POS1000 COMORBIDITIES ASSOCIATED TO SPONDYLOARTHRITIS

Background:

In contrast to other chronic rheumatic diseases such as rheumatoid arthritis, comorbidities associated to spondyloarthritis (SpA) and their impact on disease outcomes are less well studied.

Objectives:

The aim of our study was to investigate the prevalence of comorbidities among SpA patients and to determine factors influencing their appearance.

Methods:

We conducted a retrospective study including patients meeting the Assessment of SpondyloArthritis International Society (ASAS) criteria between 2000 and 2020.

The following comorbidities were collected: cardiovascular pathologies and their risk factors (smoking, arterial hypertension, diabetes, dyslipidemia and obesity), neoplasms, osteoporosis, depression, infections, gastrointestinal and pulmonary disorders.

Results:

We included 138 patients. Sixty-eight per cent of them were males. The mean age was 45.73 ± 12.66 years. The mean age at the disease onset was 28.89 ± 12.54 years. The mean CRP was 33.38 ± 39.65 mg/dL. The mean BASDAI and ASDAS-CRP were 4.21 ±2.23 and 3.06 ± 1.26, respectively. The mean BASFI was 4.77 ± 2.58.

Sixty patients had at least one comorbidity (43.5%): 53 patients had one comorbidity (38.4%), 21 accumulated two types of comorbidities (15.2%) and 7 patients accumulated three types or more (5%).

Osteoporosis was the most frequent comorbidity, it was present in 23.1% of the cases (n=32), followed by tuberculosis 8.7% (n=12), stomach ulcers 5.1% (n=7), pulmonary superinfection 2.9% (n=4), neoplasia 2.2% (n=3) and then depression 1.4% (n=2).

Cardiovascular risk factors were noted in 44 patients (31.9%): hypertension (15.9%), diabetes (12.3%), dyslipidemia (9.4%) and obesity (8.7%).

Thirty-seven per cent of our patients were smokers.

SpA patients with comorbidities were significantly older than those without (50.2±11.07 versus 42.3±12.8 years, p<0.0001).

The presence of comorbidities was significantly associated to a higher disease activity evaluated by BASDAI (p=0.005) and ASDAS-CRP (p=0.002). Furthermore, BASFI was significantly higher among patients with comorbidities (5.47±2.38 versus 4.31±2.62, p=0.028).

However, no association was found between presence of comorbidities and smocking or CRP.

Conclusion:

Our results show that more than 40% of our SpA patients presented with at least one comorbidity. Remarkably, the presence of comorbidities was associated with high disease activity, suggesting that that inflammation might promotes comorbidities. For optimal management of SpA, a systemic screening for comorbidities is essential.

Disclosure of Interests:

None declared.

AB0732 JUVENILE IDIOPATHIC ARTHRITIS IN ADULTHOOD

Background:

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of unknown aetiology in childhood. Approximately 40- 60% of patients with juvenile idiopathic arthritis (JIA) have continuous or recurrent disease activity extending into adulthood.

Objectives:

The aim of this study was to evaluate the clinical, biological and radiological course of JIA in adulthood.

Methods:

A retrospective study including 35 patients was conducted between 2010 and 2019. The patients enrolled met the ILAR criteria for the diagnosis of JIA. Patients with JIA older than 20 years were included. Data regarding sociodemographic features, Physical growth, disease activity, biological and radiological parameters were analysed.

Results:

Thirty one patients were recruited. The sex ratio was 0.53. The mean age at the time of the study was 38.9 years [20-69]. The mean age of the disease onset was 9 years [3-16]. These patients were assigned to discrete JIA categories: rheumatoid factor positive polyarthritis (47.7%), rheumatoid factor negative polyarthritis (23.9%), oligoarthritis (14.2%), enthesitis-related arthritis (9.5%), and psoriatic arthritis (4.7%).A failure to thrive was seen in 33.3% of patients. Overweight and obesity were found in 38% and 19% of patients, respectively. Biological inflammatory syndrome was noted in 52% of patients, and 65.2% had active disease. Hip involvement was noted in 43.5% of patients and 17.4% of them had a total hip replacement. Sixteen patients had neck pain and the imagining showed an atloid-axoid dislocation in 50% of them. Radiographs showed a joint destruction in 60.9% of patients and a wrist arthritis was the most frequent involvement.

Conclusion:

Most of our included patients maintain active disease and have functional impairment in adulthood.

Disclosure of Interests:

None declared

AB0611 OSTEOPOROSIS IN RHEUMATOID ARTHRITIS: A NECESSARY EVIL?

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disease that is characterized by local and general bone loss. Osteoporosis (OP) is one of the most frequent comorbidities associated with RA. Many factors are incriminated in bone loss in RA such as inflammation, glucocorticoid (GC) use, and immobility.

Objectives:

-To determine the prevalence of OP in a population of actual RA patients.

-To determine the risk factors of bone mineral density (BMD) reduction

Methods:

One hundred-fifty-two RA followed in the rheumatology department between 2015-2020 were enrolled in the study. The diagnosis of RA was established according to the American College of rheumatology/European League Against Rheumatism (ACR/EULAR) criteria 2010. BMD in lumbar spine and total hip was systematically measured in the recruited patients. Measures were taken with dual-energy x-ray absorptiometry (DEXA), and age-specific values were compared with pooled values from a local population of healthy subjects free from earlier fractures.

Results:

The mean age was 42.7±13 years. The sex ratio M/F was 0.24. The mean onset disease was 6±1.8 years. Fifty-sex patients (36.3%) were receiving conventional treatment DMARDs and 96 (63.6%) were under biological treatment. 35.5% were taken steroids with mean doses at 7.7±3.3mg/day. RF and ACPA were positive respectively in 87.3% and 82.4% of the patients. The mean disease activity score DAS28CRP was 4.8 ±2.7.

Sixty-eight point eight 68.8% of the RA population had bone loss: 37.5% had osteopenia and 31.3% had OP. Regarding the OP group, sex ratio M/F was 0.45. The mean age was 42±5.3 years. Among the 31 women, 77.4% had postmenopausal OP. The BMI average was 31.18 ± 6.19 kg/m2. Fifteen patients (33.33%) had OP in the hip site and 20 patients had OP in the lumbar site (48.8%). Ten patients had both trabecular and cortical OP.

Advanced age, glucocorticoid use and high DAS28CRP were independent risk factors for OP (respectively p=0.04, p=0.02 and p=0.01). Body mass index, smoking, disease duration high Health Assessment Questionnaire (HAQ) score (p=0.545) and smoking (p=0.326) were not associated with high risk of OP. The biological treatment was not a protective factor in OP (p=0.972). All the population subjects were free from earlier fractures, the fractural risk estimated by dint of the mean FRAXTM score was at 1.4 ± 2.3.

Conclusion:

Previous studies estimated that, approximately, osteoporosis affected one-third of RA patients which is in concordance with our study. Advanced age, glucorticoid treatment and severe disease were the most common risk factor in our study.

Disclosure of Interests:

None declared.

Knowledge, Anxiety, Fear, and Psychological Distress About COVID-19 Among University Students in the United Arab Emirates

Background: Fear of infection, the epidemic situation, unexpected lockdown, and implementation of online classes are most likely affecting the psychological well-being of students during the COVID-19 pandemic. Therefore, this study aims to assess the level of knowledge, anxiety, and psychological distress concerning COVID-19 and their association with fear, gender, age, history of mental illness, time spent reading about COVID-19, program of study, and type of dwelling among students in the United Arab Emirates (UAE). Methods and Materials: In this cross-sectional study, 433 students participated in a web-based survey. These were students at the University of Sharjah, coming from all the emirates of the UAE. Demographic scale, COVID-19 knowledge, anxiety, fear, and psychological distress scales were used to screen these problems. Results: Of the 433 students, 278 (64.2%) were male and 155 (35.8%) were female. Overall, 353 (81.5%) exhibited adequate knowledge of COVID-19. Sixty-nine (15.9%) of students were anxious and 221 (51%) were in psychological distress. Students who exhibited anxiety concerning COVID-19 anxiety (odds ratio [OR]: 2.98) and fear (OR: 1.27), and who spent more than 4 h reading about COVID-19 (OR: 11.20) were more psychologically distressed. Students with a history of mental illness showed adequate knowledge of COVID-19; however, they were more psychologically distressed (OR: 5.93). Older students were less likely to have psychological distress (OR: 0.87). Conclusion: Students possess adequate knowledge concerning COVID-19; however, they are psychologically distressed. Age, dwelling status, history of mental illness, anxiety, and fear significantly predicted psychological distress. Frequent web-based workshops that include insight, guidance, online counseling, scheduled activity, and coping mechanisms for COVID-19 are highly recommended. The authors discuss the implications for future research and provide recommendations for students and educational institutions.

Clinical characteristics and outcomes of COVID-19 hospitalized patients with diabetes in the United Kingdom: A retrospective single centre study

AIM

To describe the clinical characteristics and outcomes of hospitalized COVID-19 patients with diabetes.

METHODS

A retrospective cross-sectional study was conducted among patients admitted to the William Harvey Hospital in England between March 10th and May10th, 2020 with a laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), known as COVID-19. Variation in characteristics, length of stay in hospital, diabetes status, duration of diabetes, control of diabetes, comorbidities and outcomes were examined.

RESULTS

There were 232 COVID-19 presentations. Mean (standard deviation (SD), range) age was 70.5 (±15.7, 30-101) years, 62.5% were male, and 37.5% were having diabetes. There were 43.4% males and 27.6 females, p = 0.016, with diabetes admitted to our hospital due to COVID-19. Patients with diabetes were more likely to have longer length of stay (LOS) in hospital, 14.4 (SD ± 9.6) days, compared to the patients without diabetes, 9.8 (SD ± 17.1) days, p < 0.0001. Patients with diabetic ketoacidosis (DKA) were more likely to survive (87.1%) compared to patients without DKA (50.6%), p = 0.046.

CONCLUSION

Males were more likely to be admitted to hospital with COVID-19 illness than females. Hospitalized COVID-19 patients with diabetes had a longer LOS in hospital than patients without diabetes. Older age COVID-19 patients with diabetes and patients without DKA were less likely to survive compared to younger patients and patients with DKA, respectively. Further studies with large sample size are needed.

FRI0433 HAS THE PROFILE OF INFECTIOUS SPONDYLODISCITIS CHANGED IN 20 YEARS?

Background:

Infectious spondylodiscitis represents 2 to 4% of osteoarticular infections. Their incidence is constantly increasing. Early microbiological diagnosis and targeted multidisciplinary management are the main prognostic factors for infectious spondylodiscitis.

Objectives:

To compare the epidemiological, clinical, biological, radiological, bacteriological profile as well as the management and prognosis of spondylodiscitis over the last 20 years.

Methods:

Retrospective study including 113 patients hospitalized in our department between 1999 and 2018. The diagnosis was based on clinical, biological, radiological and bacteriological data. Spondylodiscitis were divided into two groups: spondylodiscitis occurring between 1998 and 2008 (1stdecade) and those between 2009 and 2018 (2nddecade).

Results:

Of the 113 identified patients, 54 (47.8%) occurred between 1998 and 2008, with male predominance in both groups (50.2 and 59.3% respectively; p=0.3). The average age was 55 years (p=0.7). Diabetes was more frequent in the 1stdecade but without a statistically significant difference (p=0.1). On the other hand, consumption of unpasteurized dairy products was more frequent during the 2nddecade (p<0.001) as well as the presence of intercurrent infection (p=0.01).

The estimated delay between symptom onset and diagnosis was longer between 1998 and 2008 (5.6 months and 3.2 months respectively, p=0.005). The presence of neurological signs was more frequent between 2009 and 2018 (p=0.001), especially radiculalgia (p=0.02). The sedimentation rate was higher in the 1stdecade (93mm and 72mm respectively, p=0.002).

We found no statistically significant difference in the location of spondylodiscitis (p=0.4) and the multifocal involvement (p=0.5).

Radiographic signs were significantly more prevalent in the 1stdecade (p=0.002), in particular disc space narrowing (p=0.03) and irregularity of the intervertebral plates (p=0.01). Computed tomography was more often performed during the 1stdecade (p = 0.008), unlike magnetic resonance imaging, performed in 88.1% of cases during the 2nddecade (p <0.001). In contrast, the frequency of para-vertebral abscesses, epiduritis and spinal cord compressions were similar in the two groups (p = 0.6; p = 0.9 and p = 0.3, respectively).

Tuberculosis was more frequent in the 1stdecade (p=0.009). Disco-vertebral biopsy was more often performed in the 1stdecade (p=0.04), but its efficiency was similar between the two groups (p=0.1). For pyogenic spondylodiscitis, blood cultures were more often positive in the 2nddecade but without a statistically significant difference (p=0.6). On the other hand, the anatomopathological aspect was more frequently suggestive of a pyogenic germ in the 2nddecade (p=0.04).

A surgical procedure was more frequently performed between 2009 and 2018 but with no statistically significant difference (p = 0.2). All patients received antibiotic therapy. A change in treatment was made in 23.7% of cases between 2009 and 2018 (p = 0.01). The prognosis was better during the 1stdecade (p = 0.01). On the other hand, the occurrence of immediate complication during tuberculous spondylodiscitis was more frequent during the 2nddecade (p = 0.03), in particular the toxicity of anti-tuberculosis treatment (p = 0.04).

Conclusion:

In the last decade, the diagnosis of spondylodiscitis has been made earlier. However, these are more severe forms with an increased frequency of neurological complications, probably due to an increase in the proportion of virulent germs. Moreover, the effectiveness of the bacteriological investigation does not differ between the two periods studied.

Disclosure of Interests:

None declared

AB0261 IMPACT OF COMORBIDITIES IN THE DISEASE ACTIVITY OF PATIENTS WITH SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS: TUNISIAN REGISTRY (BINAR)

Background:

Comorbidities can be associated with rheumatoid arthritis (RA) and spondyloarthritis (SpA). This association can be fortuitous but can also be secondary to rheumatism itself or to the effects of the treatments used. These comorbidities can worsen the disease and even increase patient mortality.

Objectives:

To assess the prevalence of comorbidities in RA or SpA patients from the Tunisian BIologics National Registry (BINAR) and to focus on their influence on the disease activity.

Methods:

BINAR is a multicenter non-interventional and prospective study, conducted in Tunisia with 80 rheumatologists over a period of three years. It included patients with RA (ACR / EULAR 2010 criteria) or SpA (ASAS 2009 criteria). Data were collected and analyzed through an electronic platform managed by DACIMA. They included demographic data, smoking status and types of comorbidities (cardiovascular disease, diabetes, dyslipidemia, osteoporosis, high blood pressure (HBP), neoplasia, gastrointestinal ulcer, depression and fibromyalgia). RA activity was evaluated by the DAS28-VS score and SpA activity by the BASDAI and ASDAS-CRP scores.

Results:

We included 298 patients (175 PR and 123 SpA) making the mean sex ratio 0.6 and mean age 49.18 years ± 14.1 [18-79]. Mean BMI was 27.0 ± 5.5 kg / m2[15 -45] and 17.7% of the patients were current smokers. Concerning disease activity, mean DAS28-VS in RA was at 4.9 ± 1.5 [1.1 - 8.1 and mean BASDAI and ASDAS-CRP, in SpA, were respectively 4.1 ± 1.8 and 2.8 ± 1.1. Comorbidities were noted in 54% of patients (62.1% in SpA and 37.9% in RA), with an average of 1.7 comorbidities per patient.

The most common comorbidities were osteoporosis (38.8%), cardiovascular disease (20.1%), diabetes (16.8%), HBP (18.1%), dyslipidemia (6.7%) and GIU (6.0%). Depression, fibromyalgia and neoplasia were mentioned in 1.7%, 1% and 1%, respectively.

No correlation was found between the number of comorbidities and the activity level of RA: DAS28-VS (p=0.12), nor the activity level of SpA: BASDAI(p=0.07), ASDAS-CRP(p=0.15). Correlations were studied between each comorbidity and activity disease parameters of RA and SpA, they are specified in Table 1. We found that only the presence of osteoporosis was associated with SpA activity, (ASDAS-CRP; p = 0.02).

Tableau n°1:

Relation between comorbidities and the disease activity parameters of rheumatoid arthritis and Spondyloarthritis

DAS 28 ESRBASDAIASDAS CRPDiabetesp = 0.737p = 0.633p = 0.652High Blood pressurep = 0.252p = 0.998p = 0.323Obesityp = 0.565p = 0.585p = 0.904Dyslipidemiap = 0.332p = 0.349p = 0.997Osteoporosisp = 0.372p = 0.989p = 0.020Gastrointestinal ulcerp = 0.829p = 0.286p = 0.910

DAS: disease activity score; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; ASDAS: Ankylosing Spondylitis Disease Activity Score

Conclusion:

According to this study, in patients with RA and SpA associated comorbidities may occur more frequently than expected (54%). However, they had no relation to the activity of the disease according to their frequencies or their types, except osteoporosis which was significantly associated with the SpA activity. Identifying these comorbidities may affect the management and treatment decisions for these patients to ensure an optimal clinical outcome.

Acknowledgments:

none

Disclosure of Interests:

None declared

FRI0432 INTEREST OF IMAGING IN THE DIAGNOSIS OF INFECTIOUS SPONDYLODISCITIS (ABOUT 113 CASES)

Background:

Infectious spondylodiscitis is a diagnosis and therapeutic emergency. Its clinical presentation can be insidious and standard radiographs can be falsely reassuring. This explains the interest of cross-sectional imaging and more particularly magnetic resonance imaging (MRI).

Objectives:

To analyse the contribution of imaging in the diagnosis of infectious spondylodiscitis.

Methods:

These are 113 cases of spondylodiscitis collected in a rheumatology department over a period of 20 years [1998-2018]. The diagnosis is made on the basis of clinical, biological, radiological and bacteriological data.

Results:

Our population was divided into 62 men (54.9%) and 51 women (45.1%) (p = 0.8) with an average age of 55 years [16–86]. Predisposing factors were found in 52.2% of cases: diabetes (23%), neoplasia (2.7%), hepathopathy (5.3%), long-term corticosteroid therapy (1.8), recent surgery (3.5%), history of tuberculosis (2.7%) and consumption of unpasteurized dairy products (28.3%).

The approximate time between onset of symptoms and diagnosis ranged from 0.23 to 24 months (median 3 months). Impaired general condition was observed in 81% of the cases and fever in 34.5% of the cases. Radiculalgia was found in 46% of the cases and a neurological deficit was noted in 16% of the cases. Biological inflammatory syndrome was found in 91.2% of the cases.

Standard radiographs of the spine were abnormal in 85% of cases, showing disc space narrowing (72%), irregularity of the vertebral plates (35.5%), erosions (13.1%) and para-vertebral spindle (4.7%). CT and spinal MRI were performed respectively in 57.5% and 70.8% of cases and revealed: erosions (46.2%), mirrored geodes (16.9%), para-vertebral abscess (57.5%), epiduritis (71.3%) and spinal compression (26.3%). The lumbar spine was the most affected (55.8%), followed by the dorsal spine (30.1%) and the cervical spine (8.8%). The Infectious spondylodiscitis was multifocal in 24.8% and multi-stage in 12.4% of cases.

A disco-vertebral biopsy was performed in 70% of cases and was contributory in 44.3% of cases. The causative organism was tuberculosis in 55.8% of cases, brucellosis in 21.2% of cases and pyogenic germs in 23% of cases.

Conclusion:

Imaging plays an important role in the diagnosis of spondylodiscitis. MRI is considered the key examination, capable of mapping injuries and detecting potentially serious neurological complications. The importance of imaging the entire spine to detect multifocal forms should also be emphasized.

Disclosure of Interests:

None declared

AB0879 DOES BODY WEIGHT INFLUENCE THE KNEE INJURY AND OSTEOARTHRITIS OUTCOME SCORE IN PERSONS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS?

Background:

Overweight is a major risk factor for the development and progression of knee osteoarthritis (OA). Weight loss for patients with knee OA has been associated with improvement in self-reported pain and function and is recommended by EULAR as part of the therapeutic management.

Objectives:

The aim of the study was to evaluate the relation between overweight and functional impairment in adults with knee OA.

Methods:

It was a prospective study conducted in a rheumatologic department over a 4 months period. Patients with symptomatic knee OA based on the ACR criteria, were included. A screening of body mass index (BMI) was carried out for all patients. It was categorized following the WHO classification into: normal (<25 kg/m2), overweight (25 to <30), obese (up to 30).

Pain level was evaluated using the Visual Analogue Scale (VAS). Function was assessed by the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) (KOOS-PS scores to 0 representing no difficulty and 100 representing extreme difficulty). The patients’ knee radiographies were graded according to Kellgren Lawrence criteria (KL). The patients were allocated in two groups; as grade I-II KL (Group 1) and grade III-IV KL (Group 2).

Results:

We included 143 patients with a mean age of 65.17± 10.7 years and 88.1% of women. Patients were from low socio-economic class in 30.8% of cases. Mean disease duration of the KOA was 5.4 years [3months-20 years] and mean BMI was 31.8±5.6kg/m2. Patients were with normal weight in 16.1%, overweight in 19.6% and obese in 64.3%.

Knee OA was bilateral in 85.3% and other OA sites were associated in 37.8% of patients. Mean VAS pain of knee OA was 6.6±1.5 and KOOS-PS was 48.8±16.5/100. Concerning the radiographic damage; we found grade I-II (KL) in 22.6% and grade III-IV (KL) in 77.4%.

High BMI (BMI≥25 kg/m2was not significantly associated with worse KOOS score (p=0.9), more pain (p=0.5) or an increasing severity of radiological knee osteoarthritis (p=0.14). Moreover, the level BMI was not associated with the presence of other OA sites (p=0.9) or a bilateral KOA (p=0.07).

Conclusion:

These data, from a subset of participants with symptomatic radiographic knee OA, demonstrate no correlation between obesity and pain, functional impairment and radiographic severity.

Acknowledgments:

none

Disclosure of Interests:

None declared

AB0938 PARTICULARITIES OF INFECTIOUS SPONDYLODISCITIS IN THE ELDERLY: COMPARATIVE STUDY WITH THE YOUNG SUBJECT

Background:

The incidence of infectious spondylodiscitis is steadily increasing. The prognosis depends on various parameters, including age.

Objectives:

To explore the differences in presentation and the results of further investigations and the prognosis of spondylodiscitis between young and elderly subjects.

Methods:

This is a retrospective study of 113 patients admitted to our department over a period of 20 years [1998-2018]. The epidemiological, clinical, biological, radiological and progressive aspects of spondylodiscitis in subjects over the age of 65 were compared to cases of spondylodiscitis in young subjects whose age is less than 65 years.

Results:

Of the 113 identified patients, 33 (29.2%) were classified as older, with male predominance in both groups (56.2 and 51.5% respectively; p=0.6). The presence of risk factors, particularly diabetes, was more frequent in the older subjects but without a statistically significant difference (p=0.2). Hepathopathies were also more frequent in the elderly but without statistically significant difference (p=0.3). The mean duration of progression was 3 months with no statistically significant difference between the two groups (4 and 5 months respectively, p=0.1).

The presence of neurological symptoms, especially radiculalgia, was more frequently reported in younger subjects (p=0.01). Also, young subjects were more likely to have a fever (p=0.005). On the other hand, a biological inflammatory syndrome was more frequently encountered in older subjects (p=0.03).

We found no statistically significant difference in the location of spondylodiscitis (p=0.4). Also, multifocal involvement was more frequent in older subjects but without a statistically significant difference.

Radiologically, para-vertebral abscesses, epiduritis and spinal cord compression were more common in the elderly group (p=0.03; p=0.01 and p=0.01, respectively). While the frequency of intervertebral pinching and erosions was similar in both groups (p=0.1; p=0.8, respectively).

Tuberculosis was the most involved germ in more than 50% of cases with no statistically significant difference between the two groups (57.5 and 51.5% respectively; p=0.5).

All patients received targeted antibiotic therapy.

The occurrence of immediate complications was more frequent in the elderly but without a statistically significant difference (p=0.1). They included neurological complications (spinal cord compression and Cauda equina syndrome) that occurred in 6.3% of cases in younger subjects versus 36.4% of cases in the elderly (p=0.07). Followed by treatment side effects dominated by disturbance of liver function due mainly to antituberculosis drugs occurring in 16.3% of cases in the younger group and 15.2% of cases in older subjects (p=0.8). Finally, there were 2 deaths in each group (p=0.5).

Conclusion:

Our series has shown that the picture of spondylodiscitis in the elderly is less noisy. However, the neurological damage is more pronounced on imaging. The misleading symptomatology in the elderly explains the delay in diagnosis and treatment, which leads to more frequent complications and excess mortality.

Disclosure of Interests:

None declared

AB0307 DOES FCGR2A, FCGR3A AND FCGR3B POLYMORPHISM CAN PREDICT ANTI-DRUG ANTIBODIES APPARITION IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TNF-BLOCKERS?

Background:

Fc gamma receptors (FcγRs) play a major role in the regulation of humoral immune responses. Single-nucleotide polymorphisms (SNPs) of FCGR2A and FCGR3A and FCGR3B can impact the expression level, IgG affinity and function of the CD32 and CD16 FcγRs in response to their engagement by the Fc fragment of IgG. It was described in patient treated for rheumatoid arthritis (RA), that such a polymorphism may influence patients response to TNF-blockers.

Objectives:

In this study, we aimed to investigate whether the FCGR2A H131R (rs1801274), FCGR3A F158V (rs396991), and FCGR3B NA1/NA2 polymorphisms can be involved in the genesis of anti-drug-antibody ADAb to anti-TNF therapy in RA patients under etanercept (ETA), adalimumab (ADL) and infliximab (INF).

Methods:

We included 47 patients treated for RA under TNF-blockers. To assess the association between the FCGR2A H131R (rs1801274), FCGR3A F158V (rs396991), and FCGR3B NA1/NA2 polymorphisms and immunogenicity of TNF-blockers, we used allele contrast, the recessive model, the dominant model, and the homozygote contrast. Quantitative measurements of the ADAbs was carried out by a commercial enzyme-linked immunosorbent assay (ELISA) kit (Promonitor)®after 6 months of treatment.

Results:

We involved 18 patients treated with ETA, 13 patients with ADL and 16 under INF. None of the patients under ETA has developed ADAb and respectively 1 and 7 patients developed immunogenicity with ADL and INF. We excluded patients under ETA from statistical study since they didn’t develop ADAb.

A significant association was revealed between FCGR2A H131R polymorphism and immunogenicity of INF and ADL (table 1).

Table 1.

Association between FCGR2A polymorphism and immunogenicity to INF and ADL

FCGR2A association with ADAb (n=29, crude analysis)GenotypeADAb=0ADAb=1OR (95% CI)P-valueH/H1 (4.8%)3 (37.5%)1.000.031H/R-R/R20 (95.2%)5 (62.5%)0.08 (0.01-0.98)

There weren’t significant associations between ADAb’s development and FCGR3A F158V and FCGR3B NA1/NA2 polymorphism.

Conclusion:

FCGR2A R allele carriers show less susceptibility to develop ADAb to ADL and INF with follow-up times of 6 months. Our results provide an explanation for controversies in the relationships between FCGR2A H131R polymorphism and TNF-blockers response. Further studies with larger population of RA patients should be undertaken to confirm this hypothesis.

References:

None

Disclosure of Interests:

None declared

AB0945 CONTRIBUTION OF MICROBIOLOGICAL AND ANATOMOPATHOLOGICAL EXAMINATIONS IN THE DIAGNOSIS OF SPONTANEOUS PYOGENIC SPONDYLODISCITIS IN ADULTS

Background:

Pyogenic spondylodiscitis (SPD) is a serious infection of an intervertebral disc and/or adjacent vertebrae, that remains a topical problem in rheumatological practice. Early diagnosis and treatment are the only guarantees of a favorable outcome. Clinicians must strive to isolate the responsible bacteria in order to adapt the treatment, and thus reduce the risk of resistance and complications due to SPD itself, but also to the multiplication of probabilistic treatments.

Objectives:

Our aim was to study the contribution of the different microbiological and anatomopathological examinations in the diagnosis of pyogenic SPD.

Methods:

It was a descriptive study in a single rheumatology department. Data were collected retrospectively from observations of patients hospitalized in the past 20 years who have been diagnosed with pyogenic SPD. We excluded cases of tuberculous and brucellar SPD from our study because of their completely different histological and microbiological profiles.

Results:

Twenty-two cases of pyogenic SPD were collected (14M/ 8F). The mean age of the population was 55.9 years [29,80]. A bacteriological survey including at least one cytobacteriological examination of the urine (CBEU), chest X-rays and blood cultures allowed the identification of the bacteria in 16 cases (73%). The most common site were bacteria was identified was blood culture in 7 cases, skin sample and urine collection in 2 cases each. Disco-vertebral puncture and biopsy (DVPB) was performed in 19 patients when there was no bacteria identification and/or when diagnosis of infectious SPD persisted doubtful. On histopathological examination, were described: an infiltrate and/or inflammatory changes without specificity signs in 7 patients and an appearance of chronic pyogenic SPD very likely in 12 patients. Bacteriological study of DVPB fluid or paravertebral abscesses sample helped to isolate bacteria in 4 patients. DVPB or abscesses puncture were contributing by histological and/or bacteriological examination in 12 patients (63%).

Infecting bacteria was identified in 14 patients (64%). Gram-negative bacilli (GNB) and staphylococcus aureus were the most frequent germs (7 cases each) including 2 cases of co-infection. GNBs were represented by: Escherichia Coli and Enterobacter Cloacae in 2 cases each, Proteus Mirabilis, Serratia Marcescens and Klebsiella oxytoca in 1 case each. Clostridium clostridioforme and Lactococcus cremoris were isolated in 1 case each. For patients whose etiological investigation remained negative, SPD diagnosis was retained based on imaging (MRI) guided by anamnestic, clinico-biological and histopathological arguments.

Conclusion:

SPD is a rare condition that needs to be treated rapidly. Once the diagnosis is suspected, bacteria must be isolated before starting any antibiotic therapy. Simple and non-invasive exams as blood cultures, CBUE and chest rays, should be undertaken first. In fact, these simple exams allowed a germ identification in 73% cases in our study. If doubt persist, DVPB could be contributive to the diagnosis.

References:

None

Disclosure of Interests:

None declared

AB0880 NEUROPATHIC PAIN IN PATIENTS WITH KNEE OSTEOARTHRITIS: PREVALENCE AND RELATED FACTORS

Background:

Discordance between radiographic and pain severity in osteoarthritis (OA) has led researchers to investigate other pain mechanisms, including neuropathic pain (NP). Recent meta-analysis concluded that NP prevalence in people with knee or hip OA was 23% [1].

Objectives:

The primary objective of this study was to determine the prevalence of NP in patients with painful knee OA. Secondarily, we evaluated the relationship between NP and pain intensity, function and radiographic severity of knee OA.

Methods:

This cross-sectional study enrolled patients with knee OA (ACR criteria) from a rheumatology outpatient Hospital over a four-month period. Exclusion criteria were: knee surgery, chronic conditions of the nervous system, cognitive or psychiatric disorders. The patient’s characteristics and pain severity using the Visual Analogue Scale (VAS) were evaluated. The NP was assessed according to the Douleur Neuropathique 4 questionnaire (DN4) (arabic valid version). Functional impairment was estimated using the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) (KOOS-PS scores to 0 representing no difficulty and 100 representing extreme difficulty). Radiographs were rated using the Kellgren Lawrence (KL) grade classification (I-IV). Statistical analysis was performed to find the factors closely related with NP.

Results:

Ninety three patients with knee OA were included in the study. The mean age was 65.03±18.5 years with a sex ratio of 0.08. Mean duration of symptoms was 3.5 years [3months-20 years]. Concerning the marital status: 53.8% were married, 34.4% were widow and 10.8% were divorced. The majority of patients were illiterate (65.6%) and only 2.2% went to university. Patients were from low socio-economic class in 37.6% of cases. At least one comorbidity was revealed for 90.3% of patients and their mean BMI was 31.6±6.3 [19.9-52.3]. Concerning the clinical features of the KOA, mean VAS pain was 6.6±1.6 and KOOS-PS was 45.6±18.5. Of the subjects, 22.6% have radiographic at grade II, 57% at grade III and 20.4% at grade IV based on KL grading.

The mean (SD) score by the study participants on the DN4 was 4.9± 2.4. The prevalence of NP (DN4≥4) was 71%.

A DN4 score≥4 was significantly associated with the VAS pain (p=0.00) and the KOOS-PS (p=0.00) and the presence of comorbidity (p=0.04). However, there was no significant relation between DN4 score and, age, sex, marital status, socio economic class, level of education, BMI and KL grade (p=0.7, p=0.08, p=0.7,p=0.3, p=0.7, p=0.7, p=0.6).

Conclusion:

Our results highlight the high frequency of NP in patients with knee OA according to the DN4. Knee OA patients with NP encounter clinically relevant functional limitation. Thus, it is important to be aware of this neuropathic component to ensure appropriate management in the treatment of knee OA pain.

References:

[1]French HP, Smart KM, Doyle F. Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2017;47(1):1-8.

Acknowledgments:

none

Disclosure of Interests:

None declared

FRI0431 PROFILE OF INFECTIOUS SPONDYLODISCITIS ACCORDING TO THE SITE: UNIFOCAL VERSUS MULTIFOCAL

Background:

Infectious spondylodiscitis is a therapeutic emergency and is a current problem. It can affect the different levels of the spine. Multifocal forms, touching several floors, however remain rare.

Objectives:

To compare the clinical, biological, radiological and therapeutic aspects of unifocal versus multifocal spondylodiscitis.

Methods:

This is a retrospective study of 113 patients admitted to our service over a period of 20 years [1998-2018]. The diagnosis of spondylodiscitis was made on the basis of clinical, biological, radiological and bacteriological data. We have divided our population into two groups: unifocal and multifocal spondylodiscitis.

Results:

Spondylodiscitis was more frequently unifocal (75.2%) than multifocal (24.8%). The average age of the patients was 55.8 years. There were 62 men and 51 women. There was no difference in age and sex between the two groups (p=0.5 and p=0.8, respectively).

Diabetes was more frequent in the group of multifocal spondylodiscitis but with no statistically significant difference (p=0.4). No statistically significant difference between the two groups regarding the start mode (p=0.7), the schedule (p=0.3), the presence of neurological signs (p=0.7), fever (p = 0.2), impaired general condition (p=0.6) and biological inflammatory syndrome (p=0.6).

Cervical and dorsal spine involvement was more common in multifocal spondylodiscitis (p = 0.02 and p = 0.01; respectively). There were 11 spondylodiscitis involving 2 floors (cervical and dorsal: 2 cases, cervical and lumbar: 3 cases, dorsal and lumbar: 6 cases) and 3 spondylodiscitis involving 3 floors.

Radiologically, the presence of vertebral fracture and involvement of the posterior arch was more frequent during the multifocal form (p=0.03 and p=0.001; respectively). The frequency of para-vertebral abscesses, epiduritis and the presence of spinal cord compression were similar in the two groups (p=0.6; p=0.7 and p=0.2, respectively).

Tuberculosis was more frequent during the multifocal form (p = 0.05) and brucellosis during the unifocal form (p = 0.03). Disco-vertebral biopsy was performed in 79 cases. It was more often contributory during multifocal spondylodiscitis (p = 0.03).

The occurrence of immediate complications was more frequent in multifocal spondylodiscitis but with no statistically significant difference (p=0.2).

Conclusion:

Multifocal sppondylodiscitis is seen mainly in immunocompromised subjects. Our study found that diabetes is the most common factor in immunosuppression. Note also the predominance of involvement of the posterior elements, tuberculous origin and immediate complications.

Disclosure of Interests:

None declared

AB0796 PSORIATIC ONYCHOPATHY: MORE THAN MEETS THE EYE

Background:

Psoriatic onychopathy is an independent predictor of the onset of psoriatic arthritis (PsA). Assessment of nail disease is difficult given the limited utility of clinical assessment tools for the nail.

Recently, ultrasound (US) proved to be informative in the assessment of nail involvement.

Objectives:

We aimed to describe morphologic ultrasonographic nail disease changes and to look for correlations between these features and the characteristics of the PsA.

Methods:

The study included patients who met the CASPAR criteria for PsA.

An US scan of patient’s nails was performed in order to study the nail, matrix and skin thickness.

Results:

We included 33 patients with PsA with a mean age of 51.2±12.5 years. The mean DAPSA was 22.8±19.7 (remission:9 patients, low activity: 5 patients, moderate activity: 11 patients and high activity: 8 patients).

Twenty-nine patients had a personal history of skin psoriasis, present in 64 % of the patients the day of the examination with a mean PASI of 2.76 ±3.9.

Eleven patients (33.4%) presented with psoriatic onychopathy (45 fingernails) with a mean mNAPSI of 14.1± 16.

The most common patterns of nail involvement were:

Oil-drop patches (5 fingernails), pitting (4 fingernails), onycholysis (3 fingernails), crumbling (3 fingernails), subungual hyperkeratosis (2 fingernails), leukonychia (2 fingernails),paronychia(2 fingernails), splinter hemorrhages (1 fingernail).

We scanned 330 fingernails. The US study revealed dystrophy in 75 nails (22.7%) of the nails, in 17 patients (51.5%): Undulations or pitting (n=47), followed by disappearance of the anechoic space (n=38) and anechoic ventral nail plate (n=18).

The mean thickness of skin, nail plate and nail matrix region were 2.25±0.32 mm, 0.38±0.07 mm and 1.89±0.33, respectively.

We found a positive correlation between nail plate thickness and both skin and nail matrix region thickness (r=0.561, p=0.001 and r=0.523, p=0.002).

Skin, nail and nail matrix thickness were significantly higher in men and in smokers. Manual workers did not have greater skin, nail plate nor nail matrix thickness.

There were no correlations between disease activity evaluated by the ASDAS-CRP, DAS28, PASI, ESR or by CRP and any of the US parameters.

In contrast, there was a significant negative correlation between psoriatic disease duration and nail plate thickness (r=-0.372, p=0,036).

Conclusion:

Ultrasound offers an appropriate alternative for the evaluation of the nail unit. In our study it was able to detect subclinical involvement of the nail in 30 fingernails and in two patients.

Disclosure of Interests:

None declared

AB0797 ULTRASONOGRAPHIC ASSESSMENT OF ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS

Background:

Entheseal involvement is a frequent and distinctive feature of psoriatic arthritis (PsA), often under diagnosed. It is especially associated with nail involvement. Because clinical examination is not sensitive enough for the detection of early signs of this involvement, US may be considered as an alternative imaging technique in the diagnosis of enthesopathy.

Objectives:

The aim of the present study is to evaluate US entheses abnormalities in PsA and their correlation with clinical characteristics

Methods:

The study included patients diagnosed with PsA according to the CASPAR criteria. They underwent a thorough clinical examination with special regard to the presence of enthesitis using the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index.

The US study bilaterally explored entheses at six sites: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion, distal quadriceps tendon and distal brachial triceps tendon. We evaluated the following elemental lesions of enthesis at each site: thickness and structure of the tendon, calcifications, bursae, erosions, power Doppler signal in bursa or enthesis full tendon.

Results:

Of the 33 patients, 39.4 % were male. The mean age was 51.2±12.5 years. The mean disease duration was 13.5±10.2 years.

The mean DAPSA was 22.8± 19.7 [0.1-84.5]: remission(n=9), low activity (n=5),moderate activity (n=11),high activity(n=8).

At inclusion, 11 patients (33.4%) patients presented with psoriatic onychopathy (45 fingernails) with a mean mNAPSI of 14.1±16. Out of the 528 entheseal sites, 92 were tender at the palpation (17,4%) with a mean SPARCC at 2.87.

A total of 396 entheseal sites were examined by US. In 140 of them (35.35%), US found at least 1 sign indicative of enthesopathy. The most affected tendon was the distal Achilles tendon (42/396), followed by proximal plantar fascia (32/396), distal patellar tendon (20/396), quadriceps tendon (20/396), distal brachial triceps tendon(14/396) and finally proximal patellar tendon (12/396).

The most common elemental lesions were enthsophytes (176), erosions (114) and calcifications (50).

We found a positive correlation between age and both calcification (r=0,4, p=0.021) and enthesophytes (r=0.479, p=0.005).

We found a positive correlation between enthesophyte and the tender and swollen joints count (r= 0.352, p=0.045, r=0.378, p=0.03) and the SPARCC score (r=0.397, p=0.022).

Patients with higher BASDAI had thicker tendons (r=0.355, p=0.05).

Patients with nail dystrophy had more bursitis and erosions.

US scores did not correlate with sexe, disease duration and disease activity measures (ASDAS, DAPSA, DAS28 and PASI). Patients with subclinical entheseal involvement didn’t have higher inflammatory biomarkers (ESR, CRP).

Conclusion:

US subclinical enthesopthy are not rare in psoriatic arthritis, in particular in patients with active disease.

Clinical nail involvement was associated with bursitis and erosions. New studies including larger study groups are required to verify the findings of the present study

Disclosure of Interests:

None declared

AB0937 COMPARATIVE STUDY OF PYOGENIC SPONDYLODISCITIS VERSUS TUBERCULOUS SPONDYLODISCITIS

Background:

Infectious spondylodiscitis is a life-threatening infection of the intervertebral disc and adjacent vertebrae that can be caused by a variety of microorganisms. Our country is at intermediate endemicity for Tuberculosis.

Objectives:

To compare the clinical, biological, radiological characteristics, management and prognosis of pyogenic versus tuberculous spondylodiscitis.

Methods:

Retrospective study of 89 patients admitted to our department over a period of 20 years [1998-2018]. The diagnosis of spondylodiscitis was made based on clinical, biological, radiological and bacteriological data.

Results:

The average age of the patients was 56.1 years. There were 46 men (51.6%) and 43 women (48.4%) with a female predominance during tuberculous spondylodiscitis (57.1%) versus 26.9% during pyogenic spondylodiscitis (p = 0.009).

Diabetes was more frequent during pyogenic spondylodiscitis but with no statistically significant difference (p = 0.4). The evolution time was statistically greater during tuberculous spondylodiscitis (p <0.001). Patients with tuberculous spondylodiscitis had more frequently an impaired general condition (p = 0.02).

Hyperleukocytosis was noted more frequently in the pyogenic group than in the tuberculosis group (p=0.03), while the increase in sedimentation rate was not significantly different between the two groups (90 mm/h and 76 mm/h, respectively, p=0.1). We found no statistically significant difference regarding the site of spondylodiscitis.

Radiologically, the frequency of para-vertebral and psoas abscesses, epiduritis and the presence of spinal cord compression were similar in the two groups (p=0.2; p=0.1 and p=0.1, respectively), whereas mirrored geodes were more frequent during tuberculosis (p = 0.04).

Surgical and interventional treatments (percutaneous sampling, abscess drainage) were more frequently noted during pyogenic spondylodiscitis, but without significant difference (p=0.2). The occurrence of immediate complications was more frequent during tuberculosis but without a statistically significant difference (p=0.2).

Conclusion:

In our series, patients with tuberculous spondylodiscitis tend to have a chronic pattern of progression and more often an impaired general condition. However, there was no significant difference in the presence of abscess, epiduritis and the occurrence of complications between tuberculous spondylodiscitis and pyogenic spondylodiscitis.

Disclosure of Interests:

None declared

Anxiety related disorders in adolescents in the United Arab Emirates: a population based cross-sectional study

Background

Anxiety disorders are common among children and adolescents. However, there is a paucity of up-to-date data on the prevalence and correlates of anxiety-related disorders among children and adolescents in the United Arab Emirates (UAE).

Methods

We conducted a cross sectional study to determine the prevalence of specific anxiety-related disorders (e.g., generalized anxiety disorder, panic disorder, separation anxiety, social anxiety) in the UAE, and identify correlations between these disorders and adolescents’ demographic variables. Participants were 968 adolescents aged 13–18 years attending secondary schools across the UAE. Convenience sampling was used to recruit participants. We collected demographic information and data about participants’ anxiety levels. Anxiety was assessed using the Arabic and English versions of the Screen for Child Anxiety Related Disorders scale. Univariate analyses (independent sample t-tests and analysis of variance) were performed to evaluate factors affecting participants’ anxiety scores. Chi-square tests were used to compare factors associated with anxiety disorders.

Results

Participants’ mean age was 16 ± 1.8 years, and 65.8% were female. The overall prevalence of anxiety disorders was 28%, with this being significantly higher in girls (33.6%) than boys (17.2%) (p < 0.0001). Participants aged < 16 years had higher generalized anxiety, separation anxiety, and social anxiety scores compared with those aged ≥16 years (p ≤ 0.05). Those from households with a maid had significantly higher generalized anxiety, panic disorder, separation anxiety, and significant school avoidance scores than those without a maid (p ≤ 0.05). In addition, participants from middle and low economic backgrounds had higher separation anxiety scores compared with children from high economic backgrounds (p ≤ 0.05). The multivariate analysis showed the main associated factors with anxiety were gender (being female, p < 0.001) and caregiver (other than mother and father together, p < 0.001).

Conclusions

We found a high incidence of anxiety-related disorders among school-aged adolescents in the UAE, with girls being more affected than boys. This suggests that age-appropriate initiatives are urgently needed to reduce the high rate of anxiety-related disorders. It may also be necessary to further investigate the two main associated factors with anxiety identified in this study (being female and non-parental caregivers).

Prevalence of alexithymia and associated factors among medical students at King Abdulaziz University: a cross-sectional study

BACKGROUND

Medical students are at higher risk of developing alexithymia due to the nature of their studies.

OBJECTIVES

Determine the prevalence of alexithymia and potential risk factors among medical students in Saudi Arabia.

DESIGN

A cross-sectional analytic study.

SETTINGS

University medical school.

PATIENTS AND METHODS

An institutional cross-sectional survey of medical students was conducted using the Toronto Alexithymia Scale (TAS-20) to assess the prevalence of alexithymia and potentially associated factors (gender, parental marital status, grade point average, status of accommodations, smoking status, year of study, childhood abuse, a history of mental illness, and physical activity).

MAIN OUTCOME MEASURES

Gender, parental marital status, grade point average, status of accommodations, smoking status, year of study, childhood abuse, a history of mental illness, and physical activity.

SAMPLE SIZE

347.

RESULTS

The prevalence of alexithymia among medical students was 49% (95% confidence interval [43.8-54.2]). A binary logistic regression model showed significant associations between alexithymia and academic year of study (lower risk of alexithymia in the clerkship (5th, 6th years); odds ratio [OR]: 0.43, 95% CI: 0.26-0.72), smoking (OR: 3.52, 95% CI: 1.60-3.34), grade point average (lowest; OR: 10.44, 95% CI: 4.24-25.77), history of childhood abuse (OR: 2, 95% CI: 1.20-8.77), and history of psychiatric illness (OR: 14.40, 95% CI: 4.76-21.06).

CONCLUSION

Almost half of the medical students suffer from alexithymia. Increasing the awareness about alexithymia among students and directing them where to seek help would facilitate the management of these problems.

LIMITATIONS

Limited only to medical students from the second year to the sixth year in a single medical college, which affects generalizability. The cross-sectional design might have also limited generalizability.

CONFLICT OF INTEREST

None.

Dyslipidaemia prevalence and associated risk factors in the United Arab Emirates: a population-based study

OBJECTIVES

To determine and describe the prevalence and pattern of dyslipidaemia and its associated risk factors among an adult Emirati population.

DESIGN

Population-based, cross-sectional study.

SETTING

Adults living in the Northern Emirates.

PARTICIPANTS

824 adult participants (51.8% men, 48.2% women, mean age 42.8±13.4 years old).

PRIMARY OUTCOME MEASURES

Fasting blood samples were collected, blood pressure and waist circumference were measured.

RESULTS

The overall dyslipidaemia prevalence was 72.5%, with 42.8% of the participants showing high total cholesterol (TC) level, 29% showing high triglyceride (TG) level, 42.5% showing low high-density lipoprotein cholesterol (HDL-C) level, 38.6% showing high low-density lipoprotein cholesterol (LDL-C) level and 72.3% showing high cholesterol ratio. The regression models showed that gender was a significant predictor of a high TG level, low LDL-C level and high cholesterol ratio. Middle-aged individuals (30-59 years old) had a significantly higher risk of having high TC, TG and LDL-C levels than young (<30 years old) and elderly (≥60 years old) individuals. Diabetes mellitus was a significant predictor of low TC, high TG and low HDL-C levels, while central obesity was a significant predictor of a high TG level, low HDL-C level and high cholesterol ratio. Smoking was a significant predictor of a high TG level only in men.

CONCLUSIONS

The prevalence of dyslipidaemia was considerably high among the local adult Emiratis. The identified dyslipidaemia predictors were gender, age, smoking, central obesity and diabetes. Further studies are recommended to assess other important risk factors and aggressive preventive measures in the United Arab Emirates.

Prevalence of Helicobacter pylori and Its Associated Factors among Healthy Asymptomatic Residents in the United Arab Emirates

The United Arab Emirates (UAE) has been under continuous populational influences from Asia, Europe, and Africa, making it an ideal site for epidemiological studies on Helicobacter pylori. However, there has been a paucity of well-designed prevalence studies on H. pylori from UAE. The aim of this study was to determine the prevalence of H. pylori and its associated risk factors in the UAE. A prospective cross-sectional study was conducted on healthy asymptomatic residents of UAE. Socio-demographic, lifestyle, and gastrointestinal characteristics of participants were obtained through a questionnaire in parallel within the stool sample collection. A total of 350 participants were included in this study and were tested for H. pylori using the stool antigen test (Premier Platinum HpSAT). Out of the total tested study participants, 41% were found to be H. pylori-infected. Logistic regression analysis has shown a significant association between H. pylori infection and gender, age, ethnicity, profession, domestic overcrowding, source of drinking water, and gastrointestinal characteristics of participants. Based on the results from this study, we suggest that preventive measures against H. pylori infection should be considered worthy by public health authorities.

The FTO rs9939609 "A" allele is associated with impaired fasting glucose and insulin resistance in Emirati population

BACKGROUND

Fat mass and obesity-associated protein gene variants have shown diverse influence on body weight and metabolism across different populations. Overweight, obesity and metabolic syndrome are multifactorial major health problems in the UAE and worldwide. Insulin resistance represents the link between overweight and development of metabolic syndrome and type 2 diabetes mellitus. We investigated two (FTO) variants in Emirati population, in relation to insulin resistance and different parameters of metabolic syndrome.

METHODS

We recruited 259 Emiratis through the UAE National Diabetes and Lifestyle Project. Ethical approval was obtained. Besides basic data collection, venous blood samples were collected. Fasting blood glucose, Lipid profile, and insulin levels were measured. Genotyping for (FTO) rs9939609 (A>T) and rs9930506 (G>A) were performed using real time-PCR. Insulin resistance were identified using HOMA2-IR calculation; with a cut-off point of 1.4 for female and 1.18 for male subjects.

RESULTS

The study included 259 Emiratis (age range 30-53 years, mean 41.76 years, 54.4% females), 24.5% are diabetic and 30.8% are hypertensive, with body mass index of 28.4 ± 5.9 and 28.7 ± 5.7 kg/m² in female and male subjects, respectively. Homozygous A of rs9939609 showed significantly higher fasting glucose compared to other genotypes (p = 0.04) with a trend of higher insulin level and HOMA-2IR. The A/A diabetic patients (n = 13) showed significantly higher insulin levels compared to other genotypes. G allele of rs9930506 showed a trend of higher fasting glucose and HOMA-2IR, but lower insulin level and HbA1c. No association of genotypes was detected with other components of metabolic syndrome.

CONCLUSION

There is an association of FTO rs9939609 A/A genotype and impaired fasting glucose and insulin resistance. Homozygous A genotype diabetic patients may be more vulnerable to blood glucose fluctuation. Focused genotyping can help the health care providers to identify high risk groups of both normal population and diabetic patients to intervene accordingly.

Statin-induced myopathy SLCO1B1 521T > C is associated with prediabetes, high body mass index and normal lipid profile in Emirati population

BACKGROUND

Statin-induced myopathy has been linked to the C allele of a single nucleotide polymorphism (SNP) (rs4149056) of SLCO1B1 gene. This effect is more significant, but not restricted to simvastatin. Many studies have included European, American, African and Southeast Asian ancestries, but few were carried out on Middle Eastern population.

AIM

To detect the prevalence of SLCO1B1 rs4149056 (521T > C) in Emirati population.

METHOD

We recruited 282 Emiratis through the UAE National Diabetes and Lifestyle Project. Ethical approval was obtained before the study starts. Besides basic data collection, venous blood samples were collected. Fasting blood glucose, Lipid profile, and insulin levels were measured. Genotyping for rs4149056 (521T > C) was tested in triplicates through Real Time-PCR using TaqMan® Drug Metabolism Genotyping Assay. rs2306283 (388A > G) was analyzed for comparison. In addition, presence of minor alleles of both SNPs define stronger association with statin-induced myopathy.

RESULTS

The study included 282 individuals, 52.8% were males with median age of 39.5 years. 10% had Diabetes Mellitus and 23% were hypertensive. Median of body mass index (BMI) was 27.68 kg/m² in males and 28.38 kg/m² in females. One-hundred ninety-seven (69.9%) showed abnormal lipid profile (either increased LDL-cholesterol or triglycerides or both). For rs4149056, C allele was present in 21.3% (2.8% homozygous C and 18.4% heterozygous CT). Although homozygous C genotype prevalence was low, compared with Caucasians (4%) and Africans (0%), C allele was associated with a trend of having higher BMI and abnormal lipid profile. C allele subjects were all pre-diabetics with mean glycated hemoglobin above 6%. Mean BMI in CC, CT, and TT genotypes was 30.91 ± 4.4, 29.48 ± 4.2, 27.96 ± 5.5 kg/m² respectively, with lack of such a trend observed with the different genotypes of the rs2306283 (used for comparison). Abnormal lipid profile was observed in 7/8(87.5%), 38/52(73.1%) and 152/222(70%) of the CC, CT, and TT genotypes respectively.

CONCLUSION

There is lower prevalence of statin-induced myopathy-linked C allele of rs4149056 in SLCO1B1 gene in Emirati population, compared to Caucasians and Africans. However, there is a trend of higher glycosylated hemoglobin and BMI associated with normal lipid profile in patients having this allele.

Development of a high-rate submerged anaerobic membrane bioreactor

Typically, anaerobic membrane bioreactors are operated at an organic loading rate (OLR) less than 10 kg chemical oxygen demand (COD)/m³d. This paper discusses the development and performance of a high-rate submerged anaerobic membrane bioreactor (SAnMBR) for a high-strength synthetic industrial wastewater treatment. An OLR as high as 41 kg COD/m³ d was achieved with excellent COD removal efficiency (>99%). The membrane was operated at constant fluxes (9.4-9.9 ± 0.5 L/m² h) and the change in trans-membrane pressure (TMP) was monitored to characterize the membrane performance. The results showed a low TMP (<5 kPa) under steady-state operation with only biogas sparging and relaxation as control strategy for over 300 days, implying no significant fouling was developed. Inorganic fouling was the dominant fouling mechanism occurred at the end of the study. The results suggest that the newly developed SAnMBR configuration can treat high-strength wastewater at lower capital expenditure while still providing superior effluent quality for water reuse or system closure.

Diabetes risk score in the United Arab Emirates: a screening tool for the early detection of type 2 diabetes mellitus

OBJECTIVE

The objective of this study was to develop a simple non-invasive risk score, specific to the United Arab Emirates (UAE) citizens, to identify individuals at increased risk of having undiagnosed type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

A retrospective analysis of the UAE National Diabetes and Lifestyle data was conducted. The data included demographic and anthropometric measurements, and fasting blood glucose. Univariate analyses were used to identify the risk factors for diabetes. The risk score was developed for UAE citizens using a stepwise forward regression model.

RESULTS

A total of 872 UAE citizens were studied. The overall prevalence of diabetes in the UAE adult citizens in the Northern Emirates was 25.1%. The significant risk factors identified for diabetes were age (≥35 years), a family history of diabetes mellitus, hypertension, body mass index ≥30.0 and waist-to-hip ratio ≥0.90 for males and ≥0.85 for females. The performance of the model was moderate in terms of sensitivity (75.4%, 95% CI 68.3 to 81.7) and specificity (70%, 95% CI 65.8 to 73.9). The area under the receiver-operator characteristic curve was 0.82 (95% CI 0.78 to 0.86).

CONCLUSIONS

A simple, non-invasive risk score model was developed to help to identify those at high risk of having diabetes among UAE citizens. This score could contribute to the efficient and less expensive earlier detection of diabetes in this high-risk population.

Clinical and diagnostic features of trochanteric tuberculosis

Trochanteric tuberculosis is a very rare localization of musculo-skeletal tuberculosis. The diagnosis is difficult and is often made in a late stage. The authors describe five cases of trochanteric tuberculosis. The mean age of patients was 46.6 years. Time to diagnosis was long (7.6 months on average). The tuberculosis was plurifocal in all cases. Diagnosis was based on positive Lowenstein culture in one case, on the presence of caseum granuloma in one case and through a pathognommonic manifestation in one case. For the remaining two cases, diagnosis was established on clinical and paraclinical arguments. The patients recovered after medical treatment alone.

Acute Headache Presentations to the Emergency Department: A Statewide Cross-sectional Study

OBJECTIVES

The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergency department (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined.

METHODS

A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined.

RESULTS

There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was "worst ever" in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography (CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and "primary headache not further specified" in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning could thus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and 23% of cases, respectively.

CONCLUSIONS

The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving CT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overall underwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions.

What is the chance all your trainees will pass the next Fellowship exam: A statistician's view

Your department has had a good track record over many years for preparing trainees to successfully sit for the ACEM Fellowship exam. On average the pass rate for your trainees is over 80%. Then, to your dismay, suddenly only two of five of your trainees pass the latest Fellowship exam. Does this anomaly necessitate an urgent review of your department's training programme, or is it just a statistical quirk? Let us suppose you can prepare candidates so that they all have at least an 80% chance of passing. The probability that all five candidates would have passed is 32.8% (or 0.8⁵ ) based on the multiplication rule of probability for independent events. The probability that only two of five passed is 5.1% (or 10 × 0.8² × 0.2³ ) based on the binomial distribution, which is a probability distribution analogous to the normal distribution. The construction of the binomial distribution depends on two parameters: (i) number of candidates sitting ('n'), and (ii) probability of passing for any individual candidate ('P'). The distribution gives the probability that 'x' number of individuals will pass when 'n' number of individuals sit. Thus despite an 80% pass rate historically, the probability that only two of five candidates will pass is not negligible at 5.1%. It is an anomaly, which we may choose not to act on unless it is recurrent, noting it will be expected to occur naturally about one time out of 20. The real challenge is to maintain or increase that individual probability at 80% or higher.

[Brown tumor as an exceptional origin of lumbocruralgia with favourable outcome]

INTRODUCTION

We report a case of a particular lumbar and radicular pain revealing primary hyperparathyroidism and discuss its characteristics through a literature review.

CASE REPORT

A 55-year-old woman was hospitalized for a nerve root pain associated with recent weight loss with normal physical examination. Biology showed no evidence for acute phase response and normal kidney and liver functions. However, hypercalcemia and hypophosphatemia were evidenced. Radiographs of the lumbar spine showed a lytic lesion occupying the body of L4. A lumbar spine CT scan confirmed the presence of a compressive nerve root brown tumor. High level of PTH and parathyroid mass raised the possibility of the diagnosis of primary hyperparathyroidism. After parathyroidectomy all signs of hyperparathyroidism resolved with complete disappearance of spinal brown tumors in a two year follow-up CT scan.

CONCLUSION

Although uncommon, brown tumor should be a diagnosis to consider in their presence of a spinal tumor. The improvement after conservative treatment could be dramatic.