La maladie de Paget était traditionnellement la seconde maladie métabolique osseuse en fréquence dans les pays d'Europe occidentale. Sur les continents asiatique et africain, elle a toujours été rare. La diminution de l'incidence et de la prévalence a été constatée de façon concordante dans de nombreux travaux épidémiologiques que l'approche soit clinique (signes et complications de la maladie), radiologique (détection fortuite des formes asymptomatiques) ou biologique (dosage de marqueurs osseux). Parallèlement, la sévérité de la maladie est aussi déclinante dans la plupart des régions où elle a été évaluée. Les causes de cette raréfaction sont essentiellement environnementales : diminution de l'exposition à des agents pathogènes ou à des habitudes quotidiennes. Cette raréfaction de la maladie expose les futurs médecins à une méconnaissance par défaut de formation et les malades à un retard de prise en charge diagnostique et thérapeutique.Paget's disease was traditionally the second most common bone metabolic disease in Western European countries. On the Asian and African continents, it has always been rare. The decrease in incidence and prevalence has been found to be consistent in many epidemiological studies with several approaches: clinical (signs and complications of the disease), radiological (fortuitous detection of asymptomatic forms) or biological (bone marker assays). At the same time, the severity of the disease is also declining in most of the regions where it has been evaluated. The causes of this scarcity are essentially environmental: decreased exposure to pathogens or daily habits. The rarefaction of the disease exposes the future doctors to a lack of knowledge by default of training and exposes the patients to a delay for diagnostic and therapeutic management.

Background Comorbidities including cardiovascular (CV) risk, cancer and osteoporosis are frequent in RA.[1] Objectives To quantify at baseline and 3 years later, the prevalence (at baseline) and incidence (over 3 years) of some selected comorbidities. Methods This was an open long term (3 years) extension of the COMEDRA 6-month randomized controlled trial in which patients with definite, stable RA were visiting a nurse for comorbidity counselling.[2] Comorbidity status was assessed through face-to-face interviews and nurses provided advice on screening and management, at baseline and 3 years later. The frequency of comorbidities was assessed at both timepoints and incidence of new cases was assessed as overall % of patients and as relative increase in the given comorbidity. Results Of the 970 recruited patients, 776 (80%) were followed up at 2–4 years (15, 1.5%, had died) and 769 (79%) had available data for comorbidities at both timepoints: at baseline, mean (±SD) age 58 (±11) years, mean disease duration 14 (±10) years; 614 (80%) were women and 538 (70%) were receiving a biologic with a mean DAS28 of 3.1±1.3. At baseline, the most frequent comorbidities were history of fracture (31.9%) and high blood pressure (30.9%) and at 3 years the comorbidity which had most increased (i.e., incidence) in this population aged around 60 years, was high blood pressure (4%) whereas smoking had decreased (Table). Conclusions Comorbidities are frequent in RA though screening does not always address the most frequent or severe comorbidities. Efforts must be pursued to improve comorbidity screening and prevention. References Ref 1. Baillet A, Gossec L et al. Ann Rheum Dis. 2016;75(6):965–73. Ref 2. Dougados M, Soubrier M, et al. Ann Rheum Dis. 2015;74(9):1725–33. Acknowledgements grant from Roche France and from the French National Research Program (PHRC AOM 12072). Disclosure of Interest None declared

Background Managing the increasing burden of chronic diseases is a major public health problem. Are early diagnosis and management a key point for their optimal care and outcome? Objectives Assessing early diagnosis and management of chronic diseases was the aim of a study carried out by the High Council for Public Health (HCSP), independent national body gathering experts nominated by the Minister of Health, to provide health authorities with expertise on development of national public health goals, assess their achievement and contribute to their monitoring Methods A multidisciplinary working party run within the HCSP a review of scientific data supporting early intervention benefits, as well as frequency, impact and mechanisms of delayed management on individuals and society, in order to produce national guidelines. A huge amount of data were analyzed:argued contributions from national Professional organizations and Patient associations, literature analysis, audition of national agencies representatives. Results Early stages of chronic diseases are less studied than later ones.Nevertheless, there is a strong evidence that delayed diagnosis and management are frequent and often adversely affect patients and society. The frequency, length and burden of delayed care were analyzed, varying with each disease, availability of efficient treatments and guidelines, socio-economic context. Optimal time for adequate management from symptom onset was reviewed, as well as medico-economic studies Rheumatologic disorders appeared as models, notably Rheumatoid Arthritis (well-established window of opportunity, international guidelines for early diagnosis and management, including T2T and patient active implication). Evidence for early treatment benefit was also found for spondyloarthritis, osteoporosis, obstructive sleep apnea syndrome, chronic obstructive pulmonary disease, renal insufficiency, autism spectrum disorders, bipolar disorders, ... Ethical considerations may arise; in Alzheimer9s disease, a diagnosis source of marked anxiety, there is no effective pharmacological treatment- but non pharmacological treatments are quite helpful for patients and family and therefore recommended by health authorities. Obviously, the benefit of early intervention must be strongly assessed. When this benefit is proven, too many patients are facing delays, often long, with adverse consequences and increased burden for society. The mechanisms of such delayed management are multiple and often intricate; we analyzed the barriers to optimal care linked with professionals, patients, family, health system and society, in order to identify the ways to optimize the outcomes and therefore improve the global health status of the population. Finally the HCSP established a set of guidelines, in 3 axis disseminate widely the available knowledge among professionals, patients, the general public, taking into account the social poor perception of chronic diseases implement effectively change in practice toward early treatment, when appropriate:timely coordination between professionals and patient, fair diagnosis announcement, early patient implication, fight against social health inequalities develop research on early stages of chronic diseases, diagnosis, management and outcomes. Conclusions From a national public health perspective, early diagnosis and management, in the chronic diseases where their benefit is proven, should be better known and effectively implemented. Disclosure of Interest None declared

Current medical information systems are too complex to be meaningfully exploited. Hence there is a need to develop new strategies for maximising the exploitation of medical data to the benefit of medical professionals. It is against this backdrop that we want to propose a tangible contribution by providing a tool which combines conceptual graphs and Dung׳s argumentation system in order to assist medical professionals in their decision making process. The proposed tool allows medical professionals to easily manipulate and visualise queries and answers for making decisions during the practice of teleexpertise. The knowledge modelling is made using an open application programming interface (API) called CoGui, which offers the means for building structured knowledge bases with the dedicated functionalities of graph-based reasoning via retrieved data from different institutions (hospitals, national security centre, and nursing homes). The tool that we have described in this study supports a formal traceable structure of the reasoning with acceptable arguments to elucidate some ethical problems that occur very often in the telemedicine domain.

Purpose. - To report the characteristics of uveitis cases occurring while on biologic therapy ordisease modifying antirheumatic drugs (DMARDs) reported to the French national pharmacovigilance database. Methods. - All the uveitis cases occurring in patients with chronic rheumatologic diseases, chronic inflammatory intestinal diseases or connective tissue diseases, while treated with DMARDs and/or biologic therapies between 2000 and 2015 and reported to the French National Pharmacovigilance Database were collected. Results. - During the study period, 32 cases of uveitis were reported (15 men, 17 women). Two patients were treated with one DMARD alone, 24 with biologic therapy alone, and six with both treatments. Anterior uveitis was diagnosed in 19 patients (8 cases were bilateral); intermediate uveitis was found (unilaterally) in one patient; posterior and diffuse uveitis occurred in 5 and 2 cases respectively. Five cases were inconclusive with regard to the anatomical type of uveitis. The uveitis was of infectious origin in 5 cases: 2 toxoplasmosis, 2 herpes virus and 1 tuberculosis. In the 27 other cases, it was not possible to state whether the uveitis was associated with the underlying disease (uncontrolled) or a side effect of the biologic/DMARD treatments. The occurrence of the uveitis led to 9 switches in biologic therapy and 13 discontinuations of treatment (8 complete discontinuations, 5 discontinuations only until uveitis remission was obtained). In 4 cases, the treatments were not modified. The database does not specify the ultimate course or rheumatologic disease activity at the time of the uveitis. Conclusions. - The presence of uveitis while on biologic therapy must not be taken to indicate a therapeutic failure, especially if the ocular manifestation is isolated. In the case of uveitis occurring in patients treated with biologic therapies and/or DMARDs, infectious complications should be ruled out. (C) 2018 Elsevier Masson SAS. All rights reserved.

OBJECTIVES:To explore the relationship between clinical findings, biologic biomarkers, conventional radiography and MRI in patients with painful hand OA.METHODS:The following patient baseline data from the DORA study (evaluating anti-TNF-α agents against painful hand OA) were used: clinical assessment (pain, swelling, stiffness and function: Dreiser functional hand index [FIHOA] and Cochin hand functional scale [CHFS]); measurement of biomarkers (cartilage oligomeric matrix protein (COMP), type IIA collagen N-propeptid (PIINP), hyaluronic acid (HA), ultrasensitive C-reactive protein (usCRP), tumour necrosis factor (TNF), interleukin (IL)-6, IL-1β and urinary CTXII); radiological staging (Verbruggen, Kallman, Kellgren-Lawrence); anatomical evaluation by contrast-enhanced MRI of proximal and distal interphalangeal joints of dominant hand. Associations between clinical, biomarker and imaging findings were assessed using the Spearman correlation coefficient and test.RESULTS:18 patients were recruited, and 144 joints studied. A correlation was found between clinical features (pain, FIHOA, CHFS) and the Verbruggen score (respectively: p=0.05, r=0.47; p=0.05, r=0.48; p=0.05, r=0.48). Serum IL-1 level was strongly associated with loss of function (FIHOA: p=0.02, r=-0.73; CHFS: p=0.01, r=-0.76) and radiological erosions (p=0.03, r=0.7) as with urinary CTX2. A significant association was found between MRI osteophytes and usCRP (p=0.0026). MRI and radiological features were significantly correlated except for synovitis and bone marrow lesions.CONCLUSIONS:MRI synovitis was not correlated with radiological scores, clinical or biologic markers of inflammation. There was a strong correlation between other MRI features and radiological scores. Serum IL-1 level was associated with structural damage and function.

The addition of venetoclax to hypomethylating agents (HMA-V) improved the outcome of patients with newly diagnosed acute myeloid leukemia (AML) ineligible for intensive treatment. The aim of our study was to confirm data reported in literature, in a real-life multicenter experience. We retrospectively evaluated 56 naïve AML patients who received HMA-V at 8 different collaborating Hematology Units in the North-East of Italy, from September 2018 to October 2020. Patients received azacitidine or decitabine at standard dose, adding venetoclax starting from cycle 1–3. The median time-to-response was 2 cycles and composite complete remission rate (CCR) was 67.9%. Thirteen out of 38 responders (34.2%) relapsed, with a median response duration of 13.7 months. Transfusion independence (TI) was obtained in 27 (87.0%) and 28 (90.3%) out of 31 patients for red blood cells and platelets, respectively. Median OS was 12.3 months (95% CI, 8.1–16.5), and median PFS was 11.3 months (95% CI, 4.6–17.9). Cytogenetic risk was the only variable impacting on survival, while no differences were observed stratifying patients by age, bone marrow blasts, WHO classification or type of HMA. In conclusion, our real-life multicenter experience indicates that HMA-V treatment allows achieving good response rates in naïve AML patients, ineligible for intensive chemotherapy.

Oxytocin, a neurohypophysial hormone, regulates bone metabolism in animal studies and postmenopausal women. In men, oxytocin is not associated with bone mineral density, bone turnover markers, or prevalent fractures, but weakly negatively with incident fragility fracture requiring further studies.

Objectives To evaluate pneumococcal (PV) and influenza (IV) vaccination status in patients (pts) on biotherapies by researching influencing factors. Methods Pts on biotherapies seen between February and July 2013 were questioned about PV and IV status. Variables analysed: age, sex, disease, treatment, immunisation status, reason for non-vaccination and history of pulmonary infection on biotherapy. Percentage comparisons were performed using chi-square and McNemar9s tests. Results 594 pts were analysed (406 F + 188 M): 307 rheumatoid arthritis (RA) (51 M +256 F, mean age 59 years); 277 spondyloarthritis (SpA) (135 M +142 F, mean age 48 years); and 10 other diseases. In the RA group, 189 pts were treated with anti-TNFs: 115 with etanercept (Etn); 37 with adalimumab (Ada); 19 with infliximab (Inf); 13 with certolizumab (Cer); and 5 with golimumab (Gol). 118 other pts were treated with another biotherapy, including 42 with rituximab (Rtx); 38 with tocilizumab (To); 24 with abatacept (Aba); and 14 with anakinra (Ana);151 pts had at least 2 biotherapies. One DMARD was combined in 60% and cortisone in 35%. In the SpA group, 271 were treated with anti-TNFs (Ada 121, Etn 85, Inf 46, Gol 14, Cer 5) and 6 with other biotherapies, 86 pts had at least 2 biotherapies. One DMARD was combined in 28% and cortisone in 5%. The 2012-2013 winter IV (recommended for 37% by the general practitioner [GP]; 45% for RA and 28% for SpA), and in 63% after age 65, and in 79% by the rheumatologist (including 82% for RA and 75% for SpA, and in 93% after age 65) was given to 260 pts (43.77%; including 44% for RA and 43% for SpA and in 62% of pts >65 years). Pts having refused were 47%, (55% were RA and 39% were SpA), generally because of fear (45% RA and 32% SpA). PV over the last 5 years (recommended in 14% by the GP, including 16% for RA and 12% for SpA, and in 24% after age 65, and in 78% by the rheumatologist in RA and SpA, and in 86% after age 65) had been done for 370 pts (62.29%; including 60% in RA and 65% in SpA, and in 70% over age 65). Pts having refused were 25% (31% RA and 17% SpA). In total, 37% had two vaccinations (53% after age 65): 33% one of two; 30% neither of the two. 67 pts (48 RA) had an infection (11%), including 20 hospitalisations. Variables selected for a better vaccination: a prior IV; the recommendation by the GP and the rheumatologist (p<0.001); age >65 years (IV p<0.001, PV p=0.02). The other parameters were not influencing (type and number of biotherapies, DMARDs, cortisone, disease). Infections were not lower in those vaccinated compared to those non-vaccinated (number of pts too low). The PV was up-to-date more frequently than the IV (p<0.001) in the two diseases. Fear of side effects was one of the causes of non-vaccination. Conclusions The rate of IV was 44% compared to 62% for PV. Age influences the vaccination status, as well as the information given to the patient. This should be repeated with pts and physicians in order to improve protection. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.1935

Background Few data have been published about the diagnostic value of standard AP view and Schuss X rays association Objectives Our objective is to compare the contribution to diagnosis of the association standard AP view and Schuss X rays versus the single Schuss X ray. Methods Studied population: From 2007 to 2009, a general population, two-phase study was conducted in 6 French centers to estimate the prevalence of knee and/or hip OA gather a cohort which included only patients with Kellgren Laurence (KL) ≥2 (KHOALA (1)). During this prevalence study we obtained X-rays from 3707 subjects aged 40 to 75 years old. For the current work, we selected the first 304 participants regardless of their stage. X-rays reading: A first reading of standard AP + Schuss views was carried out by an expert rheumatologist (BM), and then a second reading of Schuss X-rays only was carried out remotely (blinded to the results of the first lecture), by the same examiner. Delay between the two readings was 2 years. Analysis focused on the comparison of KL stage of each knee, as well as on osteophytes detection and localization (Medial Condyle (MC), Lateral (LC), Medial Tibial Plateau (MTP) or Lateral (LTP) ranked from 0 to 3), Joint space narrowing (JSN) (ranked from 0 to 4) and bone sclerosis (MC, LC, MTP, LTP). Results Mean age was 58 years (8.6), Body Mass Index (BMI) was 29.8 (5.4). Comparison of 2 readings showed a significantly higher proportion of patients with a KL ≥2 with the two X-ray combined (right knee: p<0.0001; left knee: p<0.0003). In contrast, a finer analysis taking into account JSN (respectively p=0.8 and 0.07), osteophytes (0.8 and 0.3), and bone condensation (0.6 and 0.6) didn9t show any significant differences. Our data suggested a less value of Schuss X-ray alone when BMI is high. A comparison of Schuss versus standard AP X-rays alone showed a Schuss superiority to detect JSN and osteophytes (p=0.0001 and p=0.0001). Conclusions Combined procedure detect more radiological OA than Schuss X ray alone. However, when assessing separately the two main features of OA (JSN and osteophytes), no significant difference appeared in spite of a trend favouring the combined procedure. The partly subjective global KL scoring system is probably more robust to detect OA than separated assessment of JSN and osteophytes alone.Finally, regarding higher cost and irradiation of both radiographs compared to schuss alone, the choice of the procedure will depend on the aim of the study: in epidemiological studies only schuss may be realised, while in a clinical diagnosis perspective both views should be recommended. References Guillemin F et al; KHOALA cohort study. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012;79(6):597-603 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3477

Background Real life experience and health beliefs impact quality of life and adherence to medication. Educational management programs have proved beneficial for patients with osteoporosis (OP). Objectives To understand perceptions and educational needs of patients with different types of osteoporosis. The aim was to target patients perceptive to help the construction of educational programs. Methods Focus group were conducted with a semi directive interview guide developed by the multidisciplinary working group SOLID’OS including rheumatologists, health care professionals, members of a patient association and experts in qualitative research. Interviews involved 18 post-menopausal women with osteoporotic fractures (2 groups), 10 post-menopausal women without osteoporotic fractures (2 groups), 14 men with osteoporosis (2 groups) and 10 patients with corticosteroid (CS) -induced osteoporosis (2 groups). Each group included 4 to 10 patients in 7 different cities. Thematic analysis was performed. Results A wide range of health beliefs about OP was found : OP is considered as a natural consequence of aging or on the contrary leads to dramatic feelings and self-depreciation. Patients regret the delay to diagnosis before fractures occur. Patients are in fear of new fractures and consequently limit their daily life activities. Patients with CS-induced osteoporosis take better care of the causal disease than of OP. Men have negative perceptions, considering that OP principally affects women. Men have difficulties to cope with the loss of their functional abilities. Patients have a rather good knowledge of treatment except for CS treated patients whose knowledge is lower. Some patients are confident in health care providers and medication efficacy whereas others focus on adverse effects and doubt of the benefit of treatments. All patients need support and look for evidence of treatments efficacy. Patients show a great interest for non-pharmacologic management such as calcium intake and physical activity. Errors are frequent about adverse effects of calcium and milk, which for instance is believed to cause arthritis. Patients feel that group follow up by health professionals will enhance their motivation especially for exercises. They show preferences for group education close to their place of residence. Men often go on the Internet for brief information and like booklets. Education should include physical activity, fall prevention and dietetics. The benefit of including partners remains doubtful for almost all patients. Conclusions This qualitative study showed that patients’ perspective differ according to the type of osteoporosis. A personalized assessment of patients’ needs and objectives should then be performed before inclusion in educational programs. Patients have a major interest for non-pharmacological treatments and prefer group education. Disclosure of Interest None Declared

Estimer la prévalence échographique des enthésites chez les patients atteints de psoriasis avec ou sans signes articulaires et étudier leur évolution sous traitement systémique donné pour leurs symptômes cutanés.Étude prospective sur deux centres (rhumatologie et dermatologie) de six mois, incluant des patients atteints de psoriasis nécessitant un traitement général avec ou sans signes ostéoarticulaires et/ou rhumatisme psoriasique (RP). L’évaluation clinique comprenait (M0 et M6) : le BASDAI, le HAQ, le SPARCC, le PASI et l’atteinte unguéale. L’évaluation échographique (M0 et M6) en mode B et doppler puissance (DP) de 10 enthèses fut effectuée par un rhumatologue entraîné à l’insu des données cliniques et biologiques réalisant un score morphologique des lésions structurales et du signal DP.Des données complètes ont été obtenues sur 340 enthèses chez 34 patients. Vingt-deux étaient asymptomatiques (PsO) et 12 symptomatiques (RP). Ils recevaient un traitement conventionnel et/ou une biothérapie. À l’inclusion : une anomalie enthésitique échographique a été observée chez 97,1 % de la population totale et 86,4 % des patients PsO. Quatre-vingt-quinze sur 340 enthésites furent observées, 57/220 chez les PsO contre 38/120 chez les RP (p = 0,258). Aucun des deux groupes n’avait de signal DP. Il a été mis en évidence 24/90 enthésites chez les patients ayant une atteinte unguéale contre 33/130 sans (p = 0,831). À M6 : 23 patients ont été évalués. Les anomalies morphologiques (épaisseur et hypoéchogénicité) furent améliorées chez les patients PsO (n = 13) (p = 0,021) et les patients RP (n = 10) (p = 0,164) avec une diminution significative du BASDAI, du HAQ et du SPARCC.Nous avons observé une fréquence élevée d’enthésites échographiques chez les patients porteurs d’un psoriasis avec ou sans signes ostéoarticulaires nécessitant un traitement systémique. À six mois nous avons mis en évidence une amélioration des anomalies échographiques morphologiques. D’autres études seraient intéressantes pour valider nos données et évaluer leur impact potentiel sur l’évolution vers un RP.

Background In 2009, patient education was recognised as a full component of care for patients with chronic diseases by the French Law HPST (“hospital, patients, health, territories”). As per January 2011, physicians and health professionals teams were allowed to run patient education only after having received a formal agreement from their territorial health agency (ARS), under precise conditions, published at the national level. A yearly report to the ARS became mandatory. The French society of rheumatology created a working group for patient education, devoted to its optimisation at the national level. Objectives To make an inventory of the agreements for patient education in rheumatology and to collect the main points of the teams’ first year activity report, at the national level. Methods We run a national survey via the website of the French Society of Rheumatology, using two questionnaires, early 2011 (patient education programs and agreements) and early 2012 (evaluation of the 1st year of working according to the new rules). Results 56 answers were collected (all from hospital rheumatology teams), gathering 70 agreements out of 91 requests. The approved programs were targeted on inflammatory joint disorders (25), RA (18), SA (9), osteoporosis (5), low back pain (5), chronic pain (2), rare diseases (6). The experience of the first year of working under the new Law was coherent with the previsions of the patient education teams in 22 cases out of 32 answers. The main reported difficulties (27 answers) were : lack of staff (16), of financial resources (8), recruitment (2), patient motivation (2), lack of recognition (1).… 15 teams (out of 28 answers) were likely to submit new requests for agreement, for osteoporosis (9), low back pain (2), other (RA, SA, lupus, gout, OA, chronic pain, orthopaedic surgery…). The response rate to our survey was correct (about 70% of all the patient education programs in rheumatology agreed at the national level - synthesis by the ARS). The agreement rate in rheumatology was similar to the global national one (all chronic diseases). The patient education programs in Rheumatology stand at the 6th raw for agreements, after diabetes, cardio-vascular diseases, respiratory disorders, obesity, renal insufficiency. Globally (all chronic diseases) the main reasons for not being agreed were: lack of conformity with the regulatory pre-requisite, patient education “action” instead of “programme”, projects devoted mainly to the caregivers… Conclusions According to the new Law “HPST”, patient education became a full part of patient care in chronic diseases. This survey confirms the dynamism of Rheumatology in the field of patient education, with a fair agreement rate at the national level to run various educational programs. After the first year of working accordingly with the new rules, the difficulties mentioned by the patient education teams in Rheumatology were mainly linked with some lack of staff and lack of financial resources, without negative impact on the construction of new projects, targeted notably on under represented diseases (including osteoporosis). This survey provides additional data to strengthen further developments of patient education in Rheumatology. Disclosure of Interest None Declared

Background The current T2T and EULAR recommendations (e.g. measures of disease activity must be obtained and documented regularly [1]. Nurses should promote self-management skills in order that patients might achieve a greater self efficacy and improvement [2]) are difficult to apply in daily practice Objectives To evaluate the impact of a nurse led program of patient self-assessment of disease activity on the management of Rheumatoid Arthritis (RA). Methods Study design: Prospective, randomized, controlled, open, 6-month trial (NCT #0131652).Participants 1/Patients: Consecutive RA attending a clinic of the 20 participating centers were invited .2/ Nurses :all participated at a 1.5 day training session prior the start of the study. 3/Treating rheumatologists: aware of the study but not of its primary objective. Study treatment: a program including: 1) a video explaining both the interest, calculation and interpretation of the DAS28-ESR, 2) Training of a self joint assessment, 3) A booklet and a calculator permitting the patient to report the results of his/her “auto” DAS28-ESR and to show the results to his/her treating rheumatologist. Treatment allocation:After written informed consent, the treatment was allocated randomly via en electronic system (e.g. either this above program or an evaluation of potential co-morbidities (not reported here). Outcome variables:Primary: percentage of patients with a change in DMARD therapy during the 6 months follow-up period. Other variables: changes in symptomatic parameters. Results There was no difference in the baseline characteristics of the 970 recruited patients (488 and 482 in the active and control groups respectively): Age: 58±11 years, female gender: 79%, disease duration: 11[6.2-19.1] years, DAS28-ESR: 3.1±1.3, mHAQ: 0.25[0.00-0.62]; RAID: 2.7[1.3-4.3]. At the month 6 visit, the % patients bringing back a completed booklet was 89%. During the 6 months follow-up period, a DMARD therapy was changed in 17.2% vs. 10.9% in the active vs. control group (p=0.0012) (OR=1.70 [1.17-2.19]). During the time of the study, there was no statistically significant inter-group differences (-0.10 [-0.10;0.3], p=0.41; -0.03 [-0.25; 0.18], p=0.761; -0.01 [-0.05; 0.04], p=0.806, in the DAS28-ESR, HAQ and RAID in the active vs. control group respectively. Conclusions This study demonstrates the short term impact of a nurse leaded patient self assessment of RA disease activity program. Longer term follow up of patients is required to better evaluate the clinical benefit of this program References Smolen J.S. et al; Ann Rheum Dis 2010; 69, 631-7 Van Eijk-Hustings y. et al. Ann Rheum Dis. 2012; 71, 13-9 Acknowledgements This study was conducted thanks to a grant from the French National Research Program ( PHRC) and thanks to an unrestricted grant from Roche Ltd France Disclosure of Interest None Declared

A central tenet of the T-cell hypothesis of psoriasis is that lymphocytes can change epidermal growth homeostasis, leading to increased keratinocyte proliferation and abnormal differentiation of these apoptotic cells that end their life cycles as corneocytes. Here, Jan Bos and Menno De Rie discuss the possibility that T cells directly activate resting keratinocyte stem cells, through as yet undefined soluble mediators.

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.

The phenotypic and functional characteristics of immune cells of osteoporotic women compared to healthy controls similar for age and estrogen level showed for the first time significant changes in several B lymphocytes populations in postmenopausal osteoporosis, related to bone mineral density (BMD) and fractures, and a significant lower basal secretion of interferon-gamma (IFN-γ) by CD4+.

We describe the case of a 74-year-old French Caucasian woman, born in Nice, a former storekeeper, with a history of seropositive and erosive rheumatoid arthritis (RA) dating from 1993. She had been treated unsuccessfully (inefficacy or severe side effects) with hydroxychloroquine, methotrexate, and leflunomide. In February 2002, she was given infliximab 3 mg/kg/8 weeks in combination with leflunomide 20 mg per day. Hepatic cytolysis necessitated discontinuation in February 2005. Etanercept alone was tried for 7 months, also unsuccessfully. The hepatic cytolysis was subsequently attributed to the use of nonsteroidal antiinflammatory drugs. In October 2005, infliximab was introduced (5 mg/kg/8 wks) in association with leflunomide (10 mg/day) without glucocorticoids.In September 2006, she was admitted to our department with headache, tiredness, equilibrium disturbances, and a clinical cerebellar syndrome. Treatment was discontinued but, 24 h later, right flaccid hemiplegia appeared with dysarthria. Brain computed tomography scan showed a pattern of cerebrovascular ischemic accident, and she was treated with low molecular weight heparin plus platelet antiaggregants. The motor deficiency was resolved within a few days, but temporospatial disorientation and confusion were still present 5 days after hospitalization. The confusion syndrome worsened, with fever (39.1°C) and symptoms of meningitis. Cerebrospinal fluid (CSF) was clear, 200 elements/mm3, with lymphocyte predominance (99%), high proteinorrhachia [2.73 g/l (normal 0.15–0.45)] … Address correspondence to Dr. Da Silva. E-mail: dasilva.v{at}chu-nice.fr