Background Early arthritis is often undifferentiated and may resolve spontaneously, remain undifferentiated, or progress to rheumatoid arthritis or to another chronic joint disease such as SpA. There is a need for improving the early diagnosis of ankylosing spondylitis (AS) and other spondyloarthritis (SpAs). Objectives To 1- assess the level of agreement between a SpA at baseline and 10 years later in a cohort of patients with recent-onset arthritis and 2- evaluate the ability of baseline clinical, laboratory, and radiographic features to predict a final diagnosis of SpA. Methods Patients with swelling of at least one joint between 1995 and 1997 were included. Ten years later, the physicians of each patient were contacted to determine the final diagnosis. Baseline pelvic radiographs were subjected to centralized blinded review. The statistical analysis used the chi-square test, Mann-Whitney test, and Cohen’s kappa coefficient. Results The diagnosis at baseline and 10 years later was known for 164 patients. At baseline, a diagnosis of SpA was suggested in 25 (15.2%) patients, of whom only 10 had a diagnosis of SpA 10 years later, in addition to 10 patients not diagnosed with SpA at baseline (20/164, 12.2%, Kappa=0.36±0.1). The 10-year diagnoses were ankylosing spondylitis (n=3), psoriatic arthritis (n=7), reactive arthritis (n=4), undifferentiated SpA (n=4), SAPHO syndrome, and Crohn’s disease (n=1). Of the 20 patients with a 10-year diagnosis of SpA, only 4 had inflammatory back pain at baseline (versus 11/144 non-SpA patients, p=0.72), 5 had psoriasis (versus 9/144 non-SpA patients, p=0.005), and 1 had uveitis (p=0.12); 10 of the 20 SpA patients were HLA-B27-positive versus 8/144 non-SpA patients (p<0.0001). Blinded review of baseline pelvic radiographs in 12 patients with a 10-year SpA diagnosis showed sacroiliitis in only 2 patients. Conclusions SpA is relatively rare and extremely challenging to diagnose in patients with early peripheral arthritis. Disclosure of Interest None Declared

Objective: Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France.Design: A two-phase population-based survey was conducted in six regions in 2007-2009. On initial phone contact using random-digit dialing, subjects 40-75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren-Lawrence grade >= 2). Multiple imputation for data missing not-at-random was used to account for refusals.Results: Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7-5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6-14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively.Conclusions: This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity. Study registration ID number 906297 at http://www.clinicaltrials.gov/. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:To assess the performance of a telephone-administered questionnaire suitable for use in 2-phase surveys in the detection of symptomatic hip and knee osteoarthritis (OA) cases.METHODS:A questionnaire was designed based on typical symptoms and self-reported OA diagnosis. Three groups of subjects were consecutively enrolled from rheumatology units at French university hospitals. The disease status, based on American College of Rheumatology criteria, was first confirmed by a rheumatologist. Subjects then completed the screening questionnaire administered by interviewers unaware of the diagnosis and the clinical examination results. Three screening strategies were evaluated.RESULTS:In all, 119 subjects with hip OA, 137 with knee OA, and 111 subjects with other rheumatic diseases with lower extremity symptoms were recruited. The highest sensitivity for both hip and knee OA was obtained with the strategy based on reporting the presence or absence of symptoms (>96%). The specificity of this strategy was low (42% for both joints). When taking into account the self-reported OA diagnosis, the sensitivity slightly decreased (>91%), and the specificity increased greatly, from 76% to 78%. The highest specificity was obtained with the third strategy, requiring a rheumatologist opinion (from 82% to 85%) at the expense of lower sensitivity (>90%).CONCLUSION:The questionnaire tested in this study is a simple, valid, and reliable instrument to screen symptomatic hip and knee OA. As such, it fails to reach complete accuracy and clinical examination and radiographs remain necessary for complete ascertainment procedure.

showed variability according to race, possibly due to substantial differences in education, occupation and community poverty rates between Whites and AAs.It may be important to understand these differences for policy and community interventions, and addressing health disparities.

Objective: To assess the prevalence of rheumatoid arthritis (RA) and spondyloarthropathy (SpA) in two Lithuanian cities, Vilnius and Kaunas.Methods: The first step in this study involved the translation and validation of a telephone questionnaire developed by rheumatologists and epidemiologists in France. The second step comprised the prevalence survey. To detect RA and SpA cases in the populations of Vilnius and Kaunas, 6542 subjects selected randomly (every 50th) from the latest telephone book were interviewed by telephone using a validated case detection questionnaire (the screening phase). All subjects with rheumatic symptoms but an uncertain diagnosis were contacted by a rheumatologist (confirmation phase) by telephone. If the diagnosis remained uncertain, the subjects were invited for a rheumatological examination.Results: We attempted to contact 3370 telephone numbers in Vilnius and 3172 in Kaunas, and had a response rate of 62.5% and 67.7%, respectively. Over the course of all the study phases (telephone interview, rheumatologist's interview, and clinical examination), 39 RA cases and 27 SpA cases were detected, resulting in a crude prevalence of 0.92% for RA (95% CI 0.65-1.25) and 0.64% (95% CI 0.42-0.92) for SpA. The standardized prevalence rate according to age and sex in the Lithuanian population showed an RA prevalence of 0.55 (95% CI 0.39-0.74) and a SpA prevalence of 0.84 (95% CI 0.53-1.21).Conclusions: The prevalence of RA and SpA in Lithuania was found to be one of the higher rates in Europe. A telephone interview using a validated short questionnaire enabled a cost- and time-saving epidemiological survey to be conducted to detect RA and SpA cases in the community.

Objective: To study the feasibility and validity of a two-step telephone screening procedure for symptomatic knee and hip osteoarthritis (OA) in the general population.Method: The screening questionnaire was based on signs and symptoms, previous diagnosis of OA and validated OA criteria. A random sample of telephone numbers was obtained and, at each number, one person aged 40-75 years was included. A physical examination and knee or hip radiographs were offered when the screen was positive. A sample of subjects with negative screens was also examined. The diagnosis of hip/knee OA was based on the American College of Rheumatology criteria for signs and symptoms and Kellgren-Lawrence radiographic stage 2 or greater. Prevalence rates were estimated with correction for the performance of the screening procedure.Results: Of 1380 subjects, 479 had positive screens, among whom 109 were evaluated; symptomatic radiographic OA was found in 50 subjects, at the knee (n = 35) or hip (n = 20). Corrected prevalence estimates of symptomatic OA were 7.6% (6.4%-8.8%) for the knee and 5% (3.9%-6.1%) for the hip. The screening procedure had 87% (95% Cl 79% to 95%) sensitivity and 92% (95% Cl 91% to 93%) specificity for detecting knee OA and respectively 93% (95% Cl 86% to 100%) and 93% (95% Cl 92% to 94%) for hip OA.Conclusion: This study establishes the feasibility of telephone screening for symptomatic knee/hip OA, which could be used for a nationwide prevalence study. Pain and previous OA diagnosis were the best items for detecting symptomatic OA.

Les concepts de polyarthrite rhumatoïde (PR) et de spondylarthropathie (SP) sont pratiques, mais manque la preuve qu’il s’agisse bien de maladies. La plupart des experts les considèrent désormais plus comme des syndromes. PR et SP pourraient de fait se développer à partir d’un socle commun de rhumatismes inflammatoires indifférenciés. Ces polyarthrites indifférenciées pourraient résulter d’un défaut d’élimination au moins transitoire d’antigènes exogènes. Les PR et les SP résulteraient d’une réponse immune inadaptée à la persistance de ces antigènes en excès, la différenciation en PR et/ou en SP des rhumatismes indifférenciés dépendant de la possession ou non par le sujet de facteurs de progression variés, génétiques surtout, dont certains pourraient être communs aux PR et aux SP. La possession d’un nombre plus ou moins important de ces facteurs expliquerait aussi les sévérités très variables de ces affections après un même stimulus initial. La métaphore de « montagnes » enchevêtrées à leur base est proposée pour illustrer cette hypothèse d’une pathogénie multifactorielle et parfois intriquée des rhumatismes inflammatoires chroniques. Les classifications binaires des rhumatismes débutants en PR débutantes ou SP débutantes sont d’ailleurs souvent arbitraires et/ou le fait d’un raisonnement circulaire. De même le moment à partir duquel les signes sont considérés comme suffisants pour retenir le diagnostic de PR débutantes ou de SP débutantes varie beaucoup selon les praticiens. En témoignent l’absence de consensus sur ce thème dans la littérature récente et la mauvaise adéquation des critères existants de PR et de SP pour le diagnostic des PR et des SP débutantes.Although rheumatoid arthritis (RA) and spondyloarthropathy (SP) are useful concepts in practice, it remains unclear whether they are diseases. Most experts believe they are syndromes. RA and SP may stem from a common root of undifferentiated inflammatory joint disease, perhaps related to an at least transient impairment in exogenous antigen clearance followed by an inappropriate immune response to persistence of the excess antigens. Whether the undifferentiated joint disease evolves into RA or into SP may depend on a number of patient-related factors, most notably genes, of which some may be common to RA and SP. Differences in the number of these factors may explain the considerable variations in disease severity across patients subjected to similar triggering insults. Mountains intertwined at their base may be an apt illustration of this hypothesis of a role for multiple and partly shared pathogenic factors in chronic inflammatory joint diseases. Binary classifications of early arthritis into early RA or early SP are often arbitrary and/or based on circular reasoning. The same is true of the cutoffs considered suggestive of these “diagnoses”. The controversy in recent publications on this issue and the limited efficacy of existing criteria in diagnosing early RA and SP bear witness to these shortcomings.