Background: The least significant change (LSC) threshold of 0.03 g/cm² is used to interpret bone mineral density (BMD) scans in the general population. Our working hypothesis was that the current LSC threshold would not be applicable in obese populations. Aims: The aim of this study was to calculate the LSC in an obese population. Methods: We performed an interventional study among 120 obesity patients, in whom two measurements of BMD were performed at 3 sites. Pairs of measures were used to calculate the LSC, using the Bland and Altman method. Results: We calculated that the LSC was 0.046 g/cm² at the lumbar spine, 0.069 g/cm² at the femoral neck, and 0.06 g/cm² at the total hip. We also calculated the LSC for each class of obesity and observed an increase in LSC with increasing body mass index (BMI). We calculated a LSC of 0.05 g/cm² in patients with class 2 or class 3 obesity, whereas the LSC in patients with class 1 obesity is similar to the threshold used in the general population. Discussion: In obese population, like BMD, LSC is higher than the threshold value of the general population, and increases with increasing BMI.Conclusion: LSC of 0.05 g/cm² could be used in clinical practice in patients with class 2 or 3 obesity. These findings should help to improve the interpretation of BMD scans in these patients and optimize their management. Trial registration number: Comité de Protection des Personnes Ile-de France VII, France.

Uncontrolled gout can cause articular impairment but is also associated with a global and cardiovascular excess mortality, especially in dialysis population. Data documented within existing research is not conclusive regarding gout flares evolution during hemodialysis and their control by urate lowering therapy (ULT). Without clear guidelines concerning hemodialysis patients management with chronic gout, this study proposes to investigate whether gout flare incidence reduction could be observed on this population treated by urate lowering therapy versus patients without treatment. We performed a retrospective cohort study in two hemodialysis centers in France. Were selected patients over 18 years old with a gout history who started hemodialysis between January 2005 and September 2015. Demographics and clinicals data were recorded at hemodialysis start and throughout 5 years of follow up. Gout flare was defined as presence of uric acid crystal in joint punction or clinically diagnosed as such with a colchicine prescription. All statistical analysis were performed in SAS® version 9.4 (SAS Institute Inc., Cary, NC). One hundred eighty-one patients have been included, mean age at dialysis initiation was 68.6 years (± 12.4) with 72% of men, 54% were treated by ULT: 89.7% by allopurinol and 9.3% by febuxostat. One patient received both treatments successively. After hemodialysis initiation, 35.36% patients had experienced at least one gout flare. The appearance of at least one gout flare concerned 50% of patients in no ULT group and 22.68% patients in ULT group (p = 0.0002). Dialysis efficiency was measured at regular interval during follow-up and was similar in both groups. To study the association strength between clinical factors and gout flares occurrences, a Cox model was performed; ULT is a protector factor of gout flare (HR:0,42, CI 95: 0,25-0,71). The proportion of serum urate values within the target (median 53% vs 29.3%, p < 0.0001) was significantly higher in ULT group versus no ULT group (median 53% vs 29.3%, p < 0.0001). Urate lowering therapy limit new gout flares occurrence in hemodialysis patients with gout historyCollaboration between rheumatologists and nephrologists may help to update guidelines for urate-lowering therapies in patients on dialysis.

Background/Objectives: Radicular pain is a frequent pathology, and disc herniation is the commonest aetiology. A meta-analysis summarising international guidelines for radicular pain, published in 2021, showed that lumbar traction’s place is still a topic of debate. In this study, our aim was to evaluate the effectiveness of lumbar tractions in treating radicular pain of discal origin in association with medical treatment versus medical treatment alone. We performed a randomised, controlled, interventional, prospective, superiority trial in Reims Hospital Rheumatology Unit. Methods: We included participants with radicular pain and concordant disc herniation with ambulatory treatment failure. Participants were randomised into two groups: medical group (analgesics, anti-inflammatories treatments, at least two epidural injections); tractions group with this medical treatment associated with lumbar tractions. The primary outcome was the difference in the proportion of participants experiencing a minimum of 25% improvement in radicular pain at one month follow-up between the two groups. Results: We included 424 participants: 211 in the tractions group and 213 in the medical group. We analysed 388 participants (194 in each group). We collected demographic and clinical data, lumbar and radicular Numeric Pain Scale at baseline, one and three months. A statistical difference was found for the primary outcome: 120/194 participants (62%) in tractions group and 98/194 participants (51%) in medical group (p = 0.024). Conclusions: To our knowledge, this is the first randomised and controlled study on this topic with these results. We can assert the superiority of lumbar tractions in association with medical treatment over medical treatment alone for radicular pain with concordant disc herniation.

Therapeutic education (TE) plays a central role in the management of chronic inflammatory rheumatic diseases and inflammatory bowel disease. The BIOSECURE questionnaire was developed and validated in 2012 to assess self-management and patient safety, initially in rheumatology. Objectives: The aim of our study was to assess the knowledge of patients followed in both rheumatology and gastroenterology regarding their treatment through the BIOSECURE questionnaire. The secondary objective was to identify factors associated with a low level of knowledge according to the BIOSECURE questionnaire. Methods: This was a descriptive observational study, conducted in a single center at the Reims University Hospital between January 2023 and April 2024. The population was divided into quartiles. Participation in therapeutic education (TE) included receiving brochures about their disease or treatment and/or participation in group or individual TE sessions. We compared the patients with the lowest scores to those with the highest scores. Results: The study population consisted of 312 patients, including 32.05% with rheumatoid arthritis (RA) and 29.81% with Crohn’s disease. In our population, 82.03% had participated in therapeutic education, which included a TE session and/or the distribution of brochures about their disease and/or treatment. The median [IQR] BIOSECURE score was 71.04/100 [IQR 61.77–81.9]. When comparing patients with a low BIOSECURE score (81.9), univariate factors associated with a low score were older age (p = 0.02), less participation in therapeutic education (p = 0.01), shorter duration of targeted therapy (p = 0.01), and lower level of education (p < 0.05). Conversely, patients who had received therapeutic education had a higher BIOSECURE score (p = 0.01). There was no difference in BIOSECURE scores based on place of residence, location of patient follow-up, route of administration, or type of inflammatory disease. In a multivariate analysis with a model including age, TE participation, and duration of targeted therapy, the results remained significant (p < 0.05). Discussion: We were able to compare the results of our study with two other French studies previously conducted on the same population of 677 patients undergoing biotherapy for chronic inflammatory rheumatism. The median BIOSECURE score in those studies was 73/100. In the study by Rat AC, published in 2017, the population was divided based on their BIOSECURE questionnaire results into three groups; they compared high and low response levels. Similarly to our study, a lower educational level and unemployment were associated with a lower rate of correct responses. The same was true for the absence of therapeutic education (TE) or distribution of brochures. Conclusions: The analysis of the BIOSECURE questionnaire in our population provides a practical message: factors associated with a low BIOSECURE score include older age, lower educational level, recent initiation of targeted therapy, and lack of participation in therapeutic education. This population could be a priority target for TE in order to ensure treatment safety for these patients.

Objectives Non-adherence to rheumatoid arthritis (RA) treatments must be identified. A methotrexate (MTX) urinary dosage (METU) was recently developed. The aim of our study was to assess adherence to MTX in RA using METU in real-life conditions and to compare it with indirect adherence measurement technics. Methods We performed a cross-sectional study at Reims University Hospital. We included over 18-year-old patients with RA treated by MTX for more than 6 months. Patients were invited to complete demographic, clinical and psychological questionnaires and adherence measurement technics (Compliance Questionnaire of Rheumatology (CQR) and Medication Possession Ratio (MPR)). A urinary sample was collected to measure MTX and information about tolerance was evaluated through Methotrexate Intolerance Severity Score. Results 84 patients were included, 26 using oral MTX, 58 subcutaneous (SC) MTX. Among them, 73% were female, mean age was 61.5 years, MTX mean dose was 15 mg/week and 61.9% were treated by biological DMARDs (Disease Modifying Antirheumatic Drugs). 77 patients (91.7%) were adherent to treatment according to METU, whereas MPR and CQR reported less adherence (69.5% and 61.9%, respectively). MPR and METU were not significantly different in SC MTX users (p=0.059). Non-adherent patients had a higher number of tender joints and C reactive protein value (p<0.05). Conclusion This is the first largest study evaluating MTX adherence in patients with RA using a urinary dosage. We identified that indirect adherence measurements did not reflect real-life adherence. It would be appreciable to realise METU, in a new study, in patients with RA with unexplained response to treatment, to consider it before escalating therapeutic strategy.

Introduction: Le plasmocytome solitaire osseux est une tumeur maligne rare, unique, caractérisée par l’accumulation localisée de plasmocytes monoclonaux. Nous avons cherché les potentiels facteurs associés au risque d’évolution vers le myélome, pour guider de façon ciblée la surveillance des patients après traitement. Méthodes: Il s'agit d’une étude rétrospective monocentrique, incluant 31 patients atteints d’un plasmocytome solitaire osseux diagnostiqué entre le 1/01/2000 et le 1/06/2022. Les caractéristiques cliniques, biologiques et l’imagerie au diagnostic, le type de traitement et les doses de radiothérapie reçues ont été recueillis. La réponse au traitement a été évaluée selon les critères de l'IMWG. Résultats: Le suivi médian des patients était de 61 mois. Concernant le contrôle local à l’imagerie après traitement, le ratio normal de chaînes légères libres sériques au diagnostic était un facteur protecteur (p<0.05), tout comme la disparition du pic à l’EPS et/ou EPU, et la correction du ratio de chaînes légères libres après traitement (p<0.05). Seize patients ont développé un myélome, avec un délai médian de progression de 16 mois. Une anomalie du ratio des chaînes légères au diagnostic était un facteur prédictif du risque d’évolution vers le myélome (p<0.05). La dose délivrée supérieure à 50 Gy, le contrôle local à l’imagerie après traitement, la disparition du pic à l’EPS/EPU ou de l’anomalie du ratio de chaînes légères après radiothérapie étaient associés à la diminution du risque de développer un myélome (p<0.05). Conclusion: Nos résultats soulignent l'importance d'identifier certains facteurs pronostiques biologiques dès le diagnostic et post traitement, et l’importance de l’imagerie notamment de la TEP-TDM dans le suivi pour cibler au mieux les plasmocytomes osseux les plus à risque d'évoluer vers le myélome multiple. Objective: Solitary Bone Plasmacytoma is a rare, unique malignancy characterized by localized accumulation of monoclonal plasma cells. We investigated potential factors associated with the risk of progression to myeloma, in order to guide targeted post-treatment monitoring of patients with bone plasmacytoma. Methods: This study is a monocentric retrospective study, including 31 patients with bone plasmacytoma diagnosed between 1/01/2000 and 1/06/2022. Clinical, biological, and imaging characteristics at diagnosis were notified. Type of treatment and radiotherapy doses received were collected. Response to treatment was assessed according to IMWG criteria. Results: Median follow-up was 61 months. A normal serum free light chain ratio at diagnosis was a significant predictor of local control on imaging after treatment (p<0.05). The disappearance of the peak on serum and/or urine protein electrophoresis, and the correction of the free light chain ratio after treatment were also significant factors (p<0.05). Sixteen patients developed myeloma, with a median time to progression of 16 months. An abnormal light chain ratio at diagnosis was predictive of the risk of progression to myeloma (p<0.05). Dose delivered greater than 50 Gy, local control on post-treatment imaging, disappearance of peak on serum and/or urine protein electrophoresis and the correction of the light chain ratio abnormality after radiotherapy were associated with a reduced risk of developing myeloma (p<0.05). Conclusion: Our results highlight the importance of identifying biological prognostic factors at diagnosis and post-treatment, and the importance of imaging, particularly PET-CT, at diagnosis and in follow-up to target bone plasmacytomas most at risk of progressing to multiple myeloma.