RA subjects use health-care services more widely than NA subjects. Variation in recourse behaviour is related to differences within administrative areas.

Many pediatric medical protocols or drug posology like biantiplatelet therapy are extrapolated from adult care. This association could be indicated in specific pediatric situations such as ischemic stroke, some cardiac conditions, or to control post stent thrombosis/stenosis. If acetylsalicylic acid is commonly used, few data are available about optimal management of clopidogrel in children. We describe the case of a 7-year-old girl admitted to pediatric intensive care unit who undergoes a transitory hemiparesis after a bicycle accident. Brain magnetic resonance imaging reveals a subarachnoid hemorrhage and a wide right Sylvian arachnoid cyst. Hemorrhage predominated at the level of the optochiasmatic cistern, close to the right internal carotid artery. At the same level, angiography revealed a small aneurysm of the internal carotid artery supposed to be a postfalse traumatic aneurysm. The deployment treated this aneurysm of a flow diverter. The treatment was performed under continuous systemic heparin therapy associated with intravenous acetylsalicylic acid, and Clopidogrel was administered immediately after the procedure. An oral bi antiplatelet treatment was initiated the day 2 with acetylsalicylic acid and clopidogrel (1 mg/kg/day). To monitor clopidogrel posology, a vasodilator-stimulated phosphoprotein [VASP]) was performed. The final VASP assay result was 20% for a clopidogrel posology at 0.5 mg/kg/day. Blood pressure and neurological examination were normal during all the hospitalization. VASP assay can be used in children to define the optimal posology of clopidogrel. Further studies are required to determine an optimal initial posology.

Background In front of ageing of the population, rheumatologists are more and more confronted with the coverage of elderly, particularly regarding rheumatoid arthritis (RA). The objective of the study was to evaluate the coverage in two populations of RA, one age of more than 65 years old and one of age less than 65 years old. Methods This descriptive, transversal and retrospective study concerned patients followed in one university hospital and one hospital during the year 2008 for RA. Clinical, biological, radiological characteristics and treatments have been compared between the younger-onset RA and elderly-onset RA (begun after 65 years old), and on the other hand RA of younger patients and elderly patients (of 65 and more years old). Age, duration of the disease, disease activity score including a 28-joint count (DAS28), presence or not of anti-citrullinated protein antibodies (ACPA) and of rheumatoid factor, presence of X-Rays erosions, prescription of corticosteroids, disease modifying anti rheumatoid drugs (DMARD) or biotherapy. Results 454 patients were included in the study. There was no statistically significant difference regarding either age of diagnosis or age. There was an higher DAS 28 among elderly patients (3.72 vs. 3.14, p≤0.05) compared to younger. Corticosteroids were significantly more prescribed in elderly patients (60.5% vs. 50.8%, p=0.05) than in younger patients and in elderly-onset RA (68% vs. 52%, p=0.005) compared to younger-onset RA. As regards to DMARDs, there was no difference in the prescription of DMARD in the 2 groups (p=0,326) but biotherapy was significantly less prescribed in elderly patients than in younger patients (21% vs. 35%, p=0,001) and in elderly-onset RA compared to younger-onset RA (10% vs. 32%, p=0.001). Conclusions Even in elderly RA and elderly onset RA, corticosteroids are significantly more prescribed although biotherapy are less prescribed than in younger RA and younger onset RA. Disclosure of Interest None Declared