BackgroundCompared with the general population, patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease or events (CE): stroke, Myocardial Infarction (MI), Congestive Heart Failure (CHF) and Cardiovascular Mortality (CVM). Systemic inflammation is the cornerstone of both RA and atherosclerosis. Over the past fifteen years, new treatment strategies such as tight control, treat to target, methotrexate optimization, biologic DMARDs use has allowed a better control of this inflammation.ObjectivesThe aim of this systematic review was to assess the excess risk of presenting a CE in RA patients as compared to general population, before and after the 2000s.MethodsWe systematically searched literature (via Pubmed, Cochrane and abstracts from recent ACR and EULAR congresses) up to March 2016 for observational studies providing data about the occurrence of a CE (among stroke, MI, CHF, CVM) in patients with RA and in a control group. A meta-analysis of the relative risk (RR) concerning patients with RA in relation to the control group was performed for each cardiovascular event and for each period (before and after the 2000s).ResultsOut of 5714 screened references, 28 studies were included. For studies published before 2000, an increased risk of CEs was observed in RA patients:– RR=1.12 [95% CI 1.04; 1.21], p=0.002 for stroke– RR=1.25 [1.14; 1.37], p<0.00001 for CHF– RR=1.21 [1.15; 1.26], p<0.00001 for CVM– RR=1.32 [1.24; 1.41], p<0.00001) for MI.For all studies published after the year 2000, the increased risk was not retrieved for CHF (RR=0.58 [0.11; 3.55], p=0.52) and CVM (RR=1.07 [0.74; 1.56], p=0.71). The excess risk of MI was reduced in comparison with the period before 2000: RR=1.18 [1.14; 1.23], p<0.00001.The excess risk of stroke was stable: RR=1.23 [1.06; 1.43], p=0.006.Discussion: This meta-analysis confirms an increased risk of CEs among people with RA relative to the general population. It also appears that this excess risk is less prevalent than prior to 2000s. This might have two explanations: a better management of the cardiovascular risk in patients with RA and a better control of chronic systemic inflammation thanks to new therapeutic strategies.ConclusionsThe cardiovascular excess risk of RA patients relative to the general population has decreased since 2000s. This suggests that the recent improvements in RA management may have a positive impact on cardiovascular comorbidities.Disclosure of InterestNone declared

Background:Since the beginning of 2020, the COVID-19 pandemic has caused a considerable amount of fear, worry and concern in the general population and among certain groups such as the elderly, healthcare providers and people with pre-existing conditions in particular. Our patients suffering from chronic inflammatory rheumatism (CIR), a group of autoimmune pathologies treated by immunosuppressant medication, are particularly concerned. Actions taken – particularly quarantine and its effects on the normal activities, habits or livelihoods of many people – also have a significant impact. There is little information on the impact of the lockdown in patients with CIR with data measured prospectively, in a standardized way, before and during the first lockdown period.Objectives:The objective of this ancillary study was to evaluate the psychological impact of the first lockdown period (anxiety, depression, sleep disorders, catastrophizing...) as well as the evolution of disease activity in patients suffering from CIR.Methods:At two French university hospitals, adult patients with rheumatoid arthritis (RA) according to the ACR-EULAR 2010 criteria, spondyloarthritis (SpA) fulfilling the ASAS 2009 criteria and psoriatic arthritis (PsA) according to the Caspar 2006 criteria were consecutively included in the Catastrophism in Chronic Inflammatory Rheumatism (CRIC) study from September 2019. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires on disease activity (DAS28, CDAI, BASDAI), function (HAQ), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), insomnia (ISI) and catastrophizing scores (PCS). These data were collected prospectively at baseline, 3, 6 and 12 months.In this ancillary study, data from patients with an assessment before and during lockdown were analyzed. Statistical analyses were descriptive with a paired Student’s T-test.Results:In all, 140 patients (49 RA, 69 SpA and 22 PsA) were evaluated before and during lockdown. The median age was 53.5 [44-63] years and 60.7% were women; 74 patients (53.2%) were professionally active and 102 (72.9%) were living as couples. The majority of patients (92.9 %) had a disease lasting more than 2 years. Concerning treatments, 63 (45%) were treated by bDMARD monotherapy, 40 (28.5%) by bDMARD+ csDMARD, 17 (12.1%) by csDMARD monotherapy and 2 patients by tsDMARD; 90.7% were not taking any corticosteroids and 8.6% were taking ≤5 mg/d; 30% were on NSAIDs.When comparing before and during lockdown, pain, tender joint count, swollen joint count, disease activity (CDAI, BASDAI) and function (HAQ, SF12 physical component) were similar. However, there was a significant improvement in psychological status, anxiety (HADS, GAD7), the mental component of SF12, catastrophizing and overall quality of life (EQ5D) (see Table 1 below).Conclusion:There are very few prospective, standardized data on the impact of lockdown in patients with CIR with an assessment before and during the first lockdown period. In patients with CIR, the first lockdown period had no impact on the activity of the disease and was well experienced psychologically with less anxiety and an improvement in quality of life.Table 1.Outcome (N)140 CIR: 49 RA, 69 SpA, 22 PsABefore lockdownMean (SD)During lockdownMean (SD)Mean change(SD)PPain VAS (138)39.4 (25.3)39.4 (25.0)-0.28 (27.1)NSTJC (57)4.0 (6.8)4.7 (4.4)0.7 (5.9)NSSJC (56)1.0 (2.6)1.6 (1.7)0.5 (2.4)NSCDAI (36)11.7 (1.4)12.3 (7.5)1.2 (8.7)NSBASDAI (84)4.7 (1.9)4.9 (2.0)0.14 (1.4)NSHAQ (135)0.72 (0.57)0.72 (0.53)0.03 (0.33)NSSF12 mental(136)32.7 (8.7)36.2 (8.4)3.46 (8.01)<0.0001GAD-7 (anxiety) (135)7.7 (5.5)5.0 (5.3)-1.73 (0.40)<0.0001HADS anxiety(137)8.5 (3.9)7.8 (3.9)-0.64 (2.91)0.0113EQ5D(139)0.55 (0.31)0.61 (0.29)0.06 (0.24)0.0078PCS (catastrophizing) (137)18.9 (13.3)15.9 (11.1)-3.10 (9.60)0.0003Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is associated with a 2 fold increased risk of cardiovascular events (CVE) and mortality when compared to the general population. The systemic inflammation in RA seems to play a pivotal role by creating endothelial dysfunction and thus accelerating atherosclerosis. This long lasting inflammatory process potentiates the effects of additional classical cardiovascular risk factors. Since the 2000s, numerous therapeutic advances, in particular biologics, allow better control of this inflammation. Among these, IL6 inhibitors (IL6i) are known to provide rapid and sustained improvements in clinical, biological and radiographic outcomes. However, an increase in circulating lipid concentrations in patients treated with IL6i is usual. This raises the question of the risk -to -benefit ratio of IL6i.Objectives:The purpose of this systematic literature review and meta-analysis was to evaluate the impact of IL6i on the incidence of major adverse cardiovascular events in RA patients in comparison with TNFalpha inhibitors (TNFi), non TNFi bDMARDs or csDMARDS.Methods:A systematic literature search of MEDLINE (via PubMed), EMBASE and the Cochrane Library databases until February 2019 was performed. Included studies were observational studies or randomized controlled trials having reported relevant confirmed CVEs (death from CVE, myocardial infarction, heart failure and stroke) in patients with RA treated with IL6i, and a suitable control group. A meta-analysis of the relative risk for each CVE in RA patients treated with IL6i compared to patients in the control groups was performed. A random effect model was applied in case of substantial heterogeneity.Results:Of 6869 studies, 23 randomized controlled trials and 6 controlled cohorts could be included. IL6i were significantly associated with a reduction in the risk of myocardial infarction in comparison with TNFi (OR, 0.73; 95% CI [0.56 to 0.96]). No other significant effects were observed with regard to the risks of stroke, heart failure (HF), and death from CVE in comparison with csDMARDs, TNFi, or non-TNFi bDMARDs (table 1).Table 1.Pooled relative risks of cardiovascular events in RA patients treated with IL-6 inhibitors and respective control groupsCs DMARDSTNFiNon TNFi bDMARDSMyocardial infarction1.44 [0.50;4.17]0.73 [0.56; 0.96]0.81 [0.48; 1.36]Stroke1.08 [0.40; 2.91]1.20 [0.82; 1.77]0.73 [0.39; 1.37]Heart failure0.17 [0.01; 4.08]1.51 [0.61; 3.70]1.19 [0.71; 1.98]Cardiovascular death1.59 [0.62; 4.11]1.13 [0.72; 1.78]NAOur findings of a potentially protective effect of IL6i use on the risk of MI are reassuring. Although several beneficial effects might be involved, like the effective control of systemic inflammation, the anti-arrhythmia effect or the improvement of endothelial and left ventricle dysfunction, a potential indication bias with a decreased likelihood to prescribe these drugs in patients with high cardiovascular risk cannot be excluded.Conclusion:This review of the literature with meta-analysis provides reassuring results about the association between use of IL6i and CVE in RA patients. Data from long-term observational studies is however needful to confirm and ascertain this result.Disclosure of Interests:None declared

Background:Methotrexate (MTX) is widely used in rheumatology. About 30% of patients receiving MTX do not respond. One of the explanations could be poor adherence.Objectives:The purpose of this study was to assess adherence and to identify predictive factors influencing it.Methods:188 patients with MTX for at least 3 months (rheumatoid arthritis (RA), peripheral spondyloarthritis (PS), psoriatic arthritis (PA), lupus, Sjögren’s Syndrome (SS)) were enrolled between May 2017 and May 2018. Each patient completed a questionnaire including socio-demographic data, disease and MTX characteristics, 4-question Morisky, rheumatism activity scores including DAS 28, quality of life (EQ-5D), fibromyalgia (FiRST), anxiety and depression (HADS), catastrophism (PCS-CF), coping (WCC-R) and whether or not to participate in a therapeutic education program.Results:188 were recruited, of which 75% were women, with a mean age of 61.4 +/- 13.24 years: RA (77.12%), PS (7.98%), PA (10.11%), lupus (2.66%) and SS (2.13%). 68.6% were observant, versus 31.4% unobservant minor (28.2%) or major (3.2%) patients. In multivariate analysis, two models were performed and found a poor adherence in case of depression OR: 3.120 [1.051; 9.354], catastrophism OR: 3.974 [1.119; 14.108], anti-CCP antibodies OR: 4.019 [1.277; 12.653] in RA patients and depression OR: 2.715 [1.237; 5.963], absence of comorbidities OR: 2.309 [1.085; 4.915] with all rheumatism.Conclusion:Some modifiable factors such as depression and catastrophism were associated with the risk of non-adherence with MTX. It is important to consider depression and catastrophism when taking care of our patients to improve adherence and avoid therapeutic escalations.Disclosure of Interests:Elisabeth FILHOL: None declared, Charlotte Hua: None declared, Francoise Flaisler: None declared, Cédric Lukas: None declared, Bernard Combe Consultant for: Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Jacques Morel: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma.

Background:Catastrophizing is a negative cognitivo-affective response to an anxiety-provoking stimulus, especially anticipated or actual pain. It can be assessed quickly using a validated questionnaire: the Pain Catastrophizing Scale (PCS)1. Catastrophizing plays a role in maintaining chronic pain and is associated with several pain-related outcomes in osteoarthritis and low back pain. There is a lack of knowledge about catastrophizing in axial spondyloarthritis (AS) with only one study2 so far.Objectives:To assess the prevalence of catastrophizing and associated factors in spondyloarthritis.Methods:We performed an observational, prospective, bi-centric study. All patients aged 18 or over with AS fulfilling the 2009 Assessment in Spondyloarthritis International Society (ASAS) criteria were consecutively included. Sociodemographic data, information on the disease and its treatments were collected as well as questionnaires regarding disease activity (BASDAI), function (HAQ, BASFI), quality of life (SF12, EQ5D), anxiety and depression (HADS, GAD7), fibromyalgia (FiRST), insomnia (ISI) and catastrophizing scores (PCS). Statistical analysis included a samples t-test, one-way variance analysis, Spearman’s correlation coefficient, the Chi2 test, Fisher’s exact test, the Wilcoxon test, multivariate linear regression (considering catastrophizing as a continuous variable) and multivariate logistics regression (considering catastrophizing as a categorical variable: PCS ≥ 20 = high level catastrophizing).Results:From September 2019 to March 2020, 168 AS patients were included: 48.5% were women, the median age was 48.5 years and 100 patients (60.2%) were professionally active. Almost all patients (95.8%) had a disease lasting for more than 2 years; 110 (72%) were HLA-B27+; 84 (50%) had MRI sacroiliitis and 62 (37.6%) radiographic sacroiliitis. In all, 166 (98.8%) had axial involvement, 99 (58.9%) had peripheral involvement and 44 (26.2%) had enthesitic involvement. The median BASDAI score was 6.30 [Q1-Q3 4.65-6.30].The prevalence of a PCS score ≥20 was 45.5% [38.0;53.0]. The median PCS score was 18 [7-27]. In multivariate logistics regression, high-level catastrophizing was significantly associated with the HADS anxiety score (OR=1.54 [1.22-2.0]), HADS depression score (OR=1.25 [1.10-1.43]) and disease activity (BASDAI OR=1.14 [1.01-1.26]). In multivariate linear regression, catastrophizing was also significantly associated with anxiety (p<0.0001), depression (p<0.0001) and disease activity (p=0.0008).Conclusion:Almost half the patients with AS were high catastrophizers. Catastrophizing is linked to anxiety, depression, and disease activity. It may be interesting to detect catastrophizing in order to improve the management of our patients.References:[1]Sullivan MJL. et al. Psychological Assessment. 1995;7(4):524–32[2]Penhoat M. et al. Joint Bone Spine. 2014;81(3):235–9Disclosure of Interests:None declared.