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Resume Objectifs Des etudes ont releve une frequence moins elevee de la polyarthrite rhumatoide (PR) dans la population africaine. Il n’existe cependant aucune donnee precise concernant la population d’origine afro-caribeenne. Le projet EPPPRA est une etude epidemiologique prospective visant a definir la prevalence et les caracteristiques cliniques de la PR aux Antilles francaises (Martinique, Guadeloupe, Guyane francaise). Methodes EPPPRA regroupe l’ensemble des rhumatologues exercant aux Antilles francaises auxquels il a ete propose d’inclure pendant une periode d’un an tous les patients ayant un diagnostic clinique de PR. Nous rapportons ici les resultats obtenus en Martinique. Resultats D’apres les resultats de l’EPPPRA, la prevalence globale de la PR standardisee selon l’âge (population mondiale de reference) est estimee a 0,10 % [IC 95 % : 0,09 % a 0,11 %] en Martinique avec une nette predominance feminine (88,1 %) et 93,1 % des patients auto-declares d’origine ethnique afro-caribeenne. L’âge moyen au moment du diagnostic etait de 49,6 ± 16,0 ans. Dans la majorite des cas, les sujets remplissaient au moins 4 criteres (94,4 %) de la classification 1987 de l’American College of Rheumatology (ACR) et obtenaient un minimum de 6 points (78,2 %) selon la classification 2010 de l’ACR/European League Against Rheumatism (EULAR). Un taux eleve de seropositivite a ete retrouve (84,2 %). Malgre le retentissement fonctionnel observe chez 40,5 % des patients, la maladie etait faiblement active chez 71,4 % d’entre eux. Le traitement le plus courant etait le Methotrexate (73 %), suivi des biotherapies (24,4 %). De nombreux patients (68,6 %) ont egalement beneficie d’une corticotherapie. Les facteurs de risque cardiovasculaire tres frequents contrastaient avec une consommation de tabac particulierement basse (8,7 %). Conclusion Ce travail met en evidence la faible prevalence standardisee de la PR observee dans une population francaise d’origine afro-caribeenne et en souligne les caracteristiques specifiques (forte predominance feminine, taux de seropositivite eleve, faible consommation de tabac). Malgre la facilite d’acces aux soins de sante et aux biotherapies, la PR est d’evolution destructrice au retentissement fonctionnel invalidant dans environ la moitie des cas de cette etude.

Objectives Studies suggest that rheumatoid arthritis (RA) is less frequent in African populations. However, no recent precise data exists for Afro-Caribbeans. The EPPPRA project is a prospective epidemiological survey to describe prevalence and clinical aspects of RA in the French West Indies (Martinique, Guadeloupe, French Guiana). Methods EPPPRA involved all rheumatologists from the French West Indies who included all patients with a known clinical diagnosis of RA, during a one-year period. We outline here results for Martinique. Results EPPPRA estimated an overall world age-standardized prevalence of RA at 0.10% [95% CI 0.09% to 0.11%] in Martinique, with a high female predominance (88.1%) and 93.1% of self-reported Afro-Caribbeans. Mean age at diagnosis was 49.6 ± 16.0 years. A majority of subjects presented at least 4 criteria points from the 1987 American College of Rheumatology (ACR) classification (94.4%) and at least 6 points (78.2%) from the 2010 ACR/European League Against Rheumatism (EULAR) classification. A high immune seropositivity rate was highlighted (84.2%). Despite functional impact observed in 40.5% of patients, 71.4% presented a low disease activity level. Methotrexate was the most common ongoing treatment (73%), followed by biotherapies (24.4%). Numerous patients (68.6%) received a steroid regimen. Cardiovascular risk factors were very frequent, contrasting with a very low tobacco use (8.7%), Conclusion This work outlines low standardized prevalence of RA in a French Afro-Caribbean population with specific characteristics (high female predominance, high immune seropositivity, low tobacco use). Despite easy access to care and biotherapies, approximately half of RA patients still present destructive disease with functional impact.

Dengue fever (DF) is an epidemic viral mosquito-borne infection limited to tropical and subtropical countries. Biological therapies have been frequently used for the last 15 years in the treatment of inflammatory rheumatic conditions like rheumatoid arthritis. However, no data is available regarding the characteristics of this infection in patients on biological therapy. Yet, numerous patients on biotherapy have holidays in countries where DF exists. Moreover, the mosquitoes Aedes albopictus , vector of this viral disease, is now found in some developed countries such as southern Europe and the USA, allowing the possibility of a DF outbreak. We conducted a survey of individuals on biotherapy and described a case series of the patients experiencing DF. Our 8 patients on biotherapy (anti-TNF, n =6; rituximab, n =2) for a rheumatic condition did not experience severe DF.

Background Rheumatoid arthritis (RA) is a disabling chronic disease, regarded as the most frequent inflammatory rheumatism in adults, with a prevalence estimated between 0.3 and 1%, and a feminine ascendancy. In metropolitan France this prevalence is estimated from 0.3% to 0.5% of the general population. No precise data is available for French West Indies, and the prevalence of RA in this population of African ancestry is poorly evaluated. Objectives The objective of the study is to estimate RA prevalence in the FWI by a census forward-looking epidemiological survey in the hospital and liberal sectors for one year duration. Methods It is a unique tour with clinical examination, self-administered questionnaires and declaration. Secondary objectives are description of clinical and socio economical aspects of RA and cardiovascular comorbidities. We present the results for Martinique. Our survey was widely distributed (radio, press, patients9 associations…) to ensure a good completeness. Data were analysed using SAS 9.3 software (SAS Institute Inc., Cary, NC, USA). Throrough descriptive analysis of collected variables was conducted. Crude prevalence rates were adjusted to a standard population of Martinique (nationwide census in 2010). The 95% CIs were calculated using the Poisson distribution. Results Our completeness is good. 538 RA were collected, giving a prevalence in Martinique of 0.184% of the adult population (290 000), respectively 0.049 for men and 0.292 for women. 44% of these patients are treated in private practice and 56% in hospital. This cohort is composed of 88% women and 12% men; 92% were born in Caribbean and 7.7% elsewhere. Patients self declared of Afro Caribbean origin in 92.7%, Caribbean White in 1.7%, caucasian in 3% and other in 2.1%. Their mean disease duration was 9.7±10 years. RF and ACPA were positive in 82.2% (FR+ 392, ACPA+349, 35% low level, 65% high level): CCP+FR+ in 306, FR+CCP- in 77, FR-CCP+ in 41, FR-CCP- in 96. 17% had extra articular manifestations. ACR1987 and ACR2010 criteria were pos in 94.4% and 78%. HAQ was 1and 2 in 3%. DAS28 were respectively 5.1 in 3%. Less than 5% are ever smoker. Parodontopathy is infrequent. Cardiovascular risk factors were noticed in 89,4% with a mean of 2 CVRF beside RA. Conclusions This work clarifies the low prevalence of RA in this population of African origin. Some characteristics as: reduced prevalence, strong female representation, strong seropositivity, high levels of anti-CCP, no tobacco, differentiate our patients from other populations and evoke another etiology than tobacco. Disclosure of Interest None declared

Background Lumbar canal stenosis (LCS) is a clinicopathological and radiological disease first described in 1949, causing a neurovascular compression leading to back pain, radicular, sensory or motor deficit which treatment is difficult. Objectives The objectives of our study were appraisal of a protocolized treatment for 3 months and identification of predictive factors for failure of medical treatment. This is a prospective nonrandomized study with no control group. All patients satisfying inclusion criteria were included after clinical and radiological evaluation. Methods Clinical inclusion criteria were neurogenic claudication, radiculopathy at rest with or without back pain, mono or multirooted sensory, motor or reflex abnormalities of the lower limbs. Radiological inclusion criteria were: anteroposterior dural sac diameter 2 , reduction in the anteroposterior diameter of the spinal canal >25% on myelography in supine extended position. Results Included patients had at least one clinical and one radiological criteria. Treatment was 2 epidural injections of 125 mg hydrocortancyl 15 days apart, combined with NSAIDs or analgesic, associated with physiotherapy sessions over 2 months. 147 patients were included. Mean age was 62±13 years. F/M sex ratio is 1.3. Mean BMI was 27.5±4.3, overweight was present in 72.1%. At baseline, mean duration for back pain and radicular pain were 9.3±10.5 and 4.4±5.7years. Primary objective was evolution of the Oswestry [1] score (a low back pain disability questionnaire) at 3 months as compared to baseline. Secondary objective was the evolution of pain. At the end of treatment, the mean value for the Oswestry score decreased from 41.2 to 39.7 (p=0.17). Mean VAS for lumbar pain decreased from 53.6 to 42.1 (p BMI, duration of back and radicular pain, mean lumbar radicular VAS and mean Oswestry score at inclusion were not significantly different in improved and non improved patients. Predictors of good response to treatment were the initial presence of impulsivity cough and nocturnal pain. Conclusions In conclusion with this approach there was no significant decrease in Oswestry score, however there was a significant decrease in mean VAS lumbar and radicular pain. No predictor of poor response has been highlighted. Predictors of good response were the initial presence of impulsivity at cough and nocturnal pain. These results show the limits of medical treatment in the management of SCL. References Niskanen RO, The Oswestry Low Back Pain Disability Questionnaire. a two-year follow-up of spine surgery patients. Scand J Surg, 2002 91 (2):. P. 208-11. Disclosure of Interest None declared

Background No study describes the frequency of Behcet’s disease (BD) in the populations of African origin and its characteristics. Objectives To retrospectively assess by retrieval of multiple sources, the epidemiology and characteristics of BD in the mainly African descent population of Martinique, a French Island in the Caribbean. Methods In 2011 we consulted 5 different sources. Patients were included if they lived in Martinique, were classified as certain if they fulfilled the international criteria for BD. The diagnosis was considered only as probable if they had recurrent oral ulcers with at least one other international criteria but no other possible diagnosis. The incidence during the 1997-2011 interval and prevalence at December 31, 2010 were calculated. Basic and BD-related characteristics were recorded. Results 48 patients were indicated as BD. Only 36 (female, n=22; male, n=14) fulfilled the criteria. Mean age at diagnosis was 38.5 years old (range: 8-64), 36.6 for women and 41.6 for men. Disease onset was over 50 years old for 7 patients. Mean time between first signs and diagnosis was 4.2 years (range: 0-22). Twenty eight began their disease between 1997 and 2011 allowing a total crude mean annual incidence estimation of 0.72 new cases/10 5 inhabitants (0.79/10 5 for female and 0.59/10 5 for males, 0.37/10 5 for certain cases and 0.35/10 5 for probable). In December 2010, 28 patients were alive, 5 lost to follow up and 3 deceased: the crude prevalence was estimated as 7.04/10 5 inhabitants (Female: 7.49; male: 6.51). Genital ulcers were found in 75.6%. Dermatological manifestations were: pseudofolliculitis (52%), erythema nodosum (13.5%). Pathergy test was done for 6 patients and positive for 4. Nine patients had ophthalmologic involvement: anterior uveitis (55.5%, n=5), panuveitis and posterior uveitis (11.1%, n=1 each), conjunctival ulceration (22.2%, n=2). Parenchymal brain involvement was more frequent than non-parenchymal (7 versus 3 patients) without any cerebral venous thrombosis. Rheumatic manifestations were occurred in 20 patients (55.6%) mainly females (60%): polyarthritis (38.9%), monoarthritis and spondylarthropathy (11.1% each). Deep vein thromboses were seen in 2 cases and superficial in 1, central retinal artery occlusion in 1 patient. The colon was involved in 6 cases and the ileo-cecal region in one. Conclusions In Martinique, BD seems to be a rare disease compared to Mediterranean and most Asian countries. The incidence is comparable to Spain and Switzerland. The prevalence is higher than in most European countries and USA. Black population seems to have particular manifestations of BD: older age at onset and rare uveitis. Disclosure of Interest None Declared