot Prades: None declared, Isabelle Griffoul: None declared, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study

International audience; Self-assessment of disease activity is feasible in rheumatoid arthritis, but its frequency decreases over time.

Objective Information and education are recommended for patients with inflammatory arthritis including rheumatoid arthritis (RA) and spondyloarthritis (SpA). However, there is no consensus on which knowledge is essential to enhance patients’ self-management. The aim of this study was to determine such knowledge. Methods Based on published knowledge questionnaires (KQs) collected by a systematic literature review, a list of items was elaborated, classified in domains and sub domains. A Delphi process was performed with rheumatologists, healthcare professionals and patients in 2014–2015, selecting the items considered useful. Results Three published KQs were analysed: 2 for RA; 1 for SpA and 5 unpublished KQs were collected. In the KQs, 90 knowledge items were mentioned for RA and 67 for SpA. The 1st Delphi round enlarged the list to 322 items for RA and 265 items for SpA. The second round selected 69 and 59 knowledge items for RA and SpA respectively, of which 36 (52%) and 34 (57%) were not present or modified from the published KQs. Key domains included treatment strategies, managing cDMARDs and bDMARDs, managing symptomatic medications. Knowledge on non-pharmacological treatment concerned pain and fatigue, physical activity, adaptative skills to personal and professional environment, patient-HP communication and shared decision-making. Conclusion The present study provides a corpus of knowledge considered essential for patients in the self-management of their arthritis. The selection of many items reflects recent emphasis on professional recommendations and the patients’ perspective. Future work should lead to the development of new updated KQs for patients with inflammatory arthritis.

BACKGROUND: Adherence to treatment is a key issue in chronic inflammatory rheumatic diseases (CIRDs). OBJECTIVE: To develop recommendations to facilitate in daily practice, the management of non-adherence to disease-modifying drugs in patients with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, connective tissue diseases or other CIRDs. METHODS: The process comprised (a) systematic literature reviews of methods (including questionnaires) to measure non-adherence, risk factors for non-adherence and efficacy of targeted interventions; (b) development of recommendations through consensus of 104 rheumatologist and nurse experts; (c) assessment of agreement and ease of applicability (1-5 where 5 is highest) by the 104 experts. RESULTS: (a) Overall, 274 publications were analysed. (b) The consensus process led to 5 overarching principles and 10 recommendations regarding adherence. Key points include that adherence should be assessed at each outpatient visit, at least using an open question; questionnaires and hydroxychloroquine blood level assessments may also be useful. Risk factors associated to non-adherence were listed. Patient information and education, and patient/physician shared decision, are key to optimize adherence. Other techniques such as formalized education sessions, motivational interviewing and cognitive behavioral therapy may be useful. All health professionals can get involved and e-health may be a support. (c) The agreement with the recommendations was high (range of means, 3.9-4.5) but ease of applicability was lower (2.7-4.4). CONCLUSIONS: Using an evidence-based approach followed by expert consensus, this initiative should improve the assessment and optimization of adherence in chronic inflammatory rheumatic disorders.

Resume Contexte L’adhesion au traitement est un enjeu majeur dans les rhumatismes inflammatoires chroniques (RIC). Objectif Elaborer des recommandations visant a faciliter au quotidien la gestion de la non-adhesion aux traitements de fond medicamenteux chez les patients atteints de polyarthrite rhumatoide, de spondyloarthrite, de rhumatisme psoriasique, de connectivite ou d’autres RIC. Methodes Le processus a mis en œuvre (a) une revue systematique de la litterature concernant les methodes d’evaluation (y compris les questionnaires) de l’adhesion, les facteurs de risque de non-adhesion et l’efficacite des interventions ciblees ; (b) l’elaboration de recommandations par un consensus de 104 rhumatologues et experts infirmiers ; (c) l’evaluation du niveau d’accord et de la facilite de mise en pratique (bareme de 1 a 5, 5 etant la note la plus elevee) par les 104 experts. Resultats (a) 274 publications ont ete analysees au total. (b) Le processus de consensus a permis d’etablir cinq principes generaux et 10 recommandations concernant l’adhesion. Les principaux points stipulent que l’adhesion doit etre evaluee a chaque consultation, par au moins une question ouverte ; des questionnaires et un dosage sanguin de l’hydroxychloroquine peuvent egalement etre utiles. Les facteurs de risque associes au defaut d’adhesion ont ete recenses. L’information et l’education des patients et la decision partagee patient/medecin jouent un role cle pour optimiser l’adhesion. D’autres techniques, par exemple des sessions d’education formalisees, des entretiens motivationnels ou des therapies cognitivo-comportementales, peuvent etre efficaces. Tous les professionnels de sante peuvent intervenir et l’e-sante peut constituer un support utile. (c) L’accord sur les recommandations etait eleve (moyenne 3,9–4,5) mais la facilite de mise en pratique etait plus faible (2,7–4,4). Conclusions Cette initiative utilisant une approche fondee sur des preuves suivie par un consensus d’experts devrait permettre d’ameliorer l’evaluation et l’optimisation de l’adhesion dans les RIC.

Resume Objectifs Evaluer l’interet du passage d’un anti-TNFα a un autre chez des patients atteints de polyarthrite rhumatoide (PR) en fonction du motif de changement (echec primaire, echappement ou intolerance) et en fonction du sens de rotation [anticorps monoclonal (mAc) vers recepteur (sR) ou sR vers le mAc]. Methodes Entre 2000 et 2008, 356 patients atteints de PR ont recu un anti-TNFα [infliximab (IFX), etanercept (ETA) ou adalimumab (ADA)]. L’activite de la maladie etait evaluee de facon standardisee au cours de cette etude retrospective. Les donnees demographiques, cliniques et biologiques etaient recueillies a l’introduction du premier anti-TNFα et au moins 6 mois plus tard pour evaluer la reponse a cet anti-TNFα en fonction des criteres de reponse EULAR. Un echec primaire, un echappement ou une intolerance au premier anti-TNFα induisait le passage a un autre anti-TNFα, dont la reponse etait evaluee 6 mois plus tard. Un score de propension mesurait ensuite toute interaction avec les variables de depart. Resultats Parmi les 356 patients atteints de PR, 38 sont passes de l’IFX ou de l’ADA a l’ETA, 26 de l’ETA a l’IFX ou de l’ADA, et 8 d’un mAc (IFX ou ADA) a l’autre. Les parametres cliniques des switchers (patients ayant change d’anti-TNFα) et non-switchers etaient comparables. Les switchers changeaient de biomedicaments en raison d’un echec primaire (36,1 %), d’un echappement (33,3 %), ou d’une intolerance (30,6 %), sans afference entre ces sous-groupes. Quels que soient la raison du changement ou le sens de la rotation, les patients repondaient davantage au second anti-TNFα qu’au premier (p Conclusion Le passage d’un TNFα a un autre est plus souvent benefique pour les patients atteints de PR quand on passe d’un mAc au sR dirige contre un anti-TNFα.

OBJECTIVE: To assess the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA). METHODS: COMEDRA is a French nationwide cross-sectional multicenter study on comorbidities in RA. Renal function was assessed from the estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease equation. RA characteristics and risk factors for renal impairment were collected. Two logistic regression models, 1 with and 1 without the Framingham Risk Score, were constructed from variables that were significantly associated with an eGFR of

ObjectiveLack of adherence to treatment is frequent in chronic inflammatory rheumatic diseases and is associated with poorer outcomes. The objective of this study was to describe and evaluate interventions that have been proposed to enhance medication adherence in these conditions.MethodsA systematic literature review was performed in Pubmed, Cochrane, Embase and clinicaltrials.gov databases completed by the rheumatology meeting (ACR, EULAR and SFR) abstracts from last 2 years. All studies in English or French evaluating an intervention to improve medication adherence in chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal related diseases, connective tissue diseases, vasculitis and Still’s disease) were included. Interventions on adherence were collected and classified in five modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others).Results1325 abstracts were identified and 22 studies were finally included (18 studies in RA (72%), 4 studies in systemic lupus erythematosus (16%), 2 studies in SpA (8%) and 1 study in gout (4%)). On 13 randomised controlled trials (RCT) (1535 patients), only 5 were positive (774 patients). Educational interventions were the most represented and had the highest level of evidence: 8/13 RCT (62%, 1017 patients) and 4/8 were positive (50%). In these studies, each patient was individually informed or educated by different actors (physicians, pharmacists, nurses and so on). Supports and contents of these educational interventions were heterogenous.ConclusionDespite the importance of medication adherence in chronic inflammatory rheumatic disorders, evidence on interventions to improve medication adherence is scarce.

International audience; Objectives : To evaluate the benefits for rheumatoid arthritis (RA) patients of switching from one tumor necrosis factor inhibitor (TNFi) to another based on reason for change (primary failure, escape or intolerance) and molecule-switching order.Methods : Between 2000 and 2008, 356 RA patients prescribed a TNFi (infliximab [IFX], etanercept [ETA] or adalimumab [ADA]) and undergoing standardized evaluation were included in this retrospective study. Detailed demographic, clinical and biological data were collected before first biologic use and ≤ 6 months later to evaluate response based on EULAR-criteria. Primary failure, escape or intolerance of first TNFi triggered switch to another TNFi, the response of which was evaluated 6 months later. Propensity score then measured any interaction with baseline variables.Results : Of the 356 RA patients, 38 switched from IFX/ADA to ETA, 26 from ETA to IFX/ADA, and eight from one monoclonal antibody (mAb; IFX/ADA) to another. Clinical parameters for switchers and non-switchers were comparable. Switchers changed therapies because of primary failure (36.1%), escape (33.3%), or intolerance (30.6%), with no difference found in these subgroups. More switchers responded to the second TNFi than the first (P < 0.01), respectively, regardless of switch (ETA to IFX/ADA: 50 vs. 23.1% [P < 0.05]; IFX/ADA to ETA: 57.9 vs. 15.8% [P < 0.001]) or reason for changing. In addition, DAS28 decreased more with the second antagonist (P < 0.001) and regardless of molecules switched (P < 0.01). Survival of the second TNFi was significantly longer with switch from mAb to the soluble receptor than vice versa (P < 0.05).Discussion : Overall, any switching from one TNFi to another, especially mAb to soluble receptor, was often beneficial for RA patients.

Background Interaction with relatives has a significant role on patients9 health, and can also impair relatives9health. Education processes need codification to enrole relatives in the programms. Objectives To create a patient education program for relatives and patient affected by rheumatic inflammatory desease Methods Individual semi-directed by 2 psychologists interviews, have been performed and their thematic content analysed with the QDA Miner program. A guide had been achieved by rheumatologists, psychologists et patient association representatives. The (patient/relative) dyad, has been first questioned together, and then individually. Results 20 patients, average age 59 years (27–79) affected with Rheumatoid Arhritis (n=13), Spondyloarthritis (n=9) with an average disease duration of 12,8 years (1–39) and one of their relatives (being their spouse in 18 cases) have been recruited in 7 rheumatology departments in France. Common life duration was 27,5 years as an average (1,5–57). About 2/3 of patients and relatives have a common view on: relative9s role in bringing an emotional support but needs a knowledge on disease and treatments; emotional distress experienced by both patient and relative; the worrries and reative9s feelings of not knowing how to to do; the help brought by the relative in everyday9s life and his participation to care management. Only a few relatives talked about concerns, regrets of past life, and burden feeling of patient. Relatives also express unfairness feelings. 2/3 of patients and relatives report will of independence of the patient, who wants to manage alone, and does not express his difficulties. 50% of relatives think they anticipate patient9s needs, they are also directly resquested by the patients. On the other side, the patients often report that they watch over relative9s health. 50% of patients and relatives mention the idea of complementarity and “ team ”, but also tensions or conflicts. Patient Education contribution would be sharing and exchanging between them, according to 2/3 of patients and relatives, who therefore would prefer group education (12/20). Relatives however more often mention a common education with patient, and patients prefer a separate education of relative. The main limit to of this study is that participation to study has favored harmoniously functioning dyads, what may explain the weak rate of abandonment feeling. Conclusions Expectations on relatives9 role seem to be common in terms of practical and emotional support. Relatives sometimes mention the “positivation” of their role, but also emotional distress and helplessness feeling. Patients fear they are a burden and want to be independent. A specific educational management of relatives is more often suggested by patients than by relatives. Disclosure of Interest None declared

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 11 juillet 2017

Resume Introduction Identifier differentes strategies comportementales, adaptees ou inadaptees face a la douleur, permettrait d’optimiser la prise en charge des patients lombalgiques. Objectif Elaboration et validation d’un questionnaire identifiant differentes strategies comportementales chez des patients souffrant de lombalgie chronique non-specifique. Methodes (1) Constitution d’un questionnaire preliminaire a partir d’une etude qualitative realisee chez 25 patients lombalgiques (2) Reduction d’items et validation du questionnaire par une etude prospective multicentrique internationale chez des patients lombalgiques chroniques. Une analyse des correspondances multiples a individualise differents profils comportementaux. Leurs caracteristiques, validite interne et externe ont ete evaluees. Suivi longitudinal a 12 mois des therapeutiques effectuees chez 58 patients. (3) Evaluation de la reproductibilite chez 30 patients. Resultats (1) Questionnaire preliminaire comprenant 86 items repartis en 8 domaines de gestion de la douleur. (2) 3 groupes comportementaux ont ete identifies : comportement adapte, detresse emotionnelle, kinesiophobie. Le questionnaire a ete reduit a 7 questions (21 items). Le coefficient de Cronbach etait modere (0.47-0.66). La validite externe evaluee par rapport a l’anxiete, la depression, et les strategies de coping etait bonne. Les patients kinesiophobes avaient plus eu recours au reentrainement a l’effort que ceux avec un comportement adapte, comme attendu (50 % vs 25 %, p < 0,05). (3) La reproductibilite etait bonne (kappa = 0.70). Conclusion Ce nouveau questionnaire simple permet d’identifier 3 groupes comportementaux chez les patients lombalgiques chroniques, afin de guider une prise en charge personnalisee.

Resume Objectif Valider les criteres ACR/EULAR de 2010 de polyarthrite rhumatoide (PR), en tenant compte de la definition recente de « maladie erosive », selon l’EULAR, sur 310 patients de la cohorte VErA (arthrites tres precoces). Methodes La pertinence des criteres de 2010 a d’abord ete testee en appliquant successivement de maniere stricte ses trois elements : ≥ 1 synovite clinique/autre maladie (s)/score ≥ 6/10 puis la grille d’erosion typique en l’absence d’un score ≥ 6. Nous avons teste successivement : absence d’erosion (S1), plus d’une erosion (S2), maladie erosive selon la definition de l’EULAR (S3). Deux definitions de la PR ont ete utilisees : diagnostic d’experts a 6 ans et maladie erosive selon l’EULAR a 2 ans. Resultats L’âge median a l’inclusion etait de 52 ans ; la duree mediane de 4,2 mois. Les criteres ACR/EULAR de 2010, prenant en compte la maladie erosive definie selon l’EULAR, appliques a l’inclusion, permettaient de classer un nombre comparable de patients en utilisant les criteres de 1987 (p = 0,27). Avec le diagnostic d’experts a 6 ans, un nombre plus important de patients etaient reconnus comme etant atteints de PR avec S2 qu’avec les criteres ACR de 1987 (p Conclusions En utilisant la cohorte VErA, l’application stricte des criteres ACR/EULAR de 2010 associes a la nouvelle definition de la maladie erosive de l’EULAR etait legerement (mais pas significativement) plus performante que les criteres ACR de 1987.

Background/purposeCardiovascular (CV) risk, cancer, infections and osteoporosis should be screened for in rheumatoid arthritis (RA). The objective was to assess 3-year effects of a nurse visit for comorbidity counselling.MethodsThis was an open long-term (3 years) extension of the Comorbidities and Education in Rheumatoid Arthritis 6-month randomised controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling. Comorbidity status was assessed and nurses provided advice on screening and management, at baseline and 3 years later. A score was developed to quantify comorbidity screening and management: 0–100, where lower scores indicate better screening and management. The score was compared between baseline and 3-year assessment using a Wilcoxon test for paired data.ResultsOf the 970 recruited patients, 776 (80%) were followed-up at 2–4 years and 769 (79%) had available data for comorbidities at both time points: mean (±SD) age 58 (±11) years and mean disease duration 14 (±10) years; 614 (80%) were women, the mean Disease Activity Score 28 was 3.0±1.3, and 538 (70%) were receiving a biologic. At baseline, the mean comorbidity screening score was 36.6 (±19.9) and it improved at 3 years to 24.3 (±17.8) (pConclusionsComorbidity screening was suboptimal but improved notably over 3 years, after a nurse-led programme aiming at checking systematically for comorbidity screening and giving patient advice. This long-term efficacy pleads in favour of nurse-led interventions to better address comorbidities in RA.Trial registration numberNCT01315652

Resume L’education therapeutique (ETP) dans les rhumatisme inflammatoires chroniques est d’autant plus importante que la maladie chronique va s’installer dans le quotidien des malades, avec des consequences physiques, des douleurs ou une incapacite fonctionnelle et psychosociale. L’appreciation des besoins des patients et la determination des objectifs pedagogiques est au cœur de la demarche d’ETP. Elle est la rencontre entre le point de vue du patient et celui des soignants. Pour le soignant, il s’agit de donner au malade la capacite d’adherer activement a la strategie therapeutique proposee, et d’avoir un comportement approprie en cas de complications liees a la maladie ou a ses traitements. Pour le malade, l’education therapeutique est un espoir d’acquerir des competences d’adaptation a la maladie, pour lui permettre de vivre son quotidien avec les contraintes d’une maladie chronique, mais en restant autonome, avec une qualite de vie d’un niveau acceptable.

International audience; ObjectiveThe identification of helpful or unhelpful behavioral strategies for coping with pain would assist in optimizing the management of patients with chronic low back pain (CLBP).To develop and validate a questionnaire for categorizing behavioral strategies in patients with nonspecific CLBP.Methods(1) Development of a preliminary questionnaire based on a qualitative study in 25 patients with CLBP; (2) Item reduction and questionnaire validation by a multicenter international prospective study in patients with CLBP, with multiple correspondence analysis to identify behavioral profiles, whose characteristics and internal and external validities were assessed; 12-month study of treatments in 58 patients; (3) Evaluation of reproducibility in 30 patients.Results(1) The preliminary questionnaire had 87 items in eight pain-coping domains. (2) Three behavioral profiles were identified: effective coping, emotional distress, and kinesiophobia. The questionnaire was reduced to 21 items in seven domains. Cronbach's α indicated moderate internal consistency (0.47-0.66). External validity versus anxiety, depression, and coping strategies was good. As expected, exercise reconditioning was used more often by patients with kinesiophobia than by those with effective coping (50% vs. 25%, P

International audience; IntroductionIn chronic inflammatory rheumatic diseases (CIRDs), comorbidities such as cardiovascular disease and infections are sub-optimally managed. EULAR recently developed points to consider to collect and report comorbidities. The objective of this present study was to develop a pragmatic guide to collect, report and propose management recommendations for comorbidities, from a rheumatologist perspective.MethodsThe collection and reporting of comorbidities and risk factors was adapted from the EULAR points to consider. To develop management recommendations, the process comprised (1) systematic literature reviews by 3 fellows and (2) a 2-day consensus process involving 110 experts (rheumatologists and health professionals). Votes of agreement (Likert 1-5 where 5 indicates full agreement) were obtained.ResultsThe six selected comorbidities were ischemic cardiovascular diseases, malignancies, infections, diverticulitis, osteoporosis and depression. The literature review retrieved 97 articles or websites, mostly developed for the general population. The consensus process led to reporting presence of comorbidities, current treatment, risk factors (e.g. hypertension), screening (e.g. mammography) and prevention (e.g. vaccination). Management recommendations include physical examination (e.g. blood pressure or lymph node examination), prescribing screening procedures, and interpreting results to refer in a timely manner to appropriate other health professionals. Agreement was high (mean ± standard deviation, 4.37 ± 0.33).ConclusionsUsing an evidence-based approach followed by expert consensus, this initiative furthers the dissemination in France of the EULAR points to consider, and clearly defines what part of the management of comorbidities is potentially within the remit of rheumatologists. This initiative should facilitate systematic management of patients with CIRDs.

Objectives: Some patients with chronic low back pain are not eligible to intensive rehabilitation program because of the intensity of their pain. We assessed the value of an educational program in a rehabilitation program over a week in chronic low back pain. Methods: Patients aged 18 to 75 years with chronic low back pain were included. The rehabilitation program took place during a five-day hospitalisation in the rheumatology department of the Rouen University Hospital involving patients receiving multidisciplinary management with collective and individual workshops with special focus on education along with structured rehabilitation exercises. On the fifth day, patients and caregivers established goals to achieve within the six-month period. Patients had a follow-up visit six months later. The objective was to evaluate whether or not the goals were achieved at 6 months later. Results: Ninety-nine patients were included, and 78 were re-evaluated after six months. The patients achieved 74% of the goals that they had established, with significant behavioural changes. Clinically and functionally: significant decrease in pain VAS during the program, significant decrease in the fingertip-to-floor distance during the program and at the 6 months follow-up, significant improvement in the functional questionnaire. Conclusion: With to the educational part of their program, the patients achieved a mean of 74% of the goals. Moreover, the training course improved pain and function. For patients with a high level of pain and/or disability our short program with multidisciplinary management and an educational approach seems to be interesting as a first step before a more intensive rehabilitation.