ObjectivesThis study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France.MethodsA qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles.ResultsA total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, “my fracture is not related to osteoporosis,” was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system).ConclusionsBetter quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.

OBJECTIVES:To describe the long-term effectiveness and safety of certolizumab pegol in patients with moderate-to-severe rheumatoid arthritis (RA) in a real-world setting in France. METHODS:ECLAIR was a 3-year longitudinal, prospective, observational, multicentre study. The primary objective was to describe the EULAR response after 1 year of certolizumab pegol treatment. Other endpoints included DAS28, clinical disease activity index, health assessment questionnaire disability index, fatigue assessment scale, patient's assessment of arthritis pain, patient and physician global assessments of disease activity, patient quality of life, and long-term safety. RESULTS:A total of 792 patients were enrolled, of whom 776 comprised the safety set, and 733 the full analysis set. In the full analysis set, 559, 469 and 430 patients had a 12-, 24- and 36-month visit, respectively. This included 378, 296 and 246 patients still receiving certolizumab pegol at these visits. The percentage of EULAR responders was 75.3% (305/405 patients with an available EULAR response) at 12, 76.5% (261/341) at 24, and 79.6% (226/284) at 36 months. Among those still receiving certolizumab pegol, the percentage of EULAR responders was 81.7% (237/290) at 12, 81.1% (185/228) at 24, and 87.3% (158/181) at 36 months. Sustained improvements were observed in other effectiveness outcomes. Overall, 45.1% (350/776) of patients experienced 776 adverse drug reactions. No new safety signals were identified. CONCLUSIONS:This is the first prospective, observational study of an anti-TNF treatment in France. The results confirm the effectiveness and safety profile of certolizumab pegol treatment in patients with RA in a real-world setting.

Objective To evaluate the performance of clinical criteria for predicting late treatment failure in patients with early non-response to certolizumab pegol (CZP). Methods A protocol-specified analysis of interim data from ECLAIR, a 3-year longitudinal, prospective, observational, multicentre study of patients with active rheumatoid arthritis (RA) initiating CZP treatment in France, was conducted. Clinical measures assessed were Clinical Disease Activity Index (CDAI), Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28(ESR)) and Health Assessment Questionnaire Disability Index (HAQ-DI). Early non-response was measured at 3 months (M3) and failure to achieve low disease activity (LDA) at 12 months (M12). Results 574/792 enrolled patients were treated at M3. The numbers available for predictability analyses were 532 (CDAI), 434 (DAS28(ESR)) and 496 (HAQ-DI). Of the three indices evaluated, the highest predictor of non-response value was observed for the CDAI (88.8% (95% CI 81.0 to 94.1)), indicating that up to 88% of patients identified as non-responders at M3 failed to achieve LDA at M12, regardless of baseline disease severity or treatment history. The specificity for this measure was also very high (96.0%), indicating that less than 5% of patients who achieved CDAI response at M12 had not responded at M3. Similar predictability was observed for DAS28(ESR), but only in patients with high disease activity at baseline and/or those previously treated by a biological disease-modifying antirheumatic drug. Conclusion CDAI non-response at M3 is a predictor of failure to achieve the therapeutic target of LDA at M12 in patients with RA initiating treatment with CZP.

Objectives: To describe the care trajectories of adults aged >= 50 years with fragility fractures in France. Methods: A postal questionnaire was sent to 15,000 individuals aged >= 50 years extracted from a representative panel of the French population (METASKOPE) in April-May 2018. Respondents experiencing a single fragility fracture in the previous three years constituted the study population. Information was collected regarding diagnosis, hospitalisations, physician visits and treatment related to the fractures. Results: 13,914 participants returned a questionnaire (92.8%), of whom 436 reported a single fragility fracture. Their mean age was 68.7 +/- 10.3 years. 11.9% of this sample had undergone bone densitometry (DXA) prior to the fracture and 11.9% had received a diagnostic of osteoporosis. Following the fracture, a further 17.4% underwent DXA and 8.5% were diagnosed with osteoporosis. 74.3% of fractures were initially managed in an emergency department and 29.6% led to immediate hospitalisation. Prior to fracture, 3.4% received a specific anti-osteoporotic treatment, 10.1% vitamin D and 6.4% calcium supplementation. After the fracture, these figures rose to 10.8%, 26.8% and 19.0% respectively. 86.2% participants made at least one follow-up visit to a physician. Conclusions: The rate of DXA screening following fragility fractures in subjects over fifty is very low. Most patients with fragility fractures did not receive a diagnosis of osteoporosis. The proportion of patients treated with a specific anti-osteoporotic treatment after a fracture is low even though around half consulted their general practitioner after the fracture. Practice guidelines are thus not being adhered to in everyday clinical practice in France. (C) 2020 Published by Elsevier Masson SAS on behalf of Societe francaise de rhumatologie.

Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care. To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. In April–May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.

•Dans cet essai comparatif randomisé, permettre à des patients atteints de PR d’accéder à la plateforme e-santé interactive Sanoïa a légèrement amélioré la relation médecin-patient perçue par les patients.•Les plateformes e-santé sont des compléments prometteurs à la prise en charge par un médecin dans la PR.•Malgré une satisfaction moyenne très élevée à l’égard de la plateforme interactive, environ un quart des patients ne l’a pas utilisée.•De nouvelles études d’e-santé devraient mesurer non seulement la satisfaction des patients, mais également la combinaison de la satisfaction et de l’utilisation effective.

Background: Certain fragility fractures (for example of the hip and femur) in the elderly are considered major since they are associated with increased mortality and morbidity.1 Objectives: To describe the characteristics of adults aged ≥50 years in France experiencing fragility fractures according to the site of fracture. Methods: A postal questionnaire was sent to 15,000 individuals aged ≥50 years in order to identify and characterise subjects with a history of fragility fracture. Subjects were asked whether they had experienced a fracture in the previous 3 years and, if so, how many. Fractures were classified according to site into major (shoulder, vertebrae, pelvis, hip or femur and ≥3 ribs) or minor (other sites).1 Results: Of the 13,914 subjects returning the questionnaire, 425 (3%) reported ≥1 fragility fracture. The fracture history rate in the previous year was 1.4% [95%CI: 1.2–1.6]; this rate was higher in women (2.0%) than in men (0.7%) and increased with age. 147 subjects reported major fractures and 287 subjects minor fractures. Most fractures (82.4%) resulted from falling over. The most frequent major fracture sites were the humerus (10.6% of all fractures), vertebra (8.1%) and hip (7.1%). The most frequent minor fracture sites were the forearm/wrist (24.7%) and ankle (17.7%). 25 subjects reported >1 fractures and were excluded from further analyses. Subjects with a history of major fractures were older (p<0.01) than those with minor fractures (72.6±11.3 vs. 67.1±10.6 years; p<0.01). Distribution of gender, body mass index and comorbidities did not differ between prior fracture types. Current obesity was, however, associated with a higher rate of previous fracture of the lower limb. Subjects with a history of major fractures reported a significantly greater loss in height since the age of 20 (p<0.01) than those with a history of minor fractures (-3.38±2.35 vs. -2.75±2.02 cm). Subjects who reported lifetime corticosteroid use for ≥3 months more frequently reported major fractures than minor fractures (odds ratio: 1.90 [1.13;3.18]), as did post-menopausal women (odds ratio: 4.64[1.06;20.43]) and women using oestrogen-based hormone replacement therapy (odds ratio: 1.86 [1.06;3.29]). Parental fracture history, a history of falls, excess alcohol consumption or active smoking, and use of drugs that may increase risk of falls (antidepressants, antiepileptic drugs) were not associated with the type of fracture. Conclusion: Extrapolated to the total French population, >340,000 people aged ≥50 years would be expected to experience a fragility fracture each year. One third of these fractures are major. Characteristics found to be associated with the severity of the prior fracture were older age, corticosteroid use, post-menopausal status and use of oestrogens. Limitations of the study include retrospective data collection, risk of recall bias, lack of ascertainment of fracture history and failure to capture subjects in residential care or who had died since the fracture. References [1] Bliuc, et al. JAMA 2009; 301:513-21. Acknowledgement: The study was jointly conducted and funded by AFLAR and UCB. Editorial support was provided by Foxymed, funded by UCB Disclosure of Interests: Bernard Cortet Consultant for: Bernard Cortet has received consultancy honoraria of speaker’s fees from Amgen, Expanscience, Ferring, Lilly, Medtronic, MSD, Novartis, Roche diagnostics, Théramex and UCB, Pierre Chauvin: None declared, Jean-Marc Feron Consultant for: Jean-Marc Feron has received consultancy honoraria and conference fees from UCB, Amgen and Lilly, 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, Alain Coulomb: None declared, Robert Launois: None declared, Francoise Alliot Launois: None declared, Rahma Sellami: None declared, Chantal Touboul: None declared, Benoit Vincent Employee of: Benoit Vincent is an employee of UCB Pharma, France, Jean-Michel Joubert Employee of: Jean-Michel Joubert is an employee of UCB Pharma, France, Karine Briot Consultant for: Karine Briot has received consultancy honoraria and conference fees from UCB, Amgen, Lilly and MSD

Estimer le nombre de patients présentant une spondyolarthrite (SpA) grave en France, décrire leurs comorbidités et consigner et valoriser leur consommation de soins. Les données ont été extraites de l’Échantillon généraliste des bénéficiaires qui couvre 1/97e des personnes couvertes par l’assurance maladie en France. Tous les patients bénéficiant d’une prise en charge à 100 % (ALD, affection de longue durée) au titre d’une SpA grave en 2012 (y compris ceux présentant des dommages structuraux et/ou des poussées fréquentes) ont été identifiés et un groupe témoin apparié par fréquence selon l’âge et le sexe a été sélectionné. Les comorbidités sévères ont été documentées selon les catégories de l’ALD. La consommation de soins a été consignée et valorisée du point de vue de l’organisme payeur. Les taux de comorbidités et les coûts ont été comparés entre les patients atteints de SpA et les témoins par une méthode de test non paramétrique. Au total, 827 patients admis en ALD au titre d’une SpA grave ont été identifiés (groupe témoin n = 2 481), soit un taux de prévalence de la SpA en ALD de 0,18 % [0,17–0,19] dans la population générale. Les comorbidités sévères plus fréquentes chez les patients atteints de SpA que chez les témoins comprenaient : maladies inflammatoires chroniques de l’intestin (Odds Ratio 15,0 [2,2–6,6–36], hypertension (2,5 [1,6–3,9]), fibrillation auriculaire (4,3 [1,6,9]) et trouble dépressif majeur (2,1 [1,3,6]). La dépense de santé directe moyenne annuelle per capita était 3,6 [1–3,3,4] fois plus élevée chez les patients atteints de SpA (6122 € [5838–6406]) que chez les témoins (1682 € [1566–1798]). L’extrapolation de ces chiffres à l’ensemble des patients en France aboutit à un coût total de soins attribuables aux SpA graves de 391 millions € [355–426], dont 53,8 % pour les médicaments. Le fardeau considérable des spondyloarthrites graves en France résulte de la forte prévalence de cette maladie, des coûts directs élevés et des comorbidités associées.

To estimate the healthcare resource consumption of rheumatoid arthritis (RA) patients treated with certolizumab pegol (CZP) during routine clinical practice in France. ECLAIR was a prospective, non-interventional, multicenter study conducted in France over three years (2014–2017), in patients with moderate-to-severe, active RA starting first-line treatment with CZP followed during routine clinical practice. This study recruited 170 rheumatologists and 6 internal medicine specialists, and was designed to be representative of the French RA population. Of the 792 enrolled patients, 733 formed the full analysis set (FAS). Here, we describe the frequency of physician consultations, nurse and physiotherapist visits, hospitalisation/emergency room visits and medical procedures for the FAS. Data are reported for patients with 12-month, 24-month and 36-month visit data. In the FAS, healthcare provider consultations related to RA decreased with time; these were reported in 44.6% (243/545), 40.3% (184/457) and 37.4% (82/219) of patients with 12-, 24- and 36-month visit data, respectively. These consultations were mainly performed by rheumatologists and general practitioners. Hospitalisations >1 day in length and emergency room visits also declined with time and were reported, respectively, in 13.0% (71/545) and 7.5% (41/545) of patients with 12-month data; 10.1% (46/457) and 2.4% (11/457) of patients with 24-month data, and 11.4% (25/219) and 2.7% (6/219) of patients with 36-month data. Medical procedures (including magnetic resonance imaging, computerised tomography scans, and scintigraphy) also decreased with time, reported in 47.3% (258/545), 46.0% (210/457) and 32.9% (72/219) of patients documented at 12, 24 and 36 months, respectively. This was the first prospective, real-world study of an anti-TNF conducted in France, and provides insight on healthcare resource consumption in RA patients treated with CZP. As consultations did not influence the likelihood of patient drop-out, results suggest a decline in resource consumption over time, including physician consultations, hospitalisations/emergency room visits, and medical procedures.

Objectives: To estimate the number of patients with severe spondyloarthritis (SpA) in France, describe their comorbidities and document and value their healthcare resource consumption. Methods: Data were retrieved from an insurance claims database covering a 1/97 random sample of the French population. All patients benefiting from full insurance coverage ("ALD") for severe SpA in 2012 (including cases with structural damage and/or frequent flares) were identified, together with a control group frequency-matched by age and gender. Severe comorbidities were documented through ALD categories. Healthcare resource consumption was documented and valued from the payer's perspective. Rates of comorbidities and costs were compared in SpA patients versus controls using non-parametric testing. Results: Overall, 827 patients with ALD status for severe SpA were identified (control group: n=2.481), corresponding to a prevalence rate of 0.18% [0.17-0.19] for SpA with ALD in the general population. Severe comorbidities more frequent in patients with SpA than in controls included inflammatory bowel disorders (odds ratio: 15.0 [6.2-36.2]), hypertension (2.5 [1.6-3.9]), atrial fibrillation (4.3 [1.9-9.6]) and major depressive disorder (2.1 [1.3-3.6]). Mean per capita annual direct healthcare expenditure was 3.6 [3.2-4.1]-fold higher in SpA patients ((sic)6,122 [(sic)5,838-(sic)6,406]) than in controls ((sic)1,682 [(sic)1,566-(sic)1,798]). Extrapolating to all patients in France, total healthcare cost attributable to severe SpA patients was (sic) 391 [ (sic)355-(sic)426] million, with medication accounting for 53.8% of this cost. Conclusions: The burden of severe SpA in France is substantial, due to the high prevalence, high direct costs and associated comorbidities. (C) 2018 Published by Elsevier Masson SAS on behalf of Societe francaise de rhumatologie.

Introduction: Sanoia is an online interactive electronic e-health platform developed to allow patient selfassessment and self-monitoring. The objective was to assess in rheumatoid arthritis (RA) patients, the efficacy on patient-physician interactions, of giving access to Sanoia. Methods: In this French, multi-center, 12-months randomized controlled trial (CarNET: NCT02200068), patients with RA and internet access were randomized to: access without incentives to the Sanoia platform after minimal training, or usual care. The primary outcome was the change from baseline in patient-physician interactions, by the patient-reported Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) questionnaire. The number of accesses to Sanoia was recorded and satisfaction with the platform was assessed through a 0-10 numeric rating scale. Analyses were in intention to treat (ITT), on SAS. Results: Of 320 RA patients (159 Sanoia versus 161 usual care), mean (standard deviation) age was 57.0 (12.7) years, mean (SD) disease duration was 14.6 (11.1) years, 216 (67.5%) were taking a biologic and 253 (79.1%) were female. Mean (SD) PEPPI scores at baseline and 12 months were 38.6 (8.2) and 39.2 (8.0) (delta = +0.60 [5.52]) versus 39.7 (7.3) and 38.8 (8.0) (delta = -0.91 [6.08]) in the Sanoia and control group, respectively (A = 0.01). Although mean satisfaction with the platform was very high (1.46 [1.52]), 41 patients (25.7%) never accessed Sanoia. Conclusion: Giving RA patients access to the interactive Sanoia e-health platform led to a small improvement in patient-perceived patient-physician interactions. A disjunction between patient satisfaction and access to the platform was noted. E-Health platforms are promising in RA. (C) 2017 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

The original version of this article was revised due to a retrospective Open Access order.

To evaluate the performance of clinical markers of early treatment failure as predictors of late treatment failure in patients with rheumatoid arthritis (RA) in everyday clinical practice. Data from a 1-year interim analysis of the ECLAIR study, which followed patients with RA starting treatment with certolizumab pegol (CZP) in France, were used. Patients were evaluated at study entry and at 3-monthly routine consultations thereafter. Disease activity was assessed at each visit using CDAI, DAS28(ESR) and HAQ-DI. Early treatment response was measured at Week 12, at which point patients with missing data or no longer taking CZP were excluded from the analysis. Late treatment response was measured at 1 year, at which point linear interpolation, LOCF or NRI were used to impute missing data. Non-response at Week 12 was defined as CDAI>10, ΔDAS28(ESR)<1.2, or ΔHAQ-DI<0.22; and at 1 year as CDAI>22, DAS28(ESR)>3.2, or HAQ-DI>0.5. Positive predictive value (PPV; proportion of treatment failures at 1 year in Week 12 non-responders), sensitivity and specificity were used to evaluate the predictive performance of each tool. Overall, 792 patients were enrolled, of whom 730 were analyzed. The PPV for CDAI (assessed in 532 patients) was 88.8%, indicating that most patients identified as non-responders at Week 12 failed to respond at 1 year. Specificity was also high (96.0%), indicating that <5% of patients who achieved CDAI response at 1 year were non-responders at Week 12. Similar analyses performed for DAS28(ESR) and HAQ-DI produced PPVs of 69.0% and 75.4%, respectively. This study was the first conducted under real-life conditions in France to demonstrate a strong relationship between early and late treatment failure. Simple tools such as CDAI, assessed during routine consultations, may be reliable markers to predict treatment failure without the need for complementary biological tests.

Objectives To develop and validate an outcome measure for assessing fears in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). Methods Fears were identified in a qualitative study, and reformulated as assertions with which participants could rate their agreement (on a 0–10 numeric rating scale). A cross-sectional validation study was performed including patients diagnosed with RA or axSpA. Redundant items (correlation >0.65) were excluded. Internal consistency (Cronbach’s α) and factorial structure (principal component analysis) were assessed. Patients were classified into fear levels (cluster analysis). Associations between patient variables and fear levels were evaluated using multiple logistic regression. Results 672 patients were included in the validation study (432 RA, 240 axSpA); most had moderate disease activity and were prescribed biologics. The final questionnaire included 10 questions with high internal consistency (α: 0.89) and a single dimension. Mean scores (±SD) were 51.2 (±25.4) in RA and 60.5 (±22.9) in axSpA. Groups of patients with high (17.2%), moderate (41.1%) and low (41.7%) fear scores were identified. High fear scores were associated with high Arthritis Helplessness Index scores (OR 6.85, 95% CI (3.95 to 11.87)); high Hospital Anxiety and Depression Scale anxiety (OR 5.80, 95% CI (1.19 to 4.22)) and depression (OR 2.37, 95% CI (1.29 to 4.37)) scores; low education level (OR 3.48, 95% CI (1.37 to 8.83)); and high perceived disease activity (OR 2.36, 95% CI (1.10 to 5.04)). Conclusions Overall, 17.2% of patients had high fear scores, although disease was often well controlled. High fear scores were associated with psychological distress. This questionnaire could be useful both in routine practice and clinical trials.

Background Interactive, online electronic (e)-health services with patient-reported outcome measure (PROM)-based instruments may be helpful for patients (pts). Sanoïa is a secure, independent e- and mobile (m)-health platform developed to allow pt self-assessment, storage of questions to ask physicians, and self-monitoring of disease status. The platform offers a dedicated set of scores, PROMs and information about different diseases, including rheumatoid arthritis (RA). Objectives To characterise pts with RA who chose to access e-health services regularly over a 12-month (mo) period. Methods Post-hoc analysis of CarNET (NCT02200068): a French, multicentre, 12-mo randomised controlled trial. Pts with RA were randomised to: access to Sanoïa (30-min training via the telephone with no further incentive to access the platform) or usual care (normal internet use without access to Sanoïa). The Sanoïa group pts used a home-based e-Case Report Form to record frequency of Sanoïa access, satisfaction with the platform (0–10 scale; 0=completely satisfied, 10=not satisfied), and barriers to use (from a pre-specified list). Baseline pt characteristics associated with more frequent use (above the median) were analysed by univariate and multivariate logistic regression. Results 159 RA pts were randomised to the Sanoïa arm: mean±SD age was 56.1±13.1 years, disease duration was 15.0±11.5 years and 132 (83.0%) of pts were female. Mean DAS28 was 2.7±1.2 with 57.2% of pts in remission; 115 (72.3%) were taking a biologic; 23.3% had attended therapeutic education sessions; 15.7% were members of pt associations; and 53.5% had participated in university-level studies. Overall, 41 pts (25.7%) never accessed Sanoïa and 81 (50.9%) accessed the platform at least twice; median=2, mean±SD=4.4±11.3 connections/pt over the 12 mos. 54 pts (34.0%) used Sanoïa for ≥2 mos with a noticeable investigator effect (0.3±0.2, 0–1 scale). Mean satisfaction with the platform was very high (1.5±1.5), with 90% scoring satisfaction ≤3. One barrier was expressed in 11.8% of cases: “the platform is not useful for me since I am in remission”. In multivariate analysis, the only variable associated with greater usage of Sanoïa was being a member of a pt association: odds ratio [95% CI]=1.44 [1.17–1.77]. Conclusions A quarter of pts who participated in this trial to assess e-health did not access the platform whereas half accessed the platform at least twice. Pts expressed high satisfaction and the only barrier was lower usefulness when in remission. e-Health is a promising tool for self-management in RA. The impact of offering additional services should also be explored in a further study. Acknowledgements This study was funded by UCB Pharma. We thank the patients and their caregivers in addition to the investigators and their teams who contributed to this study. Editorial services were provided by Costello Medical Consulting. Disclosure of Interest L. Gossec Grant/research support from: UCB Pharma, Lilly, Consultant for: AbbVie, BMS, Celgene, Janssen, Novartis, MSD, UCB, A. Cantagrel: None declared, M. Soubrier: None declared, J. M. Joubert Employee of: UCB Pharma, W. Czarlewski Employee of: UCB Pharma, B. Combe Grant/research support from: Merck Pfizer Inc, Roche-Chugai, Consultant for: Merck, Pfizer, Roche-Chugai, UCB Pharma, Bristol-Myers Squibb, Celgene, Eli Lilly, Speakers bureau: Merck, Pfizer, Roche-Chugai, UCB Pharma, Bristol-Myers Squibb, Celgene, Eli Lilly, Novartis, J. M. Berthelot: None declared, D. Wendling: None declared, E. Dernis: None declared, L. Grange: None declared, C. Beauvais Speakers bureau: UCB Pharma, A. Perdriger: None declared, H. Nataf: None declared, M. Dougados Grant/research support from: UCB Pharma, AbbVie, Pfizer, Lilly, Merck, Novartis, H. Servy Shareholder of: Sanoïa platform operating company: e-health services, Employee of: Sanoïa

Notre objectif a été de comparer l’apport de l’association d’un cliché du genou de face en charge en extension et d’un cliché en semi-flexion (dit en schuss) (le gold standard actuel) versus un cliché en schuss seul dans le diagnostic de gonarthrose fémorotibiale.Des sujets âgés de 40 à 75 ans, atteints d’arthrose symptomatique de la hanche et/ou du genou (de stade ≥ 2 selon la classification de Kellgren/Lawrence [KL]) ont été recrutés par l’intermédiaire d’une enquête de prévalence multirégionale réalisée en France. Des clichés de face en extension et en schuss ont été réalisés, puis lus, deux ans plus tard, par le même examinateur, en insu des résultats de la première lecture, à une seconde lecture des incidences en schuss a été réalisée. La comparaison a porté sur les scores de KL de chaque genou mais aussi de façon indépendante sur les ostéophytes, pincement de l’interligne articulaire (JSN). L’influence de l’obésité a été étudiée.L’analyse a porté sur 350 participants atteints d’arthrose à différents stades. La comparaison des deux lectures a révélé une proportion plus élevée de patients de stade KL ≥ 2 lorsque les deux clichés étaient associés (genou droit : p < 0,0001 ; genou gauche : p < 0,001). Il n’a été noté aucune différence entre le cliché en schuss seul et l’association du cliché en extension et du cliché en schuss pour la mesure du pincement articulaire et la détection des ostéophytes. Le cliché en schuss seul lorsque comparé au cliché en extension seul a montré une meilleure aptitude à détecter la présence d’un pincement fémorotibial (p = 0,0001 et p = 0,0001) mais aucune différence n’a été observée entre ces deux clichés pour la détection des ostéophytes.Notre étude montre que le cliché en schuss est suffisant à lui seul pour détecter la présence d’ostéophytes et d’un pincement articulaire. L’utilisation d’un seul cliché radiographique permettrait de répondre à deux problématiques d’actualité que sont l’économie de la santé et la radioprotection. Le recours à deux clichés semble préférable dans le cadre d’études épidémiologiques.

Objective: To compare different early clinical criteria of non-response determined at three months as predictors of clinical failure at one year in patients with rheumatoid arthritis starting therapy with certolizumab pegol. Methods: Data were derived from a randomised Phase III clinical trial in patients with rheumatoid arthritis who failed to respond to methotrexate monotherapy. Patients included in this post-hoc analysis were treated with certolizumab pegol (400 mg qd reduced to 200 mg qd after one month) and with methotrexate. The study duration was twelve months. Response at three months was determined with the American College of Rheumatology-50, Disease Assessment Score-28 ESR, Health Assessment Questionnaire and the Clinical Disease Activity Index. The performance of these measures at predicting treatment failure at twelve months defined by the American College of Rheumatology-50 criteria was determined, using the positive predictive values as the principal evaluation criterion. Results: Three hundred and eighty two patients were available for analysis and 225 completed the twelve-month follow-up. At Week 52, 149 (38.1%) patients met the American College of Rheumatology-50 response criterion. Positive predictive values ranged from 81% for a decrease in Health Assessment Questionnaire-Disability index score since baseline > 0.22 to 95% for a decrease in Disease Assessment Score-28 score since baseline >= 1.2. Sensitivity was <= 70% in all cases. Performance of these measures was similar irrespective of the definition of treatment failure at 12 months. Conclusions: Simple clinical measures of disease activity can predict future treatment failure reliably and are appropriate for implementing treat-to-target treatment strategies in everyday practice. (C) 2017 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.