ObjectiveThe impact of gender on the response and tolerance to abatacept was assessed in a large prospective cohort during 2 years of follow-up.MethodsFrom the 1017 patients included in the Orencia and Rheumatoid Arthritis registry, disease activity was assessed at baseline, 6, 12 and 24 months. The relationship between the European League Against Rheumatism (EULAR) response, Disease Activity Score 28 (DAS28) remission, rate of adverse events and gender was explored in multivariate analysis.Results990 patients, 79.3%female, with at least one follow-up visit were analysed. At baseline, women had longer disease duration, higher disease activity and more often received antitumour necrosis factor (TNF) drugs. The remission was not different between men and women during the follow-up after adjustment on age, disease duration and activity, rheumatoid factor and anti-cyclic citrullinated pyeptide (CCP) positivity, and current disease-modifying antirheumatic drugs (DMARDs), previous TNF blockers and corticosteroids use. The proportion of men and women achieving EULAR good-or-moderate response at any endpoints was similar (52.4% vs 55.5%), as well as time to achieving EULAR response (5.4±4.9 vs 5.6±5.2 months). Moderate EULAR response was more frequent in women at 6 months (OR=1.80, p=0.02) but was no longer significant at 12 or 24 months. During the follow-up, the DAS28, the tender joint count score and the patient global assessment remained higher in women (p=0.001, 0.04 and 0.06, respectively). Drug retention and safety were comparable.ConclusionIn this large daily practice cohort of established rheumatoid arthritis treated with abatacept, women achieved similar remission and EULAR response than men despite higher disease activity and tender joint count during the treatment course.

BackgroundStress fractures are common in both young and active patients (fatigue fracture) as well as in elderly osteoporotic patients (insufficiency fractures).ObjectivesThe aim of this study was to describe characteristics of stress fractures treated in rheumatology at the Clermont-Ferrand University Hospital, to compare them according to their anatomic location (pelvis, lower limb or feet/ankle) and their diaphyseal or metaphyseal/epiphyseal location.ResultsBetween 01/01/2000 and 12/31/2015, 325 fractures were identified in 227 patients divided in 176 women (including 116 postmenopausal women) and 51 men. Population averaged age was 65.2 years [15–99 years]. 142 (43.7%) fractures occurred at pelvis, 93 (28.6%) at lower limbs and 87 (26.8%) at feet and ankles. The fracture was spontaneous in 63.6% of cases. History of pain was recorded in 92.3% with more frequently (90.3%) mechanical pain. Diagnostic delay was on average 70 days.In 51 patients (22.5%) an orthopedic factor could have promoted stress fracture. 54 patients (23.8%) had a history of chronic inflammatory rheumatism, 28 (12.3%) of cancer, and 20 (8.8%) had chronic renal failure.Among the possible iatrogenic factors, 51 patients (23.4%) received oral corticosteroid therapy, 20 (9.2%) methotrexate, 59 (27%) proton pump inhibitor and 17 (7.8%) serotonin reuptake inhibitor. 49 patients (22.5%) already had vitamin-calcium supplementation, 37 (17%) received biphosphonate therapy. 56.6% were osteoporotic and 29.5% were osteopenic.First-line medical imaging was in 87% conventional radiography, positive in 37%. 106 patients (46.7%) performed bone scan with a sensibility of 99%. MRI sensibility (n=65, 28.7%) was 88% and CT-scan sensibility (n=47, 20.7%) 65.2%.Compared to other sites, pelvic fractures were more frequent (p<0.001) and occurred more frequently in postmenopausal women (p=0.03). These patients were older (p<0.001) and had more fracture history (p=0.006). Hip bone mineral density (p=0.03) was lower, and osteoporosis prevalence higher (p=0.004).Pelvic fractures occurred more frequently after fall (p<0.001), lower limb fractures spontaneously (p=0.03) and those of the feet-ankles group after an unusual activity (p<0.001). Patients from metaphyseal-epiphyseal fracture group were older (p=0.05) than those from the diaphyseal fractures group and delay in completing complementary examinations was longer (p=0.04).ConclusionsIn conclusion, pelvic stress fractures are more frequent in a rheumatology department and suggest insufficiency fracture. Stress fracture should be more often suspected when mechanical pain of the pelvis and lower limbs occurs, even spontaneously. Regardless of the site, an assessment of fracture risk factors and bone mineral density evaluation seems necessary.Disclosure of InterestNone declared

BackgroundTocilizumab (TCZ) is an interleukin 6 (IL-6) inhibitor that is used in Rheumatoid Arthritis (RA) treatment (1). Although, IL-6 plays a role in viral immunosurveillanceObjectivesWe studied the effect of TCZ on the evolution in viral load for the Epstein Barr Virus (EBV), Cytomegalovirus (CMV) and Varicella Zoster Virus (VZV) in patients with RA.MethodsThis was a prospective monocenter study of RA patients taking TCZ. Demographic, clinical and laboratory data were collected on each patient. Viral loads (VL) were determined in whole blood (using the EBV R-gene quantification kit, Abbott Real Time CMV kit, and Biomérieux VZV R-Gene kit) at TCZ initiation and during treatment follow-up. A difference between two viral loads of 0.5log10 copies/ml of whole blood was considered significant.Results22 patients were evaluated. There were 20 (89%) women of a mean age of 57.8±11.2 with seropositive (68%) and erosive (74%) RA that had been progressing for a mean of 11.3±9.7 years. TCZ was administered alone (36.7%) or in combination with methotrexate (MTX) (50%).When TCZ was introduced, the EBV VL was positive in eight patients with a mean VL value of 1777.2±3518.3 (3.5±0.4 log10) copies/ml. Only one patient had a positive CMV VL. The VZV VL was negative in all patients. After 9.2±4.8 months had lapsed, EBV VL and CMV VL became negative in six of eight patients (p=0.02) and did not significantly vary in the remaining two patients. No VL (EBV, CMV, VZV) became positive. A positive EBV VL did not correlate with RA activity (DAS28ESR, DAS28CRP) or with inflammatory biomarkers (ESR and CRP). RA activity significantly declined after six months of TCZ treatment (DAS28ESR after six months 2.8±1.1 vs. 5.14±0.9 [p<0.001]). In our study, TCZ did not increase the VL of EBV, CMV or VZV. No other data is available for RA patients. However, in Juvenile Idiopathic Arthritis patients, Kawada et al. did not demonstrate any change in EBV or CMV VL in patients treated with MTX and TCZ, but the study was only on four patients (2). Our EBV results are identical to those that we reported on anti-TNF, which were found by other teams as well (3, 4). Nevertheless, although we did not demonstrate any changes in CMV or VZV VL in patients taking TCZ, there was one reported case of CMV pneumonia (5), one case of lethal EBV-related macrophage activation syndrome (6) and one severe case of Shingles (7).ConclusionsEBV, CMV and VZV viral loads do not seem to significantly increase with the introduction of TCZ treatment. Studies involving larger patient populations are necessary.ReferencesSmolen JS. Ann Rheum Dis 2014 Mar;73(3):492-509.Kawada J. Mod Rheumatol 2012 Aug;22(4):565-70.Balandraud N. Arthritis Rheum 2007 Jun 15;57(5):762-7.Couderc M. Joint Bone Spine 2010 Oct;77(5):414-7.Van Duin D. Emerg Infect Dis 2011 Apr;17(4):754-6.Ogawa J. Ann Rheum Dis 2006 Dec;65(12):1667-9.Kubandova Z. Joint Bone Spine 2010 Dec;77(6):623.Disclosure of InterestNone declared

BackgroundSex differences in rheumatoid arthritis (RA) outcomes as well as response rate to many RA therapies have been established. Response to DMARD or TNF blockers is lower in women. Conflicting data with Rituximab have been obtained from French and British registers and no data beyond 6 months of follow up have been published with Abatacept.ObjectivesAssess the impact of gender on the response and the tolerance with abatacept in RA patients.Methods1017 patients were included in The Orencia and Rheumatoid Arthritis (ORA) prospective registry, promoted by the French Society of Rheumatology. Disease activity (DAS28) was assessed at baseline and during follow-up (6, 12 and 24 months). The relationship between the EULAR response, DAS28 remission, rate of adverse events (at 6, 12 and 24 months) and gender was explored in multivariate analysis using a random effects model considering interaction between gender and time, subject random effect, adjustment on age, disease duration,Rheumatoid factor (RF) or anti-CCP positivity, current DMARDS or previous TNF blockers, corticoids use, RA activity, and potential impact of missing data.Results79.3% of the patients were female (age 57.3 years, disease duration 17 years [IQR 11-24]. RF and anti-CCP positivity was not different between females (69.8% and 68.5%) and males (76.9% and 75.5%). No difference was observed between sexes for the use of steroids (74.6%) or DMARDs (64.7%). At baseline, women had longer disease duration (p<0.001), higher disease activity (p=0.001), and had more often previously received anti-TNF drugs (p=0.04). The DAS28 remission rate was similar in the 2 sexes during the follow-up after adjustment on age, disease duration, RF or anti-CCP positivity, current DMARDS or previous TNF blockers, corticoids use, RA activity (Table 1). Patients with EULAR good-or-moderate response did not differ between men (52.4%) and females (55.5%). Moderate EULAR response was more frequent in women at 6 months but was no longer significant at 12 or 24 months. Time to achieving EULAR good-or-moderate response was similar in women and men (5.4±4.9 vs 5,6±5.2 months, p=0.67). Treatment with abatacept was maintained similarly in 86.9, 72.5, 52.8% of men and 91.1, 72.8, 55.8% of women at the 6, 12, 24 month follow-up visits respectively.73.1% of women and 69.4% of men stopped at least one time the treatment during the follow-up (p=0.3) because of inefficacy in 72% and 64.4% respectively (p=0.09), of adverse events in 14% and 15% (p=0.76).ConclusionsIn this large cohort of RA patients treated with Abatacept in real life, after 2 years of follow-up, similar rate of remission and good-or-moderate EULAR response were observed between men and women after adjustment on disease activity. Drug retention rate and safety were also comparable.Disclosure of InterestNone declared

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