LAUSR

We present the case of a male patient, who developped in 2002 (at the age of 37) rheumatoid arthritis, at that time positive for RF and ACPA without erosions on X-rays. He was first treated with salazopyrine, stopped in 2003 because of residual disease activity and structural damage progression on X-rays (MTP 5 erosion, JSN on both carpal joints), then methotrexate, which was efficient but was finally stopped in 2004 for suspicion of MTX pulmonary toxicity (cough, short breath, with CT-scan abnormality). Leflunomide 20 mg/day was started with adequate response up to 2009, when loss of efficacy was recorded. Addition of adalimumab 40 mg every other week was decided, leading to sustained remission. In 2011, he was on remission with this combination of treatments, and he stopped adalimumab abruptly on his own, resulting in a flare after 4 months (7 tender joints and 5 swollen joints). Adalimumab every other week was restarted, and remission was obtained a few weeks later. In 2013, he remained on sustained remission, which lead to his inclusion in a trial testing the progressive spacing of adalimumab. Every 6 months, the disease activity was assessed in consultation, and hands and feet X-rays were repeated every year: the patient remained on sustained remission according to DAS28, and there was no additional structural damage. Finally, in May 2017, DAS28 was at 1.71 with leflunomide 20 mg/day and adalimumab 40 mg every 2 months, so we proposed to stop adalimumab. When last seen, in November 2017, the patient was still on remission with leflunomide monotherapy. Disclosure of Interest None declared