Deaths Associated with Ankylosing Spondylitis in France from 1969 to 2009.

Objective.To describe deaths for which ankylosing spondylitis (AS) was on death certificates in France.Methods.Death certificates in which AS was indicated were evaluated. Standard mortality ratio (SMR) was assessed.Results.AS appeared in 2940 death certificates. The mortality rate of AS seemed stable. The most frequent initial causes were diseases of the circulatory system [28.3% in the International Classification of Diseases, 10th ed (ICD-10)]. SMR adjusted for age and sex were 2.1 (95% CI 1.45–2.91) for infections and 0.43 (0.36–0.5) for cancers (ICD-10 period).Conclusion.This study found an increase in mortality from infectious and external causes of death; conversely, patients with AS…

FRI0044 Non-steroidal anti-inflammatory drugs are more beneficial than anti-tnfα drugs on the radiographic damage in arthritis: a study in adjuvant induced arthritis

Background The management of the chronic inflammatory rheumatisms has dramatically evolved in the last decade with a concept of “treat to target”. The theory of a window of opportunity with more beneficial effects of an early intensive treatment is supported by several evidences. The positive impact of an early treatment with a TNFα blocker is expected but the place and the interest of non-steroidal anti-inflammatory treatments (NSAIDs) and glucocorticoids is not clear. Objectives The aim of this study was to evaluate the radiological outcomes after an early treatment during 21 days by Etanercept, or Naproxene, or Celecoxib, or Prednisone, or Diclofenac or Methotrexate in adjuvant induced a…

Targeted synthetic disease-modifying antirheumatic drugs in spondyloarthritis

AB0438 Safety of tnf blockers in case of non-alcoholic fatty liver disease and cirrhosisa systematic review

Background The management of inflammatory rheumatisms and psoriasis has largely evolved over the last 15 years with the emergence of biotherapies whose main adverse effect is the increased infection risk. The prevalence of metabolic syndrome is increasing and has been estimated at 30% in patients with rheumatoid arthritis with an excess of 45% compared to healthy subjects. One of the major complications of the metabolic syndrome is the Non Alcoholic Fatty Liver Disease (NAFLD), which prevalence is 25% in the global population, and 30% in a cohort of patients with rheumatoid arthritis. The main complication of NAFLD is the development of cirrhosis, known to increase infectious risk. Surprisi…

Atteinte des vaisseaux dans les spondyloarthrites axiales

Resume La spondylarthrite ankylosante est un rhumatisme inflammatoire chronique caracterise par une atteinte des entheses entrainant des douleurs inflammatoires et une impotence fonctionnelle. La spondylarthrite est associee potentiellement a des manifestations extra-articulaires (uveite, psoriasis, maladie intestinale chronique inflammatoire) et des comorbidites (cardiovasculaire et osteoporose) qui en font avec l’ankylose, la gravite de cette maladie. Comme de nombreuses maladies systemiques inflammatoires, il existe une surmortalite liee a une atteinte cardiovasculaire responsable d’un sur-risque d’infarctus du myocarde, d’accidents vasculaires cerebraux et d’evenements thromboemboliques…

Fine tuning the management of axial spondyloarthritis

Updated recommendations for the management of axial spondyloarthritis provide a useful framework for physicians treating this disease. However, the guidance on use of biologic therapies and treat-to-target strategies seems to raise more questions than it answers.

THU0406 ULTRASONOGRAPHIC INVOLVEMENT OF THE ANTERIOR CHEST WALL IN SPONDYLOARTHRITIS, A FIVE YEARS FOLLOW UP STUDY

Background Spondyloarthrits is characterized by inflammatory back pain. Anterior chest wall pain is common and a previous study reported a prevalence a 37% of ultrasonographic lesions of this anatomical region [1]. Objectives The objective of this study is to evaluate, in patient with Spondyloarthritis, the prevalence of ACW ultrasonographic lesions after a follow up of 5 years and to identify factors associated with the development of new lesions. Methods This a monocentric and prospective study including patients with Spondyloarthritis meeting the ASAS 2009 criteria. Patients were followed during five years. ultrasound B mode and power Doppler examination of the two sternoclavicular joint…

Visceral adiposity in patients with psoriatic arthritis and psoriasis alone and its relationship with metabolic and cardiovascular risk

Abstract Background Fat mass distribution, especially in the abdominal visceral region, has been rarely evaluated in patients with PsA or psoriasis (PsO). Methods Patients with PsA and patients with PsO alone were evaluated and compared with control subjects (1:1 ratio in each patient group) matched for age, sex and BMI category. Body composition and fat distribution (android and visceral fat) were evaluated by DXA. Anthropometric measurements, disease activity and the systematic coronary risk evaluation (SCORE) cardiovascular risk were assessed. Metabolic parameters (insulin, homeostasis model assessment for insulin resistance), serum adipokines [total and high-molecular-weight adiponectin…

Essential knowledge for patients with rheumatoid arthritis or spondyloarthritis: Results of a multicentric survey in France among health professionals and patients.

Abstract Objective Information and education are recommended for patients with inflammatory arthritis including rheumatoid arthritis (RA) and spondyloarthritis (SpA). However, there is no consensus on which knowledge is essential to enhance patients’ self-management. The aim of this study was to determine such knowledge. Methods Based on published knowledge questionnaires (KQs) collected by a systematic literature review, a list of items was elaborated, classified in domains and sub domains. A Delphi process was performed with rheumatologists, healthcare professionals and patients in 2014–2015, selecting the items considered useful. Results Three published KQs were analysed: 2 for RA; 1 for…

Calprotectin and spondyloarthritis

Risque cardiovasculaire dans le rhumatisme psoriasique : revue narrative

Resume Introduction Le rhumatisme psoriasique (PsA) est un rhumatisme inflammatoire chronique caracterise de longue date par un risque cardiovasculaire important. Au cours des dernieres annees, les donnees epidemiologiques ont quelque peu change depuis l’utilisation croissante de biomedicaments efficaces pour reduire cette inflammation. L’objectif de cette revue est d’evaluer les donnees actuelles sur la morbidite et la mortalite cardiovasculaires dans le PsA et d’evaluer le risque cardiovasculaire en cas de PsA. Methode Nous avons effectue une revue de la litterature sur les bases de donnees Pubmed et Medline en utilisant les mots cles suivants : « Psoriatic Arthritis » et « Cardiovascular…

Choice of second-line disease-modifying antirheumatic drugs after failure of methotrexate therapy for rheumatoid arthritis: A decision tree for clinical practice based on rheumatologists' preferences

Objective To survey rheumatologists' preferences for the choice of a second-line disease-modifying antirheumatic drug (DMARD) after inadequate response with methotrexate (MTX) therapy in rheumatoid arthritis (RA). Methods Thirty-six rheumatologists stated their preferences for RA treatment after inadequate response with MTX therapy (optimal dose at least 6 months). From the initial scenario, we derived 54 vignettes varying by rheumatoid factor or anti–cyclic citrullinated peptide antibody presence, swollen joint count, Disease Activity Score in 28 joints, and structural damage. Respondents stated their preference among 5 therapeutic options: MTX continuation, switch to another conventional …

AB0266 METHOTREXATE AND CARDIOVASCULAR RISK IN RHEUMATIC DISEASES:A COMPREHENSIVE REVIEW

Background:The management of inflammatory rheumatic disease has evolved in the last decade with the importance of the management of comorbidities. Methotrexate is the cornerstone of inflammatory rheumatic disease management, but its cardiovascular effects are still poorly understoodObjectives:To assess the cardiovascular impact of methotrexate in inflammatory rheumatic disease.Methods:A systematic review of the literature, following the prisma recommandations, was performed on the PubMed and Embase databases with the following keywords: (“Methotrexate”) AND (“cardiovascular”). We included papers written in English and including patients older than 18 years.Results:570 references were identi…

Abatacept as Adjunctive Therapy in Refractory Polymyalgia Rheumatica.

Glucocorticoids (GCs) are the mainstay of treatment for patients with polymyalgia rheumatica (PMR).1 Despite their efficacy, GCs are associated with well-known adverse events and a substantial proportion of patients with PMR do not respond adequately, or are refractory, to initial GC treatment. GC-sparing agents in PMR are limited to methotrexate (MTX).1.

Clinical practice format for choosing a second-line disease modifying anti-rheumatic drug in early rheumatoid arthritis after failure of 6 months' first-line DMARD therapy.

International audience; BACKGROUND: The objective was to develop a clinical practice format for choosing a second-line disease-modifying anti-rheumatic drug (DMARD) after a 6-month course of a first-line DMARD in patients with early RA. METHODS: A panel of 34 experts selected treatment option from various scenarios using the Thurstone pairwise method. The experts had to choose between two proposed DMARDs without proposing other options. The scenarios were obtained using the three items: DAS28, rheumatoid factor status and radiographic structural damage. A sample of 240 among 480 scenarios for each expert was taken at random. Responses given by at least 20% of the experts were considered per…

Flare in axial spondyloarthritis. The dark side of the outcome

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease with many phenotypes,1 but the frame of the disease is still a matter of debate, particularly regarding the non-radiographic forms of axial SpA.2 ,3 The disease evolution may have several profiles, mainly related to the treatment strategy, balancing from periods of remission or low disease activity to flares of the disease. The recommended treatment strategies are supposed to be tailored to the disease activity, aiming to reach remission or low disease activity in a T2T strategy,4 with management of remission (reduction of dosage or increase in interval of administration), as well as treatment intensification in case of fla…

Cardiovascular risk in psoriatic arthritis, a narrative review

Abstract Introduction Psoriatic arthritis (PsA) is a chronic inflammatory rheumatism characterized for a long time by a high degree of cardiovascular risk. Chronic inflammation is one of the mechanisms that explain this cardiovascular excess of risk through direct and indirect pathways. In recent years, epidemiological data have changed somewhat since the increasing use of bio-drugs that are effective in reducing this inflammation. The purpose of this review is to assess the current state of cardiovascular morbidity and mortality in PsA and thus to assess the cardiovascular risk in case of PsA. Method We conducted a literature review using Pubmed and Medline databases with the following key…

Immunogenicity of TNF alpha inhibitors in rheumatology: many questions, enough answers?

Aerobic exercise for axial spondyloarthritis - its effects on disease activity and function as compared to standard physiotherapy: A systematic review and meta-analysis

Aim To evaluate the impact of an aerobic fitness program on disease activity, defined by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in case of axial spondyloarthritis. Methods A systematic review of the literature, following the Prisma recommendations, was performed by two reviewers on the PubMed and Embase databases. Controlled trials assessing the efficacy of aerobic exercises compared to physiotherapy on axial spondyloarthritis disease activity were included. The diagnosis of axial spondyloarthritis was meeting the New York criteria and/o…

Impact of glucocorticoids on systemic sirtuin 1 expression and activity in rats with adjuvant-induced arthritis

The class III histone deacetylase sirtuin 1 (SIRT1) plays a pivotal role in numerous biological and physiological functions, including inflammation. An association between SIRT1 and proinflammatory cytokines might exist. In addition to their important role in inflammation associated with rheumatoid arthritis (RA), proinflammatory cytokines mediate the development of systemic effects. Here, we evaluated systemic SIRT1 expression and enzymatic activity, in peripheral blood mononuclear cells (PBMCs) and in liver isolated from rats with adjuvant-induced arthritis (AIA), treated or not with low or high doses of glucocorticoids (GCs). We also measured the production of tumour necrosis factor alph…

Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice

International audience; Objective. The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA.Methods. This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the …

Le savoir nécessaire aux patients atteints de polyarthrite rhumatoïde ou de spondyloarthrite. Résultats d’une enquête multicentrique française auprès de professionnels de santé et de patients

Resume Contexte L’information et l’education (ETP) du patient sont recommandees pour les patients atteints de rhumatisme inflammatoire chronique (RIC) : polyarthrite rhumatoide (PR) et spondyloarthrite (SpA). Cependant, il n’y a pas de consensus sur les connaissances essentielles destinees a ameliorer l’autogestion par les patients de leur maladie. Le but de cette etude etait de determiner ces connaissances. Methodes A partir des questionnaires de connaissances patients (QC) publies et selectionnes par une revue de la litterature, une liste d’elements de connaissances a ete etablie, classes par domaines et sous-domaines. Un processus Delphi conduit aupres de rhumatologues, professionnels de…