Background/purpose Studies have demonstrated that rheumatoid arthritis (RA) patients who achieve low disease activity or remission are able to taper biological disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to evaluate the proportion of patients in whom bDMARDs can be tapered in daily practice and to analyse the characteristics of these patients. Other objectives were to analyse which bDMARDs are more suitable for dose reduction and the cost savings. Results Data from 332 eligible RA patients from our Brussels UCLouvain cohort were retrospectively analysed; 140 patients (42.1%) received a tapered regimen, and 192 received stable doses of bDMARDs. The age at diagnosis (43.1 vs 38.7 years, p = 0.04), health assessment questionnaire (HAQ) score (1.3 vs 1.5, p = 0.048), RF positivity rate (83.3 vs 72.9%, p = 0.04) and disease duration at the time of bDMARD introduction (9.7 vs 12.1 years, p = 0.034) were significantly different between the reduced-dose and stable-dose groups. Interestingly, relatively more patients receiving a tapered dose were treated with a combination of bDMARDs and methotrexate (MTX) (86.7% vs 73.8%, p = 0.005). In our cohort, anti-TNF agents were the most commonly prescribed medications (68%). Only 15 patients experienced a flare during follow-up. Adalimumab, etanercept and rituximab were the most common bDMARDs in the reduced-dose group and were associated with the most important reductions in annual cost. Conclusion In daily practice, tapering bDMARDs in RA patients who have achieved low disease activity or remission is an achievable goal in a large proportion of patients, thereby reducing potential side effects and annual drug-associated costs. The combination of bDMARDs with MTX could improve the success of dose reduction attempts. Trial registration This retrospective non-interventional study was retrospectively registered with local ethics approval.

Objectives To evaluate the proportion of patients with ERA who have initiated or not GC, to analyse the baseline characteristics, and to assess the clinical benefit and side effects of GC during 5 years of follow-up. Methods We included patients with ERA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria and were naïve to cDMARDs. We retrospectively collected patient characteristics prior to the introduction of cDMARDs with or without GC. Efficiency and serious adverse events were analysed at 6, 12, 36 and 60 months. Results Data from 474 eligible ERA patients were collected. 180 patients initiated GC compared with 294 who did not. At baseline, the increased CRP is the main factor that favors the initiation of GC followed by smoking, absence of ACPA, prescription of methotrexate as a monotherapy and age. 5 years follow-up of DAS28-CRP, HAQ or VAS pain values did not differ between the two groups. We also analysed a subgroup of 139 patients who received >1 g of prednisolone during the 5 years period. We confirmed the same baseline differences and observed in addition more males and higher DAS-28CRP values. During the 5 years follow up, DAS-28CRP, VAS pain and HAQ remained significantly higher in this subgroup. More severe infections were also reported. Conclusion In our ERA cohort, the initiation of GC treatment does not bring additional benefit for the short and long-term control of the disease. GC was more prescribed in seronegative RA patients with a higher level of inflammation. Disclosure statement the authors declare no conflicts of interest. Ethics statement authors declare that the study complies with the Declaration of Helsinki.

BackgroundSynovitis is the common feature of patients suffering from inflammatory arthropathies (IA). The development of ultrasound (US)-guided synovial biopsy will enable synovial tissue collection from small joints and will facilitate molecular studies, thus improving the understanding of mechanisms of IA as small joints are frequently involved in these diseases.ObjectivesTo assess the safety, tolerability and feasibility to perform synovial biopsies from wrist and metacarpophalangeal (MCP) joints, using a minimally invasive US-guided technique in patients suffering from rheumatoid arthritis (RA), spondylarthropathies (SA) or undifferentiated arthritis (UA).MethodsTwo target joints (TJ) were biopsied: wrist and MCP. Patients with at least one clinically swollen joint at these levels, suffering from RA, SA, or UA underwent a US examination. The TJ chosen for the biopsy was the joint with the most important inflammatory changes on gray-scale (GS) US. GS synovitis and power-Doppler (PD) activity were assessed by OMERACT scores, on the day of the biopsy, as well as 2 weeks (w), 6w and 6 months (m) after the biopsy. In addition, tendon tears, hematoma, paratenonitis and tenosynovitis were searched by US. Patient-reported outcomes (PRO) included a standard questionnaire given to all patients on the day of the biopsy as well as 1w, 2w, and 6w after the biopsy. Tolerability and the patient-reported willingness to repeat the procedure was assessed using the 5-point Likert scale.ResultsForty-one patients suffering from RA (27), SA (7) and UA (7) underwent US-guided biopsy of the wrists (20) and MCP (21) joints. A non-significant increase in pain was reported 24 h after the procedure. No difference in PRO of the biopsied joints was reported 2w and 6w after the biopsy, as compared to assessment before the biopsy. No infection or haemorrhage was observed after the biopsy. PRO did not differ significantly among patients suffering from RA, SA or UA. At the TJ, US scores tended to decrease 2w after the procedure. At 6w and 6m follow-up, no safety concerns were reported. Treatment response at the TJ was similar to the response of non-biopsied joints matched for the baseline US parameters.ConclusionsWith the exception of study of Kelly et al (Ann Rheum Dis. 2015;74:611–6117), data on safety, tolerability, feasibility and PRO using the minimally invasive US-guided biopsy technique are lacking. In this work, we confirm that US-guided biopsy of wrist and MCP joints is feasible, safe and well tolerated by RA patients. At 2w, 6w and 6m follow-up, no safety concerns were reported. Furthermore, no differences in PRO between RA, SA and UA were observed. This technique is therefore a promising approach to assess the presence and persistency of synovial inflammatory processes in patients with early and refractory IA, and to facilitate patients stratification according to transcriptomic profiles.AcknowledgementWe acknowledge Pr C. Pitzalis and S. Kelly for giving us the opportunity to learn and further disseminate minimally invasive ultraso...

Background:Over 2 million deaths from the COVID-19 disease have been reported in the world. Since no antiviral treatment is available, the vaccination is the most important option to fight the SARS-CoV-2 infection. Patients living with rheumatoid arthritis (RA) affecting the immune system or under immunosuppressive agent will be considered as a high risk population and will start the vaccination shortly. But many patients could decline the vaccine for several reasons including safety concerns.Objectives:The aim of this study is to evaluate the proportion of patients with RA who are favourable to COVID-19 vaccination, to know the reasons to decline and to analyse the characteristics of these patients.Methods:We included patients with RA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria. A simple and standard questionnaire was distributed to patients who attended rheumatology out patient and day care clinic from 14 december 20 to 14 januari 21. All patient and RA characteristics (Age, gender, education, smoking habits, disease duration, ACPA, RF, DAS28-CRP, HAQ and therapies) were collected at the same time.Results:Data from 460 eligible RA patients were analyzed. The average age of the population is 58.21 years. 72% of the patients are women. 21% are smokers and 65% are positive for anti-citrullinated protein antibody (ACPA) with a mean DAS28-CRP of 2.39 and a mean HAQ of 0.821.281 patients (61%) indicated they would receive the vaccine as soon as it is available. For the 179 patients (39%) who decline, the reasons for not having vaccine were no trust in the vaccine at this time (53%), fear of side effects (28%), opposition to vaccine (4%), previous SARS-CoV-2 infection (2%) and unknown (5%),Interestingly, there were differences among RA patients not willing to receive the vaccine. Patient under the age of 50, women, low education grade, smokers, presence of RF/ACPA and treatment with a bioDMARD were less willing to receive the vaccine. No differences were observed for RA disease duration, HAQ and DAS28-CRP (see Table 1).Table 1.Characteristics of RA population and correlation between groups.TOTALn=460VACCIN-YESn=281 (61%)VACCIN-NOn=179 (39%)Age, mn58,21 +/-0,7160,37 ± 0,900454,82 ± 1,090p=0.0001*Group Age <30 yrs25 (5%)15 (5%)10 (6%)Group Age =31-50 yrs112 (24%)53 (19%)59 (33%)Group Age =51-70 yrs209 (45%)127 (45%)82 (46%)Group Age > 70 yrs114 (25%)86 (31%)28 (16%)p=0.0003**Gender, F/M, %-F332/128(F-72%)193/88(F-69%)139/40(F-78%)p=0.043**Educ0-163 (15%)27 (11%)36 (22%)Educ2-3349 (85%)222 (89%)127 (78%)p=0.003**RA Disease duration yrs, mn14,77 +/-0,5115,24 +/-0,6914,04 +/-0,73Smokers: YES/NO/Ex-Smokers, %-YES85/248/79 (21%)42/156/52 (17%)43/92/27 (27%)p=0.018**RF YES/NO, %243/137 (64%)133/94 (59%)110/43 (72%)p=0.009**ACPA YES/NO, %244/132 (65%)127/93 (58%)117/39 (75%)p=0.001**HAQ, mn0,814+/-0,0390,797+/-0,0510,838+/-0,061DAS28-CRP, mn2,39+/-0,052,35+/-0,072,44+/-0,09GC, YES/NO, %360/86 (19%)217/55 (20%)143/31 (18%)csDMARDs (MTX), YES/NO, %124/322 (72%)72/200 (74%)52/122 (70%)BioDMARDs, NO/YES, %151/295 (66%)107/165 (61%)44/130 (75%)p=0.003**(*) - Unpaired t Test; (**) - Fisher’s exact testConclusion:In our RA cohort, the rates of willingness to receive the vaccine are promising. Dedicated education and outreach efforts should be developed, especially in some RA subpopulation.Disclosure of Interests:None declared.