OBJECTIVES To assess the vitamin D status in patients presenting inflammatory back pain suggestive of axial spondyloarthritis and to assess the relationship between vitamin D status and disease activity/severity; comorbidities at baseline and during the first two years of follow-up. METHODS DESIR is a prospective, multicentre, observational study. Vitamin D deficiency was defined as <50 nmol/L and severe deficiency less than 25 nmol/L. Clinical variables were collected at each six month interval visits during the two-year follow-up. RESULTS A total of 700 patients were analysed. The mean vitamin D was 54.2±28.7 nmol/L. Severe deficiency were observed in 11.7% versus 5% in the DESIR cohort versus the French population respectively. In the DESIR cohort, after adjusting for season and ethnicity, vitamin D deficiency remained significantly associated with presence of radiological sacroiliitis, higher ASDAS score and elevated BASDAI. Such association was also found between vitamin D deficiency and the mean value of disease activity/severity parameters during the two-year follow-up. Otherwise, vitamin D deficiency was significantly associated with the presence of baseline abdominal obesity (OR=1.65 [1.05-2.61], p=0.03), low HDL (OR=1.71 [1.14-2.55], p=0.01) and presence of metabolic syndrome (OR=2.20 [1.04-4.64], p=0.03) at baseline. CONCLUSIONS We found a higher percentage of patients with severe vitamin D deficiency in early axial spondyloarthritis. Vitamin D deficiency was associated with higher disease activity and severity and presence of metabolic syndrome. Further longitudinal studies are required to evaluate the interest of vitamin D supplementation on the long-term outcome of the disease.

Background We previously described the clinical effectiveness of TNFα blockers in a population of matched pairs within the DESIR cohort of early spondyloarthritis (SpA) patients.1 Health utilities and costs have not yet been compared among these patients. Objectives To compare costs and SF6D health utilities among SpA patients treated and not treated with TNFα blockers in the DESIR cohort. Methods The DESIR cohort includes 708 patients with early (<3 years) SpA symptoms who are followed-up every 6 months. We examined 202 matched pairs (404 patients) comprised of ‘active’ and ‘controlș patients with/without TNFα blocker use over two years of follow-up. Matching between active and control patients was done by propensity score, with baseline data used to estimate probability of TNFα blocker use. Patient-reported costs from health resource use and productivity loss were valued using French public health and national salary data. SF6D utilities were estimated from SF36 (Version 1) data. Costs and utilities were described only for matched pairs with complete post-baseline cost data. MCMC multiple imputation was used to impute missing SF36 data using BASDAI, BASFI, HAQ, and Ankylosing Spondylitis Quality of Life questionnaire scores. Pairs were compared on baseline variables associated with TNFα blocker use (age, disease duration, BASDAI, BASFI, CRP, ASDAS CRP, NSAID use (yes/no), mNY criteria, MRI sacroilitis, and HLA-B27) using Student's t-tests or Chi-square tests. Results The analysis included 324 patients. Active and control patients were significantly different on mean BASDAI (active=54.14 vs. control=49.22, p.<0.007), BASFI (active=40.29 vs. control=33.61, p.<0.005), CRP (active=12.73 vs. control=8.89, p.<0.001), ASDAS CRP (active=3.19 vs. control=2.87, p.<0.001), and binary NSAID use (active=0.91 vs. control=0.96, p.<0.001). Mean costs across all follow-ups were € 7062 in the active group and € 1963 in the control group; mean SF6D utility across all follow-ups was in the 0.61113 active group and in 0.63374 the control group. Conclusions DESIR patients with/without TNFα blocker use were significantly different at baseline in variables known to be associated with costs and quality of life, including BASDAI and BASFI scores. As a result, unadjusted health utilities and costs cannot be compared between these groups. Future studies, including an ongoing cost-effectiveness analysis, must adjust for differences in disease severity between these patients. References Moltό et. al. Arthritis Rheumatol. 2014 Jul;66(7):1734-44. Acknowledgements We acknowledge the DESIR Cohort and Scientific Committee Disclosure of Interest None declared

ObjectiveInterleukin‐6 (IL‐6) is a key cytokine in rheumatoid arthritis pathogenesis. We aimed to analyze the association between IL‐6 serum levels and joint inflammation at baseline and the correlation of time‐integrated IL‐6 values with structural damage during the first 36 months of early arthritis.MethodsIL‐6 was assessed by 2 different methods in 813 patients of the French early arthritis cohort ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) over 36 months. IL‐6 and C‐reactive protein (CRP) changes were correlated to radiographic progression assessed by the total Sharp/van der Heijde score (SHS). Synovium inflammation was assessed in a subgroup of 126 patients by ultrasonography (US). The relationship between SHS change and IL‐6 or CRP levels at baseline was investigated by a univariate regression and a multivariable analysis. A longitudinal model nested by visit and patient was conducted to assess the role of IL‐6 on SHS at each visit.ResultsAt baseline, IL‐6 was more strongly correlated with the swollen joint count than CRP level. In the univariate analysis, the time‐integrated value of IL‐6 was more strongly correlated with the swollen joint count and the variation of SHS than time‐integrated CRP level. Baseline IL‐6 was not independently associated with SHS change. Longitudinal models nested by patient showed that IL‐6 levels were associated with structural damage independently from the Disease Activity Score in 28 joints, smoking status, rheumatoid factor, and anti–citrullinated protein peptide antibody serology, treatments, and CRP levels.ConclusionIL‐6 level was a marker of US synovitis at baseline. Repeated measurements of IL‐6 are associated with structural damage.

We thank Dr. Toussirot and Dr. Dumoulin for their comments1 on our paper2. We are pleased to see that they recently published similar results in a group of 12 patients with spondyloarthritis (SpA). We thank the authors for pointing out that the software for visceral fat analysis … Address correspondence to Dr. I. Hmamouchi, Paris Descartes University, Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris, France. E-mail: ihsane.hmamouchi{at}gmail.com

ObjectiveTo estimate the frequency of use and effectiveness in daily practice of tumor necrosis factor α (TNFα) blockers in a population with inflammatory back pain suggestive of early axial spondyloarthritis (SpA).MethodsThe Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohort is a prospective, multicenter, observational cohort of 708 patients with early (<3 years' duration) inflammatory back pain suggestive of axial SpA. The percentage of patients receiving TNFα blockers over the first 2 years of followup was estimated by survival analysis. To evaluate effectiveness, the primary outcome (40% improvement in disease activity according to the Assessment of SpondyloArthritis international Society criteria [ASAS40]) was compared in patients who received TNFα blockers versus control patients who received any other treatment (usual care). Controls were matched to the patients based on a propensity score method.ResultsA total of 30.2% (95% confidence interval [95% CI] 26.7–33.7) patients received at least 1 TNFα blocker during the 24 months of followup. The percentage of ASAS40 responders was 31.5% (62 of 197 patients) in the group receiving TNFα blockers versus 13.2% (26 of 197) in the control group (OR 2.99 [95% CI 1.80–4.99], P = 0.0002). This effectiveness was more pronounced in the subgroup of patients with sacroiliitis identified on magnetic resonance imaging, with 46% of ASAS40 responders receiving TNFα blockers versus 15% of ASAS40 responders receiving usual care (OR 4.99 [95% CI 2.17–11.51]).ConclusionOur study shows that TNFα blockers are frequently used in daily practice to treat patients with early axial SpA. Our findings confirm the effectiveness of TNFα blockers as compared to any other treatment, especially in the subgroup of patients with sacroiliitis on MRI.

Pour le diagnostic de fracture vertébrale (FV) chez l’homme, la concordance entre les médecins est faible. Évaluer la concordance entre experts pour le diagnostic de FV, chez l’homme, sur radiographie standard. Évaluer cette concordance après une réunion de consensus et établissement d’un algorithme. La concordance de 13 rhumatologues, expérimentés, a été calculée chez 30 hommes ostéoporotiques. Une réunion de consensus a été mise en place ; ont été analysés 28 autres dossiers d’hommes ostéoporotiques avec suivi radiologique et FV incidente confirmée. Les experts ont défini puis hiérarchisé 18 critères sémiologiques radiologiques et établi un algorithme de diagnostic de FV. Onze experts ont relu le premier set. La comparaison des deux lectures, sans et avec algorithme, a été étudiée. Après consensus et usage de l’algorithme les résultats sont : nombre de patients fracturés (présentant au moins une FV) de 13 à 26 sur 30 (13 à 28 à la 1ère lecture), moyenne de la concordance à l’échelle du patient : 75 % (70 % à la 1ère lecture) ; nombre de FV détectées sur 390 vertèbres évaluées : 18 à 59 (18 à 98 à la 1ère lecture) ; moyenne du pourcentage de concordance entre les experts à l’échelle de la vertèbre 92 % (89 % à la 1ère lecture). L’algorithme a permis une bonne amélioration de la concordance, surtout pour 8 des 11 lecteurs. Il existe des discordances entre les experts pour le diagnostic de FV. L’algorithme a permis d’améliorer la concordance.

To the Editor: We read with great interest the recent contribution by Hmamouchi, et al 1. They reported an early and significant increase in abdominal adiposity in patients with spondyloarthritis (SpA; mainly male subjects) while receiving anti-tumor necrosis factor (TNF)-α treatment. The patients were evaluated in a 2-year prospective study for body composition using dual-energy X-ray absorptiometry (DEXA; Hologic QDR 2000), and specific DEXA software was used to distinguish subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The results showed an increase in both SAT (+31.9 cm2 or +24.2%) and VAT (+29.1 cm2 or +32.4%) at 2 years in this population, raising the question of the relationship between these changes in adipose tissue and cardiovascular (CV) risk. This is not the first study to examine the issue of adipose tissue modifications during anti-TNF therapy. We previously evaluated the longterm consequences of anti-TNF treatment on body composition and fat distribution, together with changes in serum … Address correspondence to Prof. É. Toussirot, University Hospital of Besançon, Clinical Investigation Center for Biotherapy INSERM CIC-1431, Place St. Jacques, 25000 Besançon, France. E-mail: etoussirot{at}chu-besancon.fr

Background Patients with Spondyloarthritis (SpA) have an increased risk of osteoporosis, which can be observed at the early stages of the disease, related to a systemic bone effect of inflammation. Diagnosis of SpA can be challenging because several diseases can mimick SpA symptoms and patients may be overdiagnosed especially in the presence of HLA B27. Objectives The aim of our study was to evaluate the psychometric properties (specificity, sensitivity, positive (PPV) and negative predictive values (NPV) and positive likelihood ratio (LR+)) of low BMD in patients consulting in our department for SpA suspicion. Methods From January 2008 and December 2012, patients visiting a tertiary Department of Rheumatology for symptoms suggestive of SpA were included. Exclusion criteria were biological therapies and antiosteoporotic treatment intake. Demographic data, disease duration, activity disease (BASDAI, CRP), presence of HLAB27 were assessed. BMD measurements at lumbar spine and total hip were assessed using DXA. Patients were classified into two groups: confirmed SpA and unconfirmed or uncertain SpA according to the diagnosis of the rheumatologist, which was considered the “gold standard”. BMD measurements results and percentage of patients with a low BMD (T score≤-2) at lumbar spine and total hip were compared between both groups. Comparisons of BMD measurements between patients with or without SpA, and performance of BMD (specificity, sensitivity, PPV, NPV and LR+) were performed. Results During 4 years, 267 patients were included in the study. Compared to patients with uncertain SpA (n=193), patients with confirmed SpA (n=74) were more frequently male (63.2% vs 40.5% p=0.001), with positive HLA B27 (78.5% vs 50.7%, p<0.0001), higher disease duration (11.2±9.8 vs 8.3±7.9 years, p=0.035) and higher CRP (12.2±16.9mg/l vs 4.3±10.7mg/l, p<0.0001). There were no differences in former and current therapies (corticosteroids, NSAIDs and DMARDs), and in risk factors of osteoporosis. Mean lumbar spine BMD of patients with SpA was statistically lower than patients with uncertain SpA (0.98±0.16 g/cm2 vs 1.04±0.15 g/cm2, p=0.023) without any differences for total hip BMD. The specificity, sensitivity, PPV and NPV were respectively for a T score≤-2 at lumbar spine: 90%, 26%, 87% and 32% and LR+ of 2.60. Performances values for a T score≤-2 at total hip were 96%, 14%, 89% and 30% and LR+ of 3.12. In the subgroup of patients (n=128) without radiographic sacroiliitis nor syndesmophytes, lumbar spine BMD was significantly lower for patients with SpA (n=61) 0.98 (±0.18) g/cm2 than patients with uncertain SpA (n=67) 1.04 (±0.16) g/cm2 (p=0.023). In this subgroup the specificity, sensitivity, PPV and NPV were respectively for T score≤-2 at lumbar spine: 90%, 28%, 73%, and 58%, and 95%, 12%, 70% and 54% at total hip. The LR+ were 2.90 for a T score≤-2 at lumbar spine and 2.54 at total hip. Conclusions In patients having symptoms suggestive of SpA, a low BMD (Tscore≤-2) is an additional tool for the diagnosis of SpA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1852

Objective. To estimate the frequency of use and effectiveness in daily practice of tumor necrosis factor alpha (TNF alpha) blockers in a population with inflammatory back pain suggestive of early axial spondyloarthritis (SpA).Methods. The Devenir des Spondylarthropathies Indifferenciees Recentes (DESIR) cohort is a prospective, multicenter, observational cohort of 708 patients with early (<3 years' duration) inflammatory back pain suggestive of axial SpA. The percentage of patients receiving TNF alpha blockers over the first 2 years of followup was estimated by survival analysis. To evaluate effectiveness, the primary outcome (40% improvement in disease activity according to the Assessment of SpondyloArthritis international Society criteria [ASAS40]) was compared in patients who received TNF alpha blockers versus control patients who received any other treatment (usual care). Controls were matched to the patients based on a propensity score method.Results. A total of 30.2% (95% confidence interval [95% CI] 26.7-33.7) patients received at least 1 TNF alpha blocker during the 24 months of followup. The percentage of ASAS40 responders was 31.5% (62 of 197 patients) in the group receiving TNF alpha blockers versus 13.2% (26 of 197) in the control group (OR 2.99 [95% CI 1.80-4.99], P = 0.0002). This effectiveness was more pronounced in the subgroup of patients with sacroiliitis identified on magnetic resonance imaging, with 46% of ASAS40 responders receiving TNF alpha blockers versus 15% of ASAS40 responders receiving usual care (OR 4.99 [95% CI 2.17-11.51]).Conclusion. Our study shows that TNF alpha blockers are frequently used in daily practice to treat patients with early axial SpA. Our findings confirm the effectiveness of TNF alpha blockers as compared to any other treatment, especially in the subgroup of patients with sacroiliitis on MRI.

Background A small subset of patients with presumed idiopathic intracranial hypertension are found to have isolated internal jugular vein stenosis (IJVS). Objective To review the current interventions used in patients who present with intracranial hypertension secondary to IJVS. Methods In December 2020, we performed a literature search on Pubmed/Medline and Scopus databases for original articles studying surgical and endovascular interventions used for intracranial hypertension in the setting of internal jugular vein stenosis. No date, patient population, or study type was excluded. Results All studies that included at least one case in which a surgical or endovascular intervention was used to treat IJVS were included. Selection criteria for patients varied, most commonly defined by identification of compression of the internal jugular vein. The 17 studies included in this review ranged from case reports to large single-center cohort studies. The most used surgical intervention was styloidectomy. Styloidectomy had an overall better outcome success rate (79%) than angioplasty/stenting (66%). No complications were recorded in any of the surgical cases analyzed. Outcome measures varied, but all studies recorded clinical symptoms of the patients. Conclusion Few current large cohort studies analyze surgical and endovascular interventions for patients with IJVS. Notably, the most common intervention is styloidectomy, followed by internal jugular vein stenting. By understanding the trends and experience of interventionalists and surgeons, more focused and larger studies can be performed to determine effective strategies with the best clinical outcomes.

Detection of patients with vertebral fracture is similar for areal bone mineral density (aBMD) and trabecular bone score (TBS) in patients with non-vertebral fracture. In non-osteoporotic patients, TBS adds information to lumbar spine aBMD and is related to an index of spine deterioration.

Background Diagnosis and/or classification of a patient with axial Spondyloarthritis (SpA) generally relies on the presence of structural damage of the sacroiliac joints (SIJ) assessed by plain X-rays. However, the psychometric properties of the evaluation of such abnormalities by plain X-rays are not well known. Objectives Evaluate the intra and inter-reader agreement for the scoring of the sacroiliac SIJ by pelvic postero-anterior plain X-rays. Evaluate the discriminant capacity of pelvic X-rays for the detection of structural damage of the SIJ suggestive of SpA. Methods Observational transversal mono-centric study. 77 patients were included: 29 patients Ankylosing Spondylitis (AS) according to the modified New York (mNY) criteria (from medical file) and 48 control patients with mechanical back pain (MBP). A pelvic X-ray was performed on all patients.:all 77 X-rays were anonymised and read by two readers (blinded to diagnosis) in a random order to assess inter-reader agreement. Image reading consisted of scoring from 0 to 4 for each SIJ according to the modified new York criteria for the 77 pelvic X-rays. Thereafter, psychometric properties for the detection of structural damage of the SIJ suggestive of SpA were assessed by one reader (blinded to diagnosis) considering the medical record as the gold standard (mNY sacroiliitis yes/no). Statistical analysis: a) Inter- and intra-reader agreement for sacroiliitis detection: unweighted kappa (mNY sacroiliitis yes/no, where mNY sacroiliitis was defined as a grade ≥2 at both SIJ) b) Inter-reader agreement at the SIJ level: Weighted kappa for each grade of the mNY criteria at each SIJ. c) Sensitivity, specificity and positive likelihood ratio for the presence of structural damage of the SIJ suggestive of SpA. Results 29 AS patients (mean age 50.2±14.3 years, symptom duration 25.0±12.7 years, 24 (80%) men, and 48 MBP controls (mean age 49.1±10.7 years), 9 (22.5%) men) were included. Intra-reader and inter-reader agreement for the mNY sacroiliitis was 0.40 [0.19-0.99], and 0.36 [0.09-0.63] by unweighted kappa, respectively. Inter-reader agreement for the mNY scoring at the sacroiliac level was 0.62 [0.48-0.75] Sensitivity of pelvic X-rays for the detection of structural damage of the SIJ suggestive of SpA was 0.76 [IC95%, 0.58-0.88], with a specificity of 0.84 [0.71-0.91] (positive likelihood ratio was 4.65). Conclusions This study confirms the challenge of sacroiliac joint evaluation by pain X-rays, which reveals modest agreement; nevertheless, the specificity of such imaging for structural damage evaluation of the SIJ suggestive of SpA was good (84%). Development of imaging techniques that allow more reproducible detection of structural damage is necessary. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2598

Déterminer (i) la présentation clinico-radiologique de la gonarthrose destructrice rapide (GDR) après prise en charge médicale globale incluant le lavage articulaire associé à une infiltration de corticoïdes, (ii) les facteurs prédisposant au recours ultérieur à la chirurgie. Étude rétrospective monocentrique ayant inclus des GDR fémoro-tibiales, définies par la perte d’au moins 50 % de l’interligne articulaire en un an, avec un suivi post-lavage articulaire d’au moins un an. Cent onze patients étaient inclus, âge moyen : 64,1 ans, IMC : 28,9 ; 70,3 % de femmes. L’EVA douleur était à 56,1 mm, indice de Lequesne : 11,9, score de WOMAC fonction : 51,9. Un épanchement intra-articulaire mécanique (216 globules blancs/mm3) a été retiré chez 102 patients (92 %), persistant depuis plus de six mois dans 71 % des cas. Le compartiment fémoro-tibial médial était concerné dans 79 % des cas. Le pincement de l’interligne articulaire avait atteint 52 % en extension et 71 % en schuss, sur une durée moyenne de suivi de 7,3 mois. La chondrocalcinose radiologique était présente dans 13,5 % des cas et l’ostéonécrose dans 12,6 % des cas. Un lavage articulaire (1 litre, 2 aiguilles de 14-gauge) associé à une infiltration de corticoïdes a été complété par des injections d’acide hyaluronique (AH) chez 71 % des patients. Quatre-vingt-neuf patients ont été revus avec une période moyenne de suivi de 55,0 mois. Trente-sept (41,6 %) avaient nécessité une intervention chirurgicale. Le délai moyen entre le lavage et la chirurgie était de 16,1 mois. La douleur était acceptable chez 100 % des patients opérés et 87,8 % des patients non opérés. L’analyse de régression multivariée a retenu l’atteinte fonctionnelle, évaluée par le temps de marche maximum, ainsi que la sévérité radiographique en extension comme étant des facteurs prédisposant à la chirurgie. Le devenir de la GDR semble moins sévère que prévu après une prise en charge médicale globale.

Background MTX is recommended as the first DMARD in rheumatoid arthritis. Despite its widespread use and more than two decades of experience, considerable variations exist among rheumatologists in prescribing MTX. Objectives To describe symptomatic and structural impact of different profiles of MTX regimen in early arthritis (EA) in daily clinical practice. Methods – Patients: from the French cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months, DMARD naïve), fulfilling the ACR-EULAR criteria for RA at baseline, and treated by MTX as first DMARD during follow-up – Treatment groups: MTX optimal regimen was defined 1] by the delay of introduction (within 1, 3 and 4 months after the baseline visit of the ESPOIR cohort) AND 2] by the dose: dose of initiation at least 10 mg/week and achieving at least 20 mg/w or 0.3mg/kg/w if DAS28 >2.6 as noticed at the 6 months visit of the ESPOIR cohort (or any dose noticed at month 6 in case of DAS<2.6). Sensitivity analysis on different target dose (at least 0.2mg/kg/w) was performed. – Outcomes: remissions (Boolean, SDAI and DAS28), functional stability (HAQ≤0.5 and deltaHAQ≤0.25) and absence of radiographic progression (delta Sharp score<1) after 1 and 2 years of follow-up. – Analyses: outcomes of patients receiving MTX with versus without optimal regimen were compared by chi square test. Evaluation of the symptomatic and structural efficacy has been performed by logistic regression (after adjustement on: SJC, CRP, ACPA or RF, Erosion, Center, Age, Smoking, HAQ, ACR1987 criteria). Results 352 out of 600 RA patients received MTX as first DMARD with a mean dose of MTX =13.1±3.9 mg/week within the first year of follow-up. Overall, MTX was initiated within 1 month after baseline in 53.7% of patients, within 3 months in 76.1% and within 4 months in 81%. There were no differences in remission rates, functional capacity and structure with regard to such time of introduction of MTX. In all, 25.3% were treated initially with a weekly dose of at least 10 mg/week and with dose escalation to least at 20 mg/w or 0.3mg/kg/w as noticed at months 6 if DAS28>2.6. Both remission (whatever the definitions used), and functional stability were more frequently observed in the “optimal” MTX regimen (boolean remission: 27.4% versus 10%; OR at year 1 =2.53 [1.21 -5.28] and functional stability: 74% versus 52.6%; OR at year 1 =3.04 [1.51 -6.14]) but without significant impact on radiographic progression over 2 years (34.9% versus 35.2%, OR at 1 year =1.08 [0.57-2.04]). Results were similar at 2 years. These favorable clinical outcomes were not observed with the target dose of at least 0.2mg/kg/w. Conclusions The most important aspect of the MTX optimal regimen is the escalation to least at 20 mg/w or 0.3mg/kg/w if DAS28 remission is not reached. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5814

Objective. Presence and levels of anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) contribute to the classification and prognosis of rheumatoid arthritis (RA). The objective was to determine the usefulness of repeating anti-CCP/RF measurements during the first 2 years of followup in patients with early arthritis.Methods. In patients with early undifferentiated arthritis, serial anti-CCP and RF were measured using automated second-generation assays every 6 months for 2 years. Frequencies of seroconversions (from negative to positive or the reverse) and changes in antibody levels during followup were determined.Results. In all, 775 patients, mean (SD) age 48.2 (12.5) years, mean symptom duration 3.4 (1.7) months, 76.6% female, were analyzed; 614 (79.2%) satisfied the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria for RA at baseline. At baseline, respectively for anti-CCP and RF, 318 (41.0%) and 181 (23.4%) patients were positive, of whom 298 (93.7% of the positive) and 111 (61.3% of the positive) were highly positive (above 3 x upper limit of the norm). There were only 12 anti-CCP seroconversions toward the positive (i.e., 2.6% of the anti-CCP negative), 21 seroconversions toward the negative (6.6% of the anti-CCP positive), and 8 (1.0%) changes to a higher anti-CCP level category during the 2-year followup; respectively for RF, 27 (4.6%), 95 (52.5%), and 13 (1.7%).Conclusion. In this cohort of patients with early arthritis, including in the subset of patients who did not fulfill the RA criteria, antibody status showed little increase over a 2-year period. Repeated measurements of anti-CCP/RF very infrequently offer significant additional information.

9552 Background: Comprehensive geriatric assessment (CGA) is the gold standard to help oncologist in choosing the best cancer treatment in their older patients. Some authors recently suggest that the concept of frailty, developed by L Fried, could be a more useful approach in this population. We investigated if frailty markers (FM) are associated with treatment recommendations in an oncogeriatric clinic. Methods: This prospective multicenter study included patients 65 years and older, with solid tumors, referred to the oncogeriatric consultation after a cancer treatment plan. A CGA includes 9 domains (autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls and social status) was performed. Five FM were assessed (nutrition, physical activity, energy, mobility, strength). Patients were classified as Frail (3 or more FM), pre frail (1 or 2 FM) or not frail (0 FM). Treatment recommendations were classified in 3 categories: Standard treatment, Standard treatment with adaptation, supportive/palliative care. A polytomus logistic regression models were used to analyze factors associated with treatment recommendations. Results: 217 patients, mean age 83 years (± SD 5,3) were included. The most prevalent of the FM were mobility (77%), physical activity (65%), and nutrition (61 %). 42% had at least 3 markers. In univariate analysis, grip strength, physical activity, mobility, nutrition, ADL, IADL, social status, depression, ECOG-PS and sexe were significantly associated with treatment recommendations. In the multivariate analysis, only the number of FM and ADL were significantly associated with treatment recommendations (respectively p=0.001 and p=0.015). Treatment recommendations were significantly different into the 3 FM groups (p=0,001). In the non frail group, standard treatment or standard treatment with adaptation was maintained for more than 90% of patients. In the frail group, a support/palliative care was proposed for 60% of patient. Conclusions: Frailty markers are associated with treatment recommendations in older cancer patients. Longitudinal studies are warranted to better precise their use in geriatric oncology setting.

The effect of lumbar osteoarthritis on bone density and trabecular bone score (TBS) was evaluated cross-sectionally and prospectively in postmenopausal women. Lumbar spine osteoarthritis was graded according to Kellgren and Lawrence grades. Lumbar osteoarthritis was found to increase lumbar spine bone density, but not TBS.

The agreement for vertebral fracture (VF) diagnosis in men, between doctors is poor.Objectives: To assess the agreement for VF diagnosis, in men, on standard radiographs, between experts, before and after consensual workshop and establishing an algorithm.Methods: The agreement between thirteen experimented rheumatologists has been calculated in thirty osteoporotic men. Then, the group discussed in a workshop and 28 other radiograph sets of osteoporotic men with follow-up radiographs and incident confirmed VF, have been reviewed. The experts identified and hierarchised 18 pathological features of vertebral deformation and established an algorithm of VF diagnosis. Eleven experts have realized a second reading of the first set of radiographs. We compared the agreement between the 2 readings without and with the algorithm.Results: After consensus and the use of the algorithm the results are: number of fractured patients (with at least 1 VF) according to the experts varies from 13 to 26 patients out of 30 (13 to 28 during the first reading). The agreement between the experts at the patient level is 75% (70% at the first reading). Among the 390 vertebrae analyzed by the experts, the number of VF detected varies from 18 to 59 (18 to 98 at the first reading). The agreement between the experts at the vertebral level is 92% (89% at the first reading). The algorithm allows a good improvement of the agreement, especially for 8 of the 11 experts. Discrepancies for the VF diagnosis between experts exist. The algorithm improves the agreement. (C) 2013 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.