Effect of music therapy on patients with rheumatic diseases

BACKGROUND

Music therapy seems to have a multitude of positive effects not only on mental health but also on organic pain. Some studies have showed its effectiveness on reducing pain for patients undergoing surgical procedures. However, data on its efficiency on patients' anxiety during rheumatology medical consultation for patients with chronic rheumatic diseases is lacking.

OBJECTIVES

The purpose of the present study was to describe the impact of music therapy on the mood of patients followed for chronic rheumatic diseases.

METHODS

We conducted a cross-sectional study including patients followed for chronic rheumatic diseases seen in the outpatient rheumatology department during a period of three weeks. Patients selected were randomly assigned into two groups. Patients seen while listening to music "The Mozart Sonata" formed theG1 (n = 40). Patients seen without listening to music formed the group G2 (n = 30). Participants' anxiety levels were assessedbefore and immediately after medical consultations by collecting vital signs (heart rate and respiratory rate) and by the Spielberger State Trait Anxiety inventory questionnaire (STAI).

RESULTS

The mean age of 70 patients included was 54.36 ± 14.62 years. Females outnumbered males (62.9 %).The STAI scores were 38.44 (range, 25-60) and 34.51 (range, 22-52)respectively pre- and post-consultation. The medical consultation lasted for a mean of 24 ± 1.1 min in G1 and 20.63 ± 1.3 in G2. Sharp after the consultation, the mean Heart Ratewas significantly lower in the group with music therapy (64±1.5 in G1 versus 66.3 ± 1.3 in G2, p = 0.02) and the mean STAI decreased also significantly in tne G1 (34.72±1 in G1 versus 40.7 ± 5.2 in G2, p = 0.018). However, the decline of the mean Respiratory Ratewas not significant between both groups(16.1 ± 1 in G1 versus 16.96 ± 1.7 in G2, p = 0.42).

CONCLUSION

Our study showed a significant lowering in anxiety level and heart rate in patients consulted while listening to music.This costless and available tool should be more used in our daily practice specially when treating patients with chronic painful diseases.

The first case of SARS-CoV-2-induced eosinophilic fasciitis

Eosinophilic fasciitis (EF), also known as Shulman syndrome, is a rare auto-immune fibrosing disorder of the fascia. Etiopathogeny of EF is still unclear. Nowadays, it is widely known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce hyper-stimulation of the immune system. Several cases with fasciitis and rhabdomyolysis induced by coronavirus disease 2019 vaccines have been reported in the literature. Herein, we report the first case of EF possibly triggered by SARS-CoV-2 infection. A 45-year-old Tunisian woman, with no medical history, presented to our department with severe widespread muscle pain noticed one month after a SARS-CoV-2 infection. Physical examination showed an induration of the skin and subcutaneous tissue of the arms, forearms and legs with a restricted joint mobility. The level of eosinophils was 430 E/mm3 (6.1%) [1-4%]. Electromyography and creatine kinase levels were normal. Myositis-related antibodies were negative. Magnetic resonance imaging of the left arm showed high-intensity signal and thickness of the fascia without evidence of muscle or bone involvement. A muscular biopsy from the right deltoid showed thickening and inflammation of the fascia. The patient received intraveinous injections of 1000 mg of methylprednisolone for 3 days with an oral relay of 1 mg/kg per day of prednisone equivalent during 4 weeks. At one-month follow-up, a significant improvement of the skin induration and myalgia was observed, with a disappearance of the biological inflammatory syndrome. This brief report suggests a potential link between SARS-CoV-2 infection and new-onset of auto-immune fasciitis.

Rheumatoid arthritis with concomitant fibromyalgia: The role of ultrasound in assessing disease activity

INTRODUCTION

Fibromyalgia (FM) is a chronic painful condition frequently associated with rheumatoid arthritis (RA), which may falsely increase RA activity. The aim of our study was to compare clinical scoring and ultrasound (US) assessment in RA patients with concomitant FM with those without FM.

METHODS

A cross-sectional study including patients with RA according to the ACR/EULAR 2010 criteria was conducted. Patients were divided into two groups: RA patients meeting ACR 2016 FM criteria (cases) and RA patients not meeting FM criteria (controls). Clinico-biological and US assessments of RA activity were performed on the same day for each patient.

RESULTS

Eighty patients distributed into 40 patients in each group were recruited. Biologic DMARD prescription was more frequent in RA with FM patients than the control group (p = 0.04). DAS28 was significantly greater than DAS28 V3 in RA with FM group (p = 0.002). FM group had significantly less US synovitis (p = 0.035) and less Power Doppler (PD) activity (p = 0.035). Grey scale US score (p = 0.87) and DP US score (p = 0.162) were similar in the two groups. The correlation between the clinical and the ultrasonographic scores was strong to very strong in both groups with the strongest correlation found between DAS28 V3 and US DAS28 V3 (r = 0.95) in RA + FM group.

CONCLUSION

Our study confirms the overestimation of disease activity by the clinical scores in RA with concomitant FM. DAS28 V3 score and US assessment would represent a better alternative.

Baseline predictors of fatigue and persistent fatigue in rheumatoid arthritis: A longitudinal observational study

OBJECTIVES

To determine factors associated with fatigue in patients with rheumatoid arthritis (RA), and to identify baseline predictors of persistent fatigue at 12 months of follow-up.

METHODS

We enroled patients with RA fulfiling the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Fatigue was assessed using the Arabic version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Using univariate and multivariate analyses, we examined baseline variables associated with fatigue and persistent fatigue (if the FACIT-F score was less than 40 at baseline and 12 months of follow-up).

RESULTS

We included 100 RA patients of whom 83% reported fatigue. At baseline, the FACIT-F score was significantly associated with older age (p = 0.007), pain (p < 0.001), global patient assessment (GPA) (p < 0.001), tender joint count (TJC) (p < 0.001), swollen joint count (p = 0.003), erythrocyte sedimentation rate (ESR) (p < 0.001), disease activity score (DAS28 ESR) (p < 0.001), and health assessment questionnaire (HAQ) (p < 0.001). At 12 months of follow-up, the percentage of patients who reported persistent fatigue was 60%. The FACIT-F score was significantly associated with age (p = 0.015), symptom duration (p = 0.002), pain (p < 0.001), GPA (p < 0.001), TJC (p < 0.001), C-Reactive Protein (p = 0.007), ESR (p = 0.009), DAS28 ESR (p < 0.001), and HAQ (p < 0.001). Pain was an independent baseline predictor of persistent fatigue (OR = 0.969 (95% CI [0.951-0.988]), p = 0.002).

CONCLUSIONS

Fatigue is a frequent symptom in RA. Pain, GPA, disease activity and disability were associated with fatigue and persistent fatigue. Baseline pain was the only independent predictor of persistent fatigue.

Is there an association between plantar fasciitis and knee osteoarthritis?

BACKGROUND

Knee osteoarthritis (OA) and plantar fasciitis share similar risk factors including ageing, occupation, obesity, and inappropriate shoe wear. However, the association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date.

AIM

We aimed to assess the prevalence of plantar fasciitis using ultrasound in patients with knee OA and to identify factors associated with plantar fasciitis in these patients.

PATIENTS AND METHODS

We conducted a cross-sectional study including patients with Knee OA, fulfiling the European League Against Rheumatism criteria. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the Lequesne indexes were used to evaluate pain and function of the knees. The Manchester Foot Pain and Disability Index (MFPDI) was used to estimate foot pain and disability. Each patient underwent a physical examination, plain radiographs of the knees and the heels, and an ultrasound examination of both heels to find signs of plantar fasciitis. Statistical analysis was performed using SPSS.

RESULTS

We included 40 knee OA patients, with a mean age of 59.85 ± 9.65 years [32-74] and a male-to-female ratio of 0.17. The mean WOMAC was 34.03 ± 19.9 [4-75]. The mean Lequesne for knees was 9.62 ± 4.57 [3-16.5]. Among our patients, 52% (n = 21) experienced heel pain. The heel pain was severe in 19% (n = 4). The mean MFPDI was 4.67 ± 4.16 [0-8]. Limited ankle dorsiflexion and plantar flexion were noted in 47% of patients (n = 17) each. High and low arch deformities were seen in 23% (n = 9) and 40% (n = 16) of patients. Ultrasound revealed a thickened plantar fascia in 62% (n = 25). An abnormal hypoechoic plantar fascia was noted in 47% (n = 19), with the loss of normal fibrillar architecture in 12 cases (30%). No Doppler signal was exhibited. Patients with plantar fasciitis had significantly limited dorsiflexion (n = 2 (13%) versus n = 15 (60%), p = 0.004) and plantar flexion (n = 3 (20%) versus n = 14 (56%), p = 0.026). The range of supination was also less important in the plantar fasciitis group (17.73 ± 4.1 vs. 12.8 ± 6.46, p = 0.027). The low arch was statistically more present in patients with plantar fasciitis (G1: 36% [n = 9] vs. G0: 0% [n = 0], p = 0.015). However, the high arch deformity was statistically more present in patients without plantar fasciitis (G1: 28% [n = 7] vs. G0: 60% [n = 9], p = 0.046). Multivariate analysis showed that the risk factor for plantar fasciitis in knee OA patients was limited dorsiflexion (OR = 3.889, 95% CI [0.017-0.987], p = 0.049).

CONCLUSION

In conclusion, our work showed that plantar fasciitis is frequent in knee OA patients, with reduced ankle dorsiflexion being the main risk factor for plantar fasciitis in these patients.

Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review

INTRODUCTION

Obesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis.

METHODS

This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included.

RESULTS

Three studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p<0.05). Similarly, prior BMS in RA patients was significantly associated with reduced odds ratios for all the morbidities and in-hospital mortality compared with no prior BMS (36.5% vs 54.6%, OR = 0.45, 95% CI (0.42, 0.48), p< 0.001) and (0.4% vs 0.9%, OR = 0.41, 95% CI (0.27-0.61), p < 0.001) respectively.

CONCLUSION

To conclude, published data indicate that BMS seems a promising alternative in reducing RA disease activity as well as morbidity and mortality in patients with obesity.

Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis

OBJECTIVES

Psoriatic arthritis (PsA) can mimic rheumatoid arthritis (RA) at an early stage, especially when psoriasis is lacking. In the absence of specific radiological and immunological markers, the differential diagnosis between these two diseases can be challenging. We aimed to determine whether hands ultrasonography (US) may be useful in the differential diagnosis between PsA and RA.

METHODS

We conducted a cross-sectional study including patients with PsA and RA. All wrists and small joints of the hands were examined using gray-scale and Power Doppler US. The evaluated US lesions were: synovitis, tenosynovitis of extensor carpi ulnaris, extensor communis and flexor tendons, enthesitis of extensor tendons at distal interphalangeal joints, peritendon inflammation of extensor tendons, and soft tissue edema.

RESULTS

Six hundred joints in 20 PsA patients and 900 joints in 30 RA patients were assessed. Extensor enthesitis was significantly more observed in PsA compared with RA (39.4 vs 26.3%, P = .006) with a significant higher frequency of enthesophytes and calcifications (P = .022 and P = .002, respectively). Peritendon inflammation of extensor digitorum tendons was observed in 13% of metacarpophalangeal joints in PsA patients versus 3% in RA patients with a significant difference (P < .001). Soft tissue edema was exclusively observed in PsA (1.5 vs 0%, P = .033). Power Doppler synovitis was significantly more frequent in RA (9.2 vs 5%, P = .002). Extensor carpi ulnaris tenosynovitis was significantly more frequent in RA (18.3 vs 2.5%, P = .017).

CONCLUSION

Extrasynovial US findings may be helpful to distinguish PsA from RA especially in patients with immunonegative polyarthritis and no evidence of psoriasis.

Covid 19 in patients with systemic inflammatory diseases: impact on disease activity

INTRODUCTION

COVID-19 pandemic, an international emergency, raised concerns about the interaction of this infection and disease-modifying drugs used in the treatment of Systemic inflammatory diseases (SID). Understanding the relationship between COVID-19 and disease activity is crucial to adapt the treatment. The aim of our study was to determine the impact of COVID-19 on the disease activity of rheumatic diseases.

PATIENTS AND METHODS

We performed a cross-sectional study, including patients with SID (rheumatoid arthritis (RA) and spondyloarthritis (SpA)). Disease activity was evaluated during the last check-up before COVID-19 and within the period of 6 months after the infection. Activity scores were assessed with Disease Activity Score (DAS28) for RA and Ankylosing Spondylitis Disease Activity Score (ASDAS) for SpA. Correlation and regression coefficients were used to evaluate associations among the variables.

RESULTS AND DISCUSSION

Totally, thirty-two patients were included; twenty followed for RA and twelve for axial SpA. The mean disease duration of the underlying rheumatic disease was 10.2 years [2-30]. RA was seropositive and erosive in 61% and 31%, respectively. Seventeen patients were on csDMARDs: 14 were on Methotrexate and three patients were on Salazopyrine. Ten patients (31%) were treated with bDMARDs; Tumor necrosis factor (TNF)-alpha inhibitors were used in eight cases. Rituximab and secukinumab were prescribed for one patient each. In 70%, COVID-19 was pauci-symptomatic. A severe form with a need for hospitalization was noted in 9%. Two patients were admitted to the intensive care unit (ICU). Overall, treatment with DMARDs was interrupted in all cases: when COVID-19 symptoms began in 82% and when PCR was positive in 18%. Both RA and axial SpA were not active after a mean period of 6 months after COVID-19 infection (p=0.818 and p=0.626, respectively).

CONCLUSION

Although our patients interrupted their DMARDs, our study demonstrates that disease activity as assessed by ASDAS and DAS28 in SpA and RA remained unchanged after COVID-19.

Mental Health Outcomes Among Tunisian Health Care Workers During the COVID-19 Pandemic

The pandemic caused by Coronavirus-19 Disease (COVID-19) is having negative effects on healthcare workers (HCW) mental health due to the tremendous amount of stress to which they are exposed to. We aimed to assess the number of mental health outcomes among HCW treating patients with COVID-19. This cross-sectional study collected demographic data and mental health measurements from HCW in different hospitals using an online questionnaire. Participants were asked to complete the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Insomnia Severity Index (ISI), and the 7-item Generalized Anxiety Disorder scale (GAD-7). One hundred and forty-one participants with a mean age of 30.6±25 years and a sex ratio of 0.3 completed the online questionnaire. Participants from major university-hospital centers of northern Tunisia were divided into two groups: 78% medical and 22% paramedical staff. Twenty-two participants (15.6%) had a chronic disease, and 21 (14.9%) had a history of depression. Nineteen (13.4%) of the participants were infected with COVID-19. Thirteen percent of participants experienced the same anxiety level as the first-time taking care of COVID-19 patients, while 65% were rather an at ease compared to the first time. Forty-seven percent of participants felt the need for psychological support, and 16.7% of them had consulted a psychiatrist. Mild depression was detected in 14.1% of cases, moderate depression in 4.2% of cases, and severe depression in 2.1% of cases. As for anxiety, 36.1% of participants suffered from mild anxiety, 14.9% from moderate anxiety, and 4.9% from severe anxiety. Mild insomnia was detected in 44.6% of cases, moderate insomnia in 14.9% of cases, and severe insomnia in 9.9% of cases. Female gender (depression: P=0.05; anxiety: P=0.05; insomnia: P=0.02), having friends or relatives with COVID (depression: P=0.01; anxiety: P=0.05), psychiatric illness (depression: P=0.05; anxiety: P=0.01; insomnia: P=0.01), and chronic disease (depression: P=0.02; anxiety: P=0.03) were significantly associated with more severe mental health symptoms. Tunisian HCW experienced psychological burdens and a high rate of anxiety, depression, and insomnia. HCW should be protected in order to promote mental well-being.

Assessment of the functional impact of foot involvement in patients with rheumatoid arthritis

AIM OF THE WORK

We aimed to evaluate the impact of foot involvement in patients with rheumatoid arthritis (RA) using the functional foot index (FFI) and to identify predictive factors of the functional impact of foot abnormalities in RA patients.

PATIENTS AND METHODS

This was a cross-sectional study including patients with RA meeting the criteria of the American College of Rheumatology and the European League Against Rheumatism 2010. The main epidemiological data, results of podoscopic and clinical examination of the foot and ankle, biological tests and radiological findings were collected. The presence of foot pain was assessed by a visual analogic scale (0-10), and the functional impact of foot involvement was assessed based on the validated French version of the FFI.

RESULTS

Fifty RA patients with an average age of 59.3 ± 9.9 years [39-79] were included, and 80% of them had foot involvement. Foot pain was present in 32 patients (64%), most frequently situated in the forefoot (56%). The average FFI score was 33.67 ± 30.53 [0-92.67]. The following factors had a significant association with the FFI score: an occupation soliciting the feet (p = 0.001), disease duration (p = 0.033, r = 0,302), the Health Assessment Questionnaire (p = 0.0001, r = 0,480), body mass index (p = 0.0001, r = 0,654), the presence of podiatric abnormalities (p = 0.0001) and Visual Analog Scale foot pain (p = 0.0001, r = 0,854). A significant association was also found between the FFI score and the presence of a hallux valgus (p = 0.004), a spread of the forefoot (p = 0.029), a claw of the toes (p = 0.002), a triangular forefoot (p = 0.0001), a quintus varus (p = 0.002), flat feet (p = 0.0001) and a valgus of the hindfoot (p = 0.001).

CONCLUSION

Due to the high frequency of foot involvement and its significant functional impact, meticulous examination of the feet and assessment of their functional impact must be one of the parameters for monitoring the disease. Its impact on one's quality of life can be important.

LEVEL OF CLINICAL EVIDENCE

4 (cohort studies, non experimental, observational studies).

AB1253 DISEASE PERCEPTION ASSESSMENT IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS AND THEIR PARENTS

Background

Juvenile Idiopathic Arthritis (JIA) has an impact on the quality of life of the patient and his family. Parent/patient reported outcomes have shown an increasing interest in the management of JIA because it reflects the perception of the disease course and the effectiveness of the therapeutic interventions.

Objectives

To determine the level of agreement between patients with JIA and their parents for the five quantitative items in Juvenile Arthritis Multidimensional Assessment Report (JAMAR) questionnaire.

Methods

We included children aged between 7 and 18 years old with AJI (ILAR criteria) and their parents. Demographic data and disease related parameters were collected. We asked both parent and child to complete the five quantitative items of JAMAR questionnaire. Were measured on a 21-numbered circle visual analogue scale (VAS) for pain (0 =no pain; 10 =very severe pain), disease activity (DA): (0 =no activity; 10 =maximum activity) and well-being (WB): (0 =very well; 10 =very poorly). Physical function was assessed by Juvenile Arthritis Functional Score (JAFS) [0-45] and health-related quality of life (HRQoL) [0-30] through the Physical Health (PhH) and Psychosocial Health (PsH) subscales. We calculated children and parents median scores for the five items. Intra class correlation coefficient ICC was used for analysis (ICC below 0.50: poor; between 0.50 and 0.75: moderate; between 0.75 and 0.90: good; above 0.90: excellent).

Results

A total of 21 patients/parent (12 girls and 9 boys) were included in the study. Forty percent belong to rural enviroment. Majority of patients were in secondary school (77%), 23% were in primary school. Seven patients had oligoarticular JIA, 13 had polyarticular JIA and one had systemic JIA. Median age at diagnosis was 11.4 ± 1.2 years [6-13]. Median age at disease onset was 9.5 ± 1.9 years [2-13]. Median disease duration was 4.3 years [0-7]. Median JADAS was 10 [8-18]. Uveitis was noted in 30% of cases. Comparison of parent proxy-reported and child self-reported data revealed a striking similarity for all items (p<0.001). The results of the five quantitative items of JAMAR questionnaire are represented in Table1. Good correlation was noted in JAFS, DA VAS, well-being VAS and HRQoL. Excellent correlation was noted in VAS pain.

Table 1.

Assessement of quantitative items of Juvenile Arthritis Multidimensional Assessment Report by patients and parents.

ItemsPatientsParentsICCMean pain VAS (0-10)4.2 [4-6]4.3[4-6]0.97Mean disease activity VAS (0-10)4.1 [4-5]4.2 [4-5]0.81Mean well-being VAS (0-10)4.4 [4-6]4.3 [4-5]0.9Mean Juvenile Arthritis Functional Score (JAFS)10.0 [1-20]10.2 [2-21]0.81Mean HRQoL score14.1 [7-17]14.8 [6-14]0.88

ICC: Intraclass Correlation Coefficient; HRQoL: Health-Related Quality of Life; VAS: Visual Analogue Scale.

Conclusion

Our study showed high level of agreement between patients and parents. The JAMAR provides a promising approach to quantitative measurement in standard pediatric rheumatology care. Availability of this new instrument may enhance regular use of parent/patient questionnaires in routine practice and improve disease management.

Disclosure of Interests

None declared

AB1408 WELL-BEING AND MENTAL HEALTH OF RHEUMATOLOGY AND FAMILY MEDICINE RESIDENTS

Background

Burnouts and poor well-being among medical residents are becoming a global concern for health institutions. Its negative consequences are far-reaching, affecting patients, coworkers, family members, and healthcare organizations as well as the burned-out resident.

Objectives

The aim of the study was to measure the extent of burnout among rheumatology and family medicineresidents’and to elucidate wellness status as well as barriers to wellness.

Methods

An online questionnaire was issued to rheumatology and family medicine residents. We collected sociodemographic data (Age group, gender, marital status, children, smoking and alcohol status, Sport and other activities, Specialty, Weekly working Hours,Vacation) and mental health measurements.

Participants were also requested to fill the 14-item Mental Health Continuum Short Form (MHC-SF) and the 5-item WHO-5 well-being form.

Multivariable logistic regression analysis was used to explain the relationship between well-being and the work circumstances.

Results

A total of 64 residents with a 0,28 sex-ratio completed the online questionnaire. Sixty-nine percent (69%) of responders were in the [25-29] age group.

Sixty three percent (63%) of responders were single and 14,1% had children.

Most residents were not smokers (76,6%) nor alcohol users(68,8%).

Eighty seven percent of responders were a family medicine resident.

Thirty four percent (34%) of responders practiced sports 2 to 4 times a year and 25% exercised 2 to 4 times a week.

The average working hours per week was 30 hours [10-70] with an average of 3,38 weeks’ vacation per year.

Seventy eight percent (78%) of residents worked overnight shifts in hospitals with an average of 1,83 shift per month.

Female sex (p=0,049), less physical activities (p=0,037) and long working hours (p=0,042) were associated with worst degree of quality of life (WHO5 Well-Being Index).

Residents who practice art and had fewer overnight shifts showed a significantly flourishing mental health (p=0,032, p=0,014) according to the MHC-SF.

Family medicine residents had more long working hours (p=0,039) and overnights shifts (p=0,047) than rheumatology residents.

Conclusion

Residents working more than 50 hours per week with more than 5 overnight shifts per month and those practicing fewer physical activities and art appear to be at high risk of developing languishing mental health according to the Who5 well-being index and the MHC-SF score. It is important to protect health care workers and to promote well-being to acquire a flourishing mental health.

Disclosure of Interests

None declared

AB0323 FACTORS ASSOCIATED TO CLINICAL INERTIA IN RHEUMATOID ARTHRITIS

Background

Clinical inertia in rheumatic diseases is defined as inability or undue delay to initiate or intensify therapy when the disease is active or de-escalate therapy when the disease is in remission. Understanding the various contributory factors to clinical inertia is helpful in ensuring appropriate planning to tackle the issue and achieving Treat-To-Target (T2T) goals.

Objectives

We aimed to identify medical therapeutic inertia in Rheumatoid Arthritis (RA) patients and to assess its contributing elements.

Methods

We conducted a monocentric study including 42 patients, fulfilling the 2010 ACR/EULAR classification criteria for RA, who consulted our outpatient department from november 2021 to January 2022. Study data collection included demographics, clinical and disease characteristics, and treatment history. The survey also contained the Satisfaction Questionnaire for Medication (TSQM) which provides validated score for four subscales: effectiveness, side effects, convenience, and global satisfaction. Treatment satisfaction was measured using a cutpoint global satisfaction score ≥ 80.

Results

Most patients were female (86%) with a mean age of 57±13 years and a mean disease duration of 10.8±4.7 years. The education level for most patients (62%) was secondary school education or less. Fifteen percent of patients were in full-time work, 27% were unemployed, and 54% were retired. RA impact on patients’ work-life was considerable, as 14.3% had retired early due to RA. Patients had moderate-to-high disease activity, with a mean DAS28 with C-reactive protein (CRP) of 4.2±1.4. Radiographic structural damage was apparent in 79% of patients. RA was immunopositive in 92% of patients. Most common comorbidities were cardiac disorders (32%), pulmonary disorders (13%), and metabolic/nutrition disorders (11%). Psychiatric disorders was present in 9.5% of patients. CsDMARDs were the most frequently prescribed medications, used in 69% cases, followed by bDMARDs used in 34% cases. A total of 54% received the anchor drug methotrexate as part of their treatment regime. Only 12% of patients used systemic glucocorticoids for RA. Only half (52%) of all patients had a planned switch of medication, despite long-standing disease and suboptimal symptom control with current DMARD therapy. Statistical analysis revealed that factors for switch decision to a different DMARD by the treating physician was: younger patient age (p=0.002), having a high disease activity by DAS28-ESR (p<0.001), worse HAQ score (p<0.001), lower global satisfaction score (p<0.001), and patient preference for oral administration (p=0.006). Predictors for not switching to a different DMARD included a higher number of comorbidities (p<0.001), lower current DAS28-ESR score (p<0.001) and lower number of concomitant medications (p=0.002). Mean TSQM scores were 62 for effectiveness, 45 for side effects, 65 for convenience, and 60 for global satisfaction. Only 16 % of patients were satisfied with their RA treatment.

Conclusion

Our study showed that patients with active RA may not be managed in consistency with recommendations. This phenomenon defined as clinical inertia, is multi-factorial including healthcare set-ups and providers, patients and their caregivers. That’s why before labelling management of rheumatic disease in an individual as a ‘failure’, careful consideration of relevant factors linked to clinical inertia may be helpful.

Disclosure of Interests

None declared

AB1227 ATTITUDES AND BELIEFS ABOUT LOW BACK PAIN OF TUNISIAN PATIENTS: A KEY PREDICTOR OF RECOVERY

Background

Low back pain (LBP) is a common problem related with significant disability and psychosocial dysfunction. Unhelpful beliefs about it are associated with higher levels of pain and may cause a delay in recovery due to unsuitable behaviours. Therefore, studies targeting these beliefs are necessary to modulate messages delivered to the population in order to decrease the burden of LBP.

Objectives

The aim of the present study was to assess the attitudes and beliefs in the management of patients with LBP.

Methods

We applied a cross sectional study including Tunisian patients with LBP. The arabic version of Back Pain Attitudes Questionnaire (10-item Back-PAQ) was used to evaluate back beliefs as a clinical screening tool. We analysed patients’ attitudes in 5 domains: vulnerability of the back (items 1 and 2), relationship between back pain and injury (items 3 and 4), activity participation during back pain (items 5 and 6), psychological influences on back pain (items 7 and 8), prognosis of back pain (items 9 and 10). For each item, the scale ranges from “False” to “True” which is the option that represents unhelpful beliefs for recovery. Intermediate labels are: “Possibly False”, “Unsure”, “Possibly True”. Responses were scored from −2 (“True”) to +2 (“False”). Unhelpful beliefs attract negative scores and vice versa.

Results

The questionnaire was completed by 32 participants (27 women and 5 men) with a mean age of 56.6 years [45-69]. The mean LBP’s duration was 9.1 years [2-28].

The mean Body Mass Index (BMI) was 29.4 [25.5-46.8]. The mean Schober’s Test and Fingertip-to-floor (FTF) were respectively 2.8 [1.5-4] and 13.2 [0-50].

The mean Visual Analogue Scale of pain (VAS pain) was estimated at 69 [40-100]. The mean Oswestry Disability Index (ODI) and Short form Health Survey (SF36) were 42.4 [28-66] and 48.3 [20-80] respectively.

Unhelpful beliefs were widespread. The mean Back-PAQ-10 score was -4 [-13 -3]. Women had significantly a lower score compared to men (-4.1 [-13-2] versus -1.6 [-5-3]) (p=0.01).

Vulnerability of the back had an average score of -2[-3-1]. The relationship between back pain and injury had a mean score of –2.4 [-4-0]. The activity participation during back pain had a mean score of -4 [-4-1]. The psychological influences and prognosis of back pain had an average score of -2[-3-0] and -1.6[-2-3] respectively.

Conclusion

The results of this survey reveal that Tunisian patients have high levels of negative beliefs about LBP. As beliefs and attitudes have been recognised as significant predictors of recovery from LBP, we should promote cognitive behavioural therapy aiming at coping with unhelpful beliefs.

Disclosure of Interests

None declared

AB1247 ASSESSMENT OF ARTICULAR AND EXTRA-ARTICULAR DAMAGE IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Juvenile idiopathic arthritis (JIA) affects patients’ well-being and can lead to disability and long-term damage. Evaluating damage in patients can be beneficial to make therapeutic decisions and take rehabilitation measures.

Objectives

To assess articular and extra articular damage in patients with JIA by the use of the Juvenile Arthritis Damage Index (JADI)1 and to identify variables that correlate with disease damage.

Methods

We conducted a cross-sectional study among patients with JIA who met the ILAR classification criteria and had a disease duration more than 12 months. Early clinical data was obtained from medical files. It included sociodemographic features, biological and radiological parameters, subtype of JIA, disease duration and ongoing treatments.

Damage was assessed in the last clinical visit using articular and extra-articular damage index1 (JADI-A and JADI-E).

Results

Thirty-two patients were enrolled in this study with a mean age of 23.8 ±11.6 years. Sex ratio was 0.6 (12 males and 20 females). The mean age of disease onset was 8.3 years [3-15], and the mean disease duration was 183.7 months [12-624].

At the last clinical examination, 71.9% of patients had joint damage with a mean JADI-A score of 5.09 ±5.4 and 40.6% of patients had extra-articular damage with a mean JADI-E score of 0.75±1.2. The most affected joints were: the elbows (43.8%), the hips (37.5%) and the wrists (25%). Extra articular damage was mainly: a growth failure (25%), osteoporosis (18.8%) and ocular damage (12.5%). Patients with polyarticular arthritis without rheumatoid factor had the highest JADI-A score with a mean of 7.83 while patients with systemic arthritis had the highest JADI-E score with a mean of 3.

Mean JADI-A score was significantly different between patients who received corticosteroids and those who did not receive them (8.5 Versus 3.4, p=0.004). Damage scores correlated with disease duration (p<0.001 for JADI-A score and p=0.034 for JADI-E score).

Damage scores were not significantly different between different classes of treatment (conventional dmards and biologic dmards).

Conclusion

Articular damage is frequent in patients with JIA. It is higher for patients on corticosteroids. Articular and extra articular damage correlate with disease duration, but they were not significantly different between classes of treatment.

References

[1]Viola and al: ‘Development and Validation of a Clinical Index for Assessment of Long-Term Damage in Juvenile Idiopathic Arthritis’.

Disclosure of Interests

None declared

AB1228 MEDICAL CARE CONSUMPTION BY TUNISIAN DOCTORS SUFFERING FROM LOW BACK PAIN

Background

Common low back pain (LBP) is a real public health problem. Indeed, LBP is associated with important socio-professional consequences and involves a raised cost for society due to absenteeism and medical consumption. Various studies show that it is also a major problem in workplace especially in hospitals.

Objectives

The aim of this study was to evaluate LBP medical consequences among doctors.

Methods

We performed a cross-sectional study including the medical staff of a Tunisian hospital. A standardized questionnaire was distributed to all departments and collected the following day. Doctors who had not responded to the questionnaire received two reminders before considering their exclusion. We defined two groups: Group 1 with acute LBP (<3 months) and Group 2 with chronic LBP (≥3 months). The following parameters were collected: consultation with a physician, self-medication, treatments used, hospitalization, use of imaging methods and objectified spinal abnormalities.

A p value inferior to 0.05 was considered statistically significant.

Results

Of the 217 questionnaires distributed to physicians, 107 (49.3%) were completed. The participants were composed of 85 women and 22 men. The mean age was 31.8 ± 7.7 years [25-57]. The mean BMI was 23.2±3.7 kg/m2 [16.6-36.7]. Consumption of tobacco and alcohol was noted in 16.7% and 20.4% of cases respectively. Five participants (4.6%) reported consumption of cannabinoids. Depression, anxiety and sleep disturbances were reported in 25.3%, 57.3% and 46.7% of cases respectively.

Among the participants, 84.3% reported having had LBP at least once in their life, and 71.3% reported LBP in the past 12 months. The mean duration of low back pain was greater than 3 months in 11.9% of cases. The mean pain intensity was 4.4 ± 1.9 [2-10].

Twenty participants (26%) consulted a doctor. It was a rheumatologist in 13 cases, an orthopedist in 7 cases, a neurosurgeon in 1 case and a family doctor in 1 case. More than half of the participants (57.5%) self-medicated.

Standard radiography was performed in 18 cases, computed tomography (CT) in 5 cases and magnetic resonance imaging (MRI) in 8 cases. The following abnormalities were objectified: degenerative disc disease (13.6%), herniated disc (22.7%) and posterior inter-apophyseal osteoarthritis (9%).

Medication use was noted in 56 cases (72.7%), functional rehabilitation in 9 cases (11.7%), back support belt in 3 cases (3.9%), epidural corticosteroid injection in 1 case (1.3%), thermal treatment in 1 case (1.3%), and surgery in 1 case (1.3%). Three doctors required hospitalization ranging from 2 to 15 days.

Medical care consumption was significantly more important in patients with chronic LBP: functional rehabilitation (6,8% in group 1 vs 50% in group 2, p<0.001), back support belt (1,6% vs 20%, p=0.046), epidural corticosteroid injection (0% vs 10%, p=0.035), thermal treatment (0% vs 10%, p=0.035), surgery (0% vs 10%, p=0.035) and hospitalization (0% vs 30%, p<0.001).

Conclusion

Medical care consumption was important among LBP and chronic LBP sufferers. Thus, a prevention strategy must be established in hospitals in order to reduce the socio-economic cost of LBP among caregivers.

Disclosure of Interests

None declared

AB0179 PATIENT’S SATISFACTION WITH TREATMENT IN RHEUMATOID ARTHRITIS: AN UNMET NEED

Background

Shared decision between rheumatologists and their patients has become an overarching principle in current treatment recommendations in rheumatoid arthritis (RA). Therefore, assessing satisfaction with pharmacological therapy, among patients, is becoming increasingly important in clinical settings.

Objectives

In this study, we aimed to assess the satisfaction of patients with RA about their treatment and to investigate the predictive factors.

Methods

A cross-sectional study was conducted including adults diagnosed with RA for more than a year and receiving their current Disease-modifying anti-rheumatic Drug(s) (DMARD(s)) for at least 12 months.

We used the treatment satisfaction questionnaire for medication (TSQM v1.4) to assess the treatment satisfaction among patients. Multivariable regression analysis was applied to determine the factors associated with treatment satisfaction.

Results

We included 70 patients (63F/7M) with a mean age of 57.8 ±10.6 [29-81] years at the time of the study. The mean disease duration was 13.71±7.2 [2-30] years.

Twenty-four (34,2%) patients were on a biologic DMARD (bDMARD).

Regarding the Disease Activity Score 28 (DAS28-ESR), 14.3% of patients had a low disease activity, 47.1% a moderate disease activity, 7.1% a high disease activity, and 31.4% were in clinical remission. The mean (SD) Rheumatoid Arthritis Impact Disease (RAID) overall score was 4.72 ±2.11. Mean (SD) TSQM scores were 65.42±14.77 for convenience, 68.71±18 for effectiveness, 70.60±24.5 for side effects, and 67.95±17.10 for global satisfaction.

Twenty percent of patients were satisfied with convenience, 38.6% were satisfied with effectiveness, 45.7% were satisfied with side effects and 30% were globally satisfied.

The multivariable regression analysis showed that the RAID overall score was inversely associated to global satisfaction (p=0.001) and to satisfaction with effectiveness (p=0.032).

Difficulty of coping (one of the RAID domains) was inversely associated to satisfaction with effectiveness and convenience.

It was, also, showed that satisfaction with side effects was inversely associated to the degree of interference of the RA on domestic work (p=0.020) and positively correlated to the degree of participation in treatment decision-making (p=0.014). In addition, satisfaction with current physician was positively associated to global satisfaction (p=0.029).

Satisfaction with convenience was inversely associated to bDAMARs (p=0.027).

Conclusion

We conclude from our data that despite the diversity of therapeutic strategies, almost two-thirds of patients remain not satisfied with their treatment. A better understanding of patients’ unmet needs and an individualized patient-centric approach would improve outcomes in RA.

Disclosure of Interests

None declared

AB0989 Plantar fasciitis in patients with knee osteoarthritis

Background

Knee osteoarthritis (OA) is a highly prevalent disease, it shares with plantar fasciitis similar risk factors including aging, occupation, obesity, and inappropriate shoe wear. The association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date.

Objectives

The aim of our study was to detect plantar fasciitis using ultrasound in patients with confirmed knee OA.

Methods

We conducted a cross-sectional study including 30 patients with symptomatic knee OA. Health status was evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The functional impairment of knee OA was determined by the Lequesne index. Ultrasound evaluation of heels was performed in all patients searching signs of plantar fasciitis (measure thickness, echogenicity, enthesopathy, calcification, erosion, doppler).

Results

The study included 30 patients. Mean age was 62.09 +/- 6.7 years. Patients reported lower back pain and heel pain in 67% (n=20) and 47% (n=14) respectively. Knee symptoms were evaluated by the WOMAC index: mean score for pain, stiffness, and physical function was 9.68 +/- 4.25, 4,18 +/- 7.55 and 27.27 +/- 16.39, respectively. Mean Lequesne index for the knee OA was 11,4 +/- 4,57. Physical examination revealed limited range of motion in knees in 33 % (n=10) with a genu flexum in two patients. Patella tap was positive in 20 % (n=6).

Heel ultrasound revealed thickening of the plantar fascia in 50% (n=15). Other sonographic abnormalities found were loss of fibrillar structure in 26.7% (n=8), perifascial collections in 13.3% (n=4), calcifications in 16.7 % (n=5) and erosions in 33.3% (n=10). No correlation was found between health status attested by WOMAC index and the presence of plantar fasciitis.

Conclusion

Our study showed that half of our knee OA patients have plantar fasciitis confirmed with ultrasound. More studies with larger cohorts are needed to explain the correlation between the two lesions.

Disclosure of Interests

None declared

AB0293 INDICATIONS AND THERAPEUTIC IMPLICATIONS OF HAND AND WRIST JOINT ULTRASOUND IN RHEUMATOID ARTHRITIS

Background

Ultrasound (US) has been increasingly used in the recent years for the diagnosis and follow-up of rheumatoid arthritis (RA) [1]. It is considered as a complement to physical examination with high sensitivity, specificity, and accuracy in detecting synovial thickening, synovial hypervascularization as well as cortical bone erosions [2].

Objectives

We aimed to study the indications of hand and wrist joint ultrasound and the implications of its findings on the management of RA.

Methods

A cross-sectional study was conducted on a sample of RA patients, fulfilling the ACR/EULAR 2010 RA classification criteria. We collected data about characteristics of the disease, its activity assessed by the Disease Activity Score 28 using C-Reactive Protein and erythrocyte sedimentation rate (DAS28-CRP, DAS28-ESR), treatment of RA (conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), biologics (bDMARDs), and corticosteroids (CS)), indication of hand and wrist joint US and the implications of its findings.

Results

Fifty-eight patients were enrolled in the study with 83% females, with a mean age of 58.5±11.8 years and a mean age at diagnosis of 46.8±12. years. RA was seropositive in 89.7% of patients and erosive in 84.5%. Most patients underwent csDMARDs treatment (67.3%), 29.3% underwent bDMARDs treatment, and 67.3% used oral CS with a mean dose of 4.9±4.4 mg/day of prednisone equivalent. Mean DAS28-CRP was 4.1±1.4, and mean DAS28-ESR was 4.9±1.5.

Hand and wrist joint US was performed for RA activity assessment in 93.1% of patients (n=54), for erosion assessment in recently diagnosed RA in 5.2% of patients (n=3), for erosion assessment in established RA in 1.7% of patients (n=1).

In patients who had US signs of active RA, treatment was modified in 73% of patients with initiation of a 3-day parenteral CS pulses (18.9%), initiation of oral CS (2.7%), escalation of oral CS dose (2.7%), escalation of csDMARD’s treatment (24.3%), adjunction of another csDMARD (5.4%), reintroduction of a csDMARD (2.7%), initiation of bDMARDs (24.3%), and switch of bDMARDs (5.4%). US findings had no implication in 27% of these patients. When inactive RA was assessed (31,5%), there was no implication on treatment strategy in 82.4% of patients, a decrease of oral CS dose in 11.8% and a single intra-articular CS injection in 5.9%.

Detecting ultrasonographic activity signs of RA in hand and wrist joint was more likely to have implications on treatment strategy than finding no activity signs (75% vs 22%, χ2=14.25, p<10-3).

The group of patients who had an implication of US findings on treatment strategy had significantly higher DAS28-ESR (5.53 vs 4.18, p=0.002).

Conclusion

Hand and wrist US had significant implications on treatment strategy of RA especially in patients with higher disease activity. However, it had no implications in some patients suggesting the complementary role of US compared to clinical determinants in RA treatment decision.

References

[1]do Prado AD, Staub HL, Bisi MC, da Silveira IG, Mendonça JA, Polido-Pereira J, et al. Ultrasound and its clinical use in rheumatoid arthritis: where do we stand? Advances in Rheumatology. 2018 Aug 2;58(1):19.

[2]Ceponis A, Onishi M, Bluestein HG, Kalunian K, Townsend J, Kavanaugh A. Utility of the Ultrasound Examination of the Hand and Wrist Joints in the Management of Established Rheumatoid Arthritis. Arthritis Care & Research. 2014;66(2):236–44.

Disclosure of Interests

None declared

AB1522 THE ASSESSMENT OF KNOWLEDGE OF NURSES BEFORE AND AFTER TRAINING ABOUT SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS

Background

Nurses’ education programs play an important role in the management of chronic diseases in rheumatology clinics. They can assume their own patient case-loads and provide an educative role to promote health.

Objectives

In order to foster educational programs, the present study aimed to assess the level of knowledge of nurses before and after targeted training sessions.

Methods

The nurses of the rheumatology department of Mongi Slim Hospital have been included initially during the month of September 2021, then later, after having followed a training during the month of January 2022.

Data were collected by two self-administrated tests. The rheumatoid arthritis knowledge assessment scale (RAKAS) (1) which consisted of 13 items, defined knowledge as awareness about the disease, its risk factors, symptoms and treatment and categorized it into four levels namely, excellent, adequate, low and poor knowledge. The tool had a maximum of 14 points. A nurse was designed to have excellent knowledge if the score was 11 and above, adequately knowledgeable if the score was between 8 and 10, low knowledge if the score was between 5 and 7 and poor knowledge if it was 4 or less. Spondyloarthritis knowledge assessment questionnaire (SPAKE) (2) with 14 questions and 72 possible responses, divided into four areas, (A) general knowledge, comprising etiology, symptoms, blood tests (score range 0-8), (B) immunogenetic test (B27 antigen) and inheritance (score range 0-3), (C) general management, including drug treatment and physical therapy (score range 0-9), (D) joint protection, pacing and priorities (score range 0-5)

The Wilcoxon signed rank test was used to assess the difference between test results before and after training. The level of statistical significance was set at p<0.05.

Results

Ten nurses were included with a sex ratio (M/F) of 0.3.

Initially, the average RAKAS score was 11.7 ± 1.2. Almost two thirds of the nurses had excellent knowledge (n= 7, 70%) and the rest (n= 3, 30%) had adequate knowledge.

The average SPAKE score was low (12.9±3.7). For the nurses interviewed in domain A, the maximum score was not reached and the average score was 5±1.6. For domain B, the maximum score was reached only once and the average score was 1.2±0.9. For domain C, the maximum possible score was not reached and the average score was 5.1±2.2. For domain D, the maximum score was not reached and the average score was low at 1.6±0.6.

For the post-training test, the average RAKAS score was 12.6±0.5 and all nurses had excellent knowledge (n= 10, 100%).

The average SPAKE score has risen (20.1±1.6). For the nurses interviewed in domain A, the maximum score was reached two times and the average score was 6.9±0.8. For domain B, the maximum score was reached four times and the average score was 2±0.9. For domain C, more than half of nurses have reached the maximum score (n=6, 60%) and the average score was 8.4±0.8. For domain D; the maximum score was not reached and the average score was 3.2±0.9.

Differences between pre- and post-training test scores were found to be statistically significant for the SPAKE questionnaire (p=0.005) but not for the RAKAS (p=0.077).

Conclusion

The nurses’ knowledge of rheumatoid arthritis was initially adequate, but not of spondyloarthritis, which improved significantly through the targeted training sessions.

References

[1]Naqvi AA, Hassali MA, Iffat W, Zia M, Fatima M, Shakeel S, et al. Development and validation of a novel rheumatoid arthritis knowledge assessment scale in Pakistani patients with rheumatoid arthritis. Int J Rheum Dis. nov 2019;22(11):2031‑44.

[2]Lubrano E. The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire. Rheumatology. 1 avr 1998;37(4):437‑41.

Disclosure of Interests

None declared

AB1517 SYNOVITIS COMPLICATING THE COURSE OF COMMON VARIABLE IMMUNODEFICIENCY: CAUSAL OR COINCIDENTAL?

Background

Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by hypogammaglobulinemia and an increased susceptibility to recurrent bacterial infections. Even though several immunological defects are involved in the pathogenesis of CVID, the genetic background of the disease remains unidentified [1]. Autoimmunity in CVID is not restricted to hematologic cells, as rheumatologic complications occur in perhaps 10% of patients, with females being more affected [1].

Objectives

Here by we report a case of a CVID complicated with RF negative synovitis.

Methods

We report a case of a 36-year-old woman who was referred to our department for oligoarthritis. She had a history of primary immune deficiency revealed at the age of 30 with recurrent pulmonary infections. The disease was complicated with type 1 diabetes and bronchiectasis and was treated with annual infusion of immunoglobulin. The patient presented with pain and swelling in both knees evolving for two months. On physical examination, she had synovitis in both knees. Laboratory investigations revealed normal blood count with elevated C-reactive protein (CRP) and erythrocyte sedimentation rate: 36.2mg/l, and 32 mm/h respectively. Synovial fluid aspiration analysis of the knee revealed an inflammatory liquid without crystals. Bacterial culture was negative. Her serum was negative for Rheumatoid Factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody and antinuclear Antibodies (ANA). Knee ultrasound revealed synovitis in both knees with Doppler signal. The Magnetic resonance imaging (MRI) of the knees showed active synovitis without any erosion. Ophthalmological assessment showed severe dry eye syndrome. As Sjögren’s syndrome was suspected, we performed a salivary gland biopsy that was normal.

Results

The patient did not fulfill criteria for auto-immune rheumatic related disease. She was treated with intraarticular glucocorticoids injections, with complete resolution of symptoms and disappearance of effusion on ultrasound. A follow-up was scheduled after one month. The synovitis has been attributed to rheumatologic involvement in the context of immune deficiency.

Conclusion

We report a rare case of RF negative synovitis complicating the course of CVID. Even though the symptoms could be mild compared to a typical RF+RA, it is important to educate clinicians as to the importance of maintaining a high index of suspicion about this rare, yet potentially treatable disease. Future research is indicated to understand the etiopathogenesis of rheumatologic manifestations in CVID.

References

[1]Yazdani R, Habibi S, Sharifi L, Azizi G, Abolhassani H, Olbrich P et al. Common Variable Immunodeficiency: Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis, Classification, and Management. J Investig Allergol Clin Immunol. 2020;30(1):14-34.

Disclosure of Interests

None declared

Can SARS‐CoV‐2 infection trigger rheumatoid arthritis? A case report

Inflammatory arthritis has been reported after SARS‐COV‐2 infection. We present a case of a 38‐year‐old female patient who developed polyarthralgia 1 month after SARS‐COV‐2 infection. Musculoskeletal examination was significant for synovitis of hands and wrists. Antinuclear antibody (ANA), rheumatoid factor (RF), and anti‐cyclic citrullinated peptide (CCP) antibodies were positive. Magnetic resonance imaging of the hands showed synovitis of the metacarpophalangeal joints and proximal interphalangeal joints of the hands, wrist joints, and tendinitis with tenosynovitis. The patient was diagnosed with seropositive nonerosive rheumatoid arthritis (RA) and initiated on therapy using nonsteroidal anti‐inflammatory agents and disease‐modifying anti‐rheumatic drug methotrexate leading to an improvement in symptoms.

Cases of autoimmune and auto‐inflammatory diseases triggered after COVID‐19 have been reported. We report the case of a 38‐year‐old female patient who developed seropositive, nonerosive rheumatoid arthritis (RA) one month after SARS‐CoV‐2 infection.

[Vaccinations for patients with chronic inflammatory rheumatism during a pandemic]

Vaccinations for patients with chronic inflammatory rheumatism during a pandemic.

Hyperparathyroidism: Unusual location of brown tumors

Brown tumors (BTs) are due to a proliferation of multinucleated giant cells in osteolytic lesions. They complicate the course of hyperparathyroidism. Thanks to an early screening of bone metabolism disorders; BTs are nowadays rare bone manifestations. We demonstrate through these two cases reports unusual locations of BTs in hyperparathyroidism.

Common low back pain hiding tuberculous sacroiliitis

The sacroiliac joint is rarely affected by tuberculosis. Only few cases have been reported. Consequently, the diagnosis is often delayed. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

Ultrasonography of Shoulder in Rheumatoid Arthritis: A Reliability Exercise Using Consensual Definitions among Maghrebian Rheumatologists

The shoulder may be affected in a large portion of patients with rheumatoid arthritis (RA) worldwide. However, this joint does not receive the attention required during follow-up. Indeed, although numerous clinical tests for diagnosis of a painful shoulder are available, differentiating articular from peri-articular lesions may be difficult in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA has benefited from a reliable imaging modality used to detect its exact origin-ultrasonography (US). This study was aimed at assessing the intra- and inter-observer reliability of ultrasonographic findings for patients with established RA with shoulder pain in a patient-based exercise as a clinical challenge among Maghrebian rheumatologist experts in US. A total of 7 operators examined 10 patients in two rounds independently and blindly of each other. Before beginning the session, all of the rheumatologists reached a consensus on sites and US settings by performing a brief exercise on a normal shoulder. Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions of US-detected pathologies were used. Each patient underwent US scanning of the painful shoulder in predefined sites based on US technical guidelines of the European Society of Musculoskeletal Radiology: long head of biceps (LHB), subscapularis recess, posterior recess and axillary recess. The presence of subdeltoid or subcoracoid bursitis or full rupture of the suprasupinatus was identified if present. Intra- and inter-observer reliability measures were calculated using the κ coefficient. Intra-observer reliability was good for gray-scale (GS) synovitis in subscapularis and posterior recesses (κ = 0.77 and 0.73, respectively). It was moderate in the presence of GS synovitis and effusion in LHB (κ =0.53 and 0.40, respectively), posterior and subscapularis recess effusion (κ = 0.56 and 0.60, respectively) and GS and power Doppler (PD) synovitis in axillary recesses (κ = 0.58 and 0.49, respectively). Inter-observer reliability was good for PD for LHB signals (κ = 0.78). It was moderate for GS for LHB synovitis (κ = 0.54). Inter-observer agreement was poor for effusion and GS synovitis for subscapularis, posterior and axillary recesses, and very poor for PD signals in these recesses. US was a reliable imaging tool for detecting tenosynovitis in the LHB. However, reliability was moderate to poor in detecting synovitis in subscapularis, posterior and axillary recesses. These findings could be optimized by standardization of sites to assess.

P032 Methotrexate and hepatic tolerance in Juvenile Idiopathic Arthritis

Background

Methotrexate (MTX) is considered as the main treatment for some juvenile idiopathic arthritis (JIA) subtypes. The hepatic toxicity of MTX has been reported in numerous studies in rheumatoid arthritis which have shown that prolonged treatment can induce hepatic fibrosis and a disturbance of the liver biologic tests. In patients with JIA, the potential hepatic toxicity of MTX needs to be confirmed.

Methods

A retrospective study of patients followed for JIA and treated with MTX was conducted. The results of the hepatic assessment looking for cytolysis or cholestasis performed during the pre-treatment assessment and then during regular checks were noted.

Results

Thirty-nine JIA patients were included. The mean age of disease onset was 8 years [1.5–17 years]. The JIA subtype was systemic in 11 cases, enthesitis related arthritis in 5 cases, rheumatoid factor seronegative polyarthritis in 15 cases and rheumatoid factor seropositive polyarthritis in 2 cases, and oligoarthritis in 2 cases. Patients were treated with low doses of corticosteroids (0.2–0.4 mg/kg) in majority of cases (82%). Non steroid anti-inflammatory drugs were used in 51% of cases. MTX was prescribed as monotherapy in 20 cases, in combination with Sulfasalazine in 6 cases and Anti TNF alpha in 12 cases. MTX has been used on average for 11 years [2 months-26 years]. This drug was stopped for ineffectiveness in 7 cases, for digestive intolerance in 2 cases and in one case for severe hepatic cytolysis after 2 years of treatment with a progressive normalization of hepatic laboratory tests after 6 months. During regular monitoring, no further disturbances of liver function were observed.

Conclusion

MTX hepatotoxicity appears to be very mild and rare in JIA. These results are reassuring given that MTX is a highly effective treatment in JIA.

P024 Efficacy and tolerance of methotrexate in patients with Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease for children. The therapeutic management depends on several factors and is based on different treatments including methotrexate (MTX). The aim of our study was to determine the efficacy and safety of MTX in JIA.

Methods

This is a monocentric retrospective study of 37 patients followed for JIA according to the 2001 International League of Association of Rheumatology (ILAR) criteria and treated with MTX. Socio-demographic, clinical, paraclinical and therapeutic data were collected. Disease activity was assessed by the JADAS score. Highly active JIA was defined as JADAS superior to 25.

Results

There were 25 boys (67.5%) and 12 girls (32.4%) with a median age of 6.3 years [4–13]. The average duration of the rheumatic disease was 2.7 years [2.5–5.3]. The type of JIA was: oligoarticular in 22 cases (59.4%), polyarticular in 10 cases (27%), arthritis related to enthesitis in 3 cases (8.1%) and systemic in 2 cases (5.4%). Twenty patients (54%) received oral corticosteroid therapy for a mean period of 1.7 years [0.6–3] with a mean daily dose of 10 mg/day of prednisone or equivalent.

Oral MTX was prescribed to all patients with a mean weekly dose of 10 mg/m2 body surface [10–15]. MTX was initiated after a mean period of 6.2 months [3.1–11.4] from diagnosis. The mean treatment duration was 50 months [34–66].

Observance of MTX was 80.5%. Remission with MTX was achieved in 28 patients (75.6%) after a mean treatment duration of 7.5 months [5–11], with a mean JADAS of 5.1 [3.5–10].

Despite good observance of MTX, eight patients (21.6%) continued to have high disease activity with a mean JADAS score of 32 [25–40].

Tolerance to oral MTX was good, with side effects occurring only with 5 patients (13.5%), such as epigastralgia in 2 cases (which disappeared after switching to the intramuscular administration), a skin reaction in one case, and hepatic cytolysis reversible when stopping the treatment in 2 other cases.

Conclusion

MTX still has a place in the therapeutic management of JIA and appears to be a well-tolerated and effective treatment.

P028 Impact of Juvenile Idiopathic Arthritis on schooling

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is one of the major causes of morbidity and physical disability. Due to frequent absences, children with chronic health impairments are also often confronted with educational difficulties. The aims of this study were to assess the impact of JIA on children’s schooling and to determine the factors that influence their school level.

Methods

This is a cross-sectional study including patients with JIA (ILAR criteria). A detailed questionnaire was completed for each participant by interviewing them or their parents as well as by information obtained from their medical records. Collected data included age, sex, subtype of JIA, disease duration, level of disability according to the Childhood Heath Assessment Questionnaire (CHAQ), visual analogue scale for patient’s overall assessment of disease activity (VASOA), duration of morning stiffness, tender joint counts (TJCs), swollen joint counts (SJCs), erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), Disease Activity Score (DAS28) for polyarticular and oligoarticular JIA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for Enthesitis-related arthritis. Medications used for JIA treatment were also documented.

Data on the school performance of patients and their siblings were obtained using telephone interviews (educational level, absenteeism, school delay by repetition, drop-out).

Results

A total of 43 patients with JIA were included, 25 female and 18 male, with a mean age of 26 years [12–51] and a mean disease duration of 237 months (5–496). The average age of the onset of the disease was 7.4 years [1.5–16].

The most common subtype was rheumatoid factor-positive polyarthritis (n = 18) followed by systematic (n = 8), oligoarticular (n = 8), rheumatoid factor-negative polyarthritis (n = 5) and Enthesitis-related arthritis (n = 4). The mean DAS28 was 3.02 [0.76 – 5.55] and the median CHAQ was 0.66 [0–3].

Twenty-nine of the children were receiving corticosteroid. Disease-modifying anti-rheumatic drugs were used by 38 of the 43 patients: methotrexate (n = 27), sulfasalazine (n = 8), leflunomide (n = 7), biotherapies (n = 16). Twenty patients had complications: Hip arthritis (n = 18), growth stunting (n = 14), uveitis (n = 5). Joint replacement was required in 11 cases.

Four patients were illiterate, 14 had dropped out of school, 24 reported repeated absences due to illness. A year of schooling was repeated by 50.85% of patients. Eleven out of 32 patients over the age of 20 had an university level. Almost 80% of patients were exempted of physical education.

There were no significant associations between the school-related problems, the socio-demographic characteristics and the various parameters of clinical and biological activity studied.

Conclusion

Our study suggested that JIA negatively affects schooling of children. More studies, with a larger sample of children, are needed to identify the variables associated with school failure in order to ensure the proper management of these patients and to increase their academic performance.

P019 Adulthood of juvenile idiopathic arthritis patients: professional outcome

Background

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of rheumatic diseases characterized by onset before the age of 16. Since the disease starts at an early age, it may lead to socio-professional difficulties in adulthood for JIA patients. This study aimed to describe the professional outcome of a series of 20 JIA patients.

Methods

A cross-sectional study including patients aged 20 years and more and fulfilling the ILAR criteria for the diagnosis of JIA was carried out. Telephone interviews were conducted. The responders answered questions about family status, current occupation, working h, eventual workplace adjustments, and sick leave frequency.

Results

Twenty patients answered the questionary; 14 males and 6 females. The mean age of the disease onset was 8 years. The mean age of patients at the time of the study was 24.27 years [20–36]. Polyarticular form was the most frequent (10 cases). Other subtypes diagnosed were systemic (4 cases), enthesitis-related arthritis (5 cases), oligoarticular (one case). Hip arthritis was observed in 8 patients and surgical intervention was needed in three. Eight patients were treated with csDMARDSs and 12 with bDMARDs.

Three of our patients were married (aged 24, 34, and 36). Five were still studying: 4 had good grades without absenteeism. However, one patient needed special aid to go to school and had a higher absence rate. Five other patients were full-time college students without absenteeism. Four patients were college graduates. Among them, two were searching for a job for &gt;6 months. The other two were full-time administrative workers with no absenteeism. One patient did need workplace adjustments. Six patients could not work because of their physical disabilities.

Conclusion

According to our results, a quarter of our patients could not access professional life. Disease activity and hip destruction are the two main factors causing JIA patients to miss out on important personal and professional opportunities.

P014 Use of prosthetic surgery in Juvenile Idiopathic Arthritis

Background

Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory rheumatism in childhood characterized by destructive potential. The involvement of weight-bearing joints constitutes an evolutionary turning point in the course of the disease, which may be responsible for a major functional handicap. In this context, arthroplasty constitutes a therapeutic alternative. Through this study, we aimed to determine the prevalence of the prosthetic surgery and its benefits in children with JIA.

Methods

This is a retrospective study of JIA patients. The diagnosis of JIA was selected according to ILAR criteria. All the patients included were followed for a minimum of 1 year. The parameters collected were: pain VAS, HAQ, Lequesnealgofunctional index (AFI), disease activity scores and mobility of the operated joint before and 6 months after surgery.

Results

Forty -four JIA patients were followed over an average period of 14 years (minimum of 1 year). The mean age of disease onset was 9 years [1.5–16 years]. Fifteen cases of coxitis (34%) and 4 cases of destruction of the knees (9%) were noted after an average course of the disease of 8 years [6 months–19 years]. Radiologically, coxofemoral ankylosis is reported in 6 cases, acetabular protrusion in 2 others and total destruction of the knee with misalignment in 2 cases. Eight patients required hip replacement surgery and 2 knee cases. In all cases, the hip prostheses were bilateral. Only one knee prosthesis was placed. The JIA subtype was rheumatoid factor seronegative polyarthritis in 5 cases and enthesitis related arthritis in 3 cases. Six months after surgery, the average AFI dropped from 15.4–4.5; the pain VAS from 73 mm to 50 mm and the HAQ from 2.5–1.06. In the polyarticular JIA, the DAS28 composite score decreased from 4.02–3.8 and in ERA patients the BASDAI decreased from 6.5–4.25 while BASFI remained stable. Recovery of joint mobility was partial in only one case. No immediate or late postoperative complications were noted.

Conclusion

Prosthetic surgery provided improvement in disease activity and recovery of gait pattern in children with severe JIA. However, the decision of an arthroplasty remains delicate in children, especially since this intervention can compromise the stature growth.

P030 Impact of methotrexate on growth in children with Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory disease which could be responsible for functional impairment and severe growth disturbance. Conventional disease-modifying antirheumatic drugs, such as methotrexate (MTX), may improve growth velocity especially by regulating systemic inflammation. The objective of this study was to evaluate the effect of MTX on growth parameters in pre-pubertal children with JIA and to determine the factors affecting the growth velocity.

Methods

We assessed height and changes in the height standard deviation score (SDS) at disease onset, at the onset of MTX and at the last follow-up visit in a cross-sectional study of JIA children. All patients were pre-pubertal when MTX began and were followed for at least 6 months afterward. We compared growth parameters (height, growth rate, weight and body mass index (BMI)) in responders and non-responders to MTX. The growth rate was defined as the number of millimeters of height acquired during 1 year. Associations between changes in the height SDS and discrete variables were evaluated using χ2 or Fisher’s exact tests. The significance level was set at 0.05.

Results

We enrolled 36 pre-pubertal children with JIA (34 boys and 12 girls) who had been treated with MTX orally. Median patient age was 6.2 years [4–13] at the onset of MTX and 8.4 years [6.1–14.9] at the latest follow-up. The median disease duration was 2.7 years [2.5–5.3]. Twenty-one patients (58.3%) had oligoarticular JIA, 2 patients (5.5%) had systemic JIA, 10 (27.7%) had polyarticular JIA and 3 (8.3%) had enthesitis-related arthritis. Nineteen children (52.7%) had received corticosteroids during an average period of 1.7 years [0.6–3] with a mean of 10 mg/day of prednisone or equivalent. The median duration of MTX at the latest follow-up was 3.1 years [0.62–5.5] with a mean MTX dose of 10 mg/m2/week [10–15]. Twenty-eight patients responded to MTX treatment and 8 did not. There were no significant differences between the responders and non-responders for age at treatment initiation, disease duration and mean MTX dose. At MTX onset, no significant differences between the two groups in terms of height (P = 0.52), growth rate (P = 0.08), weight (P = 0.74) and BMI (P = 0.9) were found. One year after MTX therapy, mean height (0.2 vs -1.1; P = 0.03), mean growth rate (0.5 vs –2.9 SDS; P = 0.01), mean weight (0.4 vs -2.3 SDS; P = 0.01) and mean BMI (0.6 vs -1.9; P = 0.04) were significantly higher in the responder group than in non responders, respectively. At the latest follow-up, this increase was significantly maintained for growth rate (P = 0.001) and height (P = 0.002) in the responder group. In the multivariate analysis, patients who required &gt;10 mg/m2/week of MTX, systemic JIA and patients with reliance on steroids had a significantly lower growth velocity after the onset of MTX (P &lt; 001, P = 0.02, P = 0.02 respectively).

Conclusion

In our study, the increase in growth parameters in pre-pubertal children with JIA was associated with a better control of the disease activity under MTX therapy.

P017 Complications of Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by onset before the age of 16. This term encompasses several disease categories, each of which has distinct methods of presentation, clinical signs, and prognosis. The study aimed to determine JIA complications in 51 patients.

Methods

A cross-sectional study including patients diagnosed with JIA according to ILAR criteria was conducted for 26 years [1995– 2021]. Epidemiological, clinical, therapeutic, and evolutive aspects were noted.

Results

Twenty-nine males and 22 females were included. The mean age of the disease onset was 7.6 years [1,5–16]. The mean age of patients at the time of the study was 23.29 years [9–45]. Polyarticular and seronegative form was the most frequent (34.5%). Other subtypes diagnosed were systemic (25%), enthesitis-related arthritis (21.2%), oligoarticular (12.5%), and seropositive polyarticular (5.8%).

Standard X-Ray imaging showed articular damage in 50% of the cases. Hip arthritis was observed in 32% and surgery was needed in 16.9%. One patient presented with atlantoaxial subluxation. Growth retardation was noted in 28.6%. Cardiac manifestations were seen in 3 patients (pericarditis = 2, myocarditis = 1), uveitis in 3 cases, renal manifestation (extra membranous glomerulonephritis) in one patient with polyarticular form. One patient was diagnosed with multiple sclerosis.

Small doses of corticosteroids were prescribed in 71.7%. Methotrexate was prescribed in 70.5% (interrupted for adverse effects in 3 patients), sulfasalazine in 30.6%, hydroxychloroquine in 5.7%, leflunomide in 15.4%. bDMARDs were needed in 16 patients: 14 patients received TNF alpha inhibitors, rituximab was prescribed for one patient with a polyarticular form, and tocilizumab in a patient with a systemic form.

A switch of bDMARDs was conducted in 10 patients: for inefficiency in 4 cases and adverse effects in other 4 cases. Three patients developed uveitis under Etanercept, septicemia under Adalimumab, an allergic reaction, and depression under Infliximab. One patient died from a convulsive seizure at the age of 9.

Conclusion

The presence of complications is an additional burden to JIA patients. A multidisciplinary approach is required for the management of these complications.

P085 Chronic recurrent multifocal osteomyelitis: about 2 cases

Background

Chronic recurrent multifocal osteomyelitis (CRMO) also known as aseptic osteomyelitis is a rare auto-inflammatory disease with an incidence estimated at 4/100 000 population [1]. The aim of our work was to report two cases of CRMO that illustrate challenges in the diagnosis of this rare disease.

Method

We report the case of two patients diagnosed with CRMO. Clinical, biological and radiological data as well as disease outcomes were described. We also collected data about treatment modalities.

Results

Two patients aged of 7 and 10 years respectively, without any notable pathological history, presented recurrent episodes multifocal painful swelling of limbs. In the first case, the symptoms concerned the left ankle and knee as well as the left hip, all associated with lameness and an altered general condition, with neither fever nor skin manifestations. In the second case, the swelling involved the right shoulder, right hip and the left ankle. There was no elevated CRP or ESR in any of patients. Immunological status (RF, anti-CCP, AAN) as well as the HLA-B27 antigen test were negative. In the first patient, standard radiographs showed lytic lesions of the proximal metaphysis of the tibia, the greater trochanter and the left lateral malleolus. MRI of the pelvis, knee, and sternum of the first patient revealed edematous involvement of the left greater trochanter, the right ilium, the proximal metaphyseal region of the tibia and the right edge of the sternum, whereas in the second patient, a whole-body MRI showed inflammatory signs over the left greater trochanter, the insertion of the gluteus medius and obturator externus, right trochanteric bursitis and oedema of the entire right ilium. In the first patient, bone scintigraphy showed intense uptake of radioisotopes in the left ilium, the 7 th right costo-vertebral junction, the trochanteric mass, the upper end of the tibia and the lower end of the left fibula. Bone biopsy showed bone remodeling in both cases without evidence of infection or tumor. The diagnosis of CRMO was retained, supported by the prompt response to NSAIDs and short-term corticosteroid therapy. However, the second patient presented, 8 years later, pain in the sterno-clavicular joint as well as the right hip. A relapse of the disease was confirmed by MRI. Therapeutic escalation with zoledronic acid 0.025 mg/kg intravenous infusion every six months allowed the resolution of the symptoms.

Conclusion

These observations illustrated a rare disorder in children, characterized by lytic lesions predominantly in the metaphysis of long bones. Bone scintigraphy allowed an early assessment of disease extension and histological examination ruled out a malignant tumor and an infection. The first-line treatment is anti-inflammatory drugs. In case of failure, bisphosphonates seem to be effective.

Journey of rheumatoid arthritis patients in Tunisia: From symptoms to treatment

Objectives: This study aims to assess the different delays of rheumatoid arthritis (RA) patients’ journey from disease onset to treatment initiation and to identify possible influencing factors.

Patients and methods: This cross-sectional study included a total of 100 patients (14 males, 86 females; mean age: 56.5±12.4 years; range, 26 to 82 years) who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for RA between January 2019 and January 2020. Demographic and clinical data and disease characteristics were collected from the patient interviews and medical files. Five different intervals were defined from symptom onset until the initiation of conventional synthetic disease-modifying anti- rheumatic drugs (csDMARDs).

Results: The mean age at RA onset was 46.6±12.4 years. Median delays from onset of symptoms until general practitioner (GP) and rheumatologist consultations were six (range, 0.25 to 240) months and 12 (range, 0 to 242) months, respectively. Median delays from onset of symptoms to RA diagnosis and treatment with csDMARDs were 15.7 (range, 2 to 252) months and 18 (range, 2 to 270) months, respectively. The mean number of consultations was 7.3±4.2 and the median number of physicians visited before the diagnosis was three (range, 1 to 8). The RA diagnosis delay was associated with rural geographic environment (p=0.02), lack of social insurance (p=0.027), progressive symptoms onset (p=0.006), morning stiffness (p=0.023), being initially examined by a GP (p=0.02), number of consultations (p<0.001; r=0.49), and number of physicians consulted before diagnosis (p=0.001; r=0.33) respectively. Based on the patients’ self-perception, the main causes of this long delay were lack of financial means (33%), wait times until exploration results (31%), wait times until the first GP or rheumatologist visit (26%), and geographical difficulty in accessing healthcare services (18%).

Conclusion: Our study results suggest that patients with RA experience a significant delay until diagnosis and initiation of treatment. Healthcare providers should urgently consider factors related to diagnosis delay to shorten RA patients’ journey.

Validity of Remission Criteria in Rheumatoid Arthritis Compared to Ultrasound-Defined Remission

Objectives: Remission is the ultimate purpose of treatment in Rheumatoid Arthritis (RA). However, even when the most stringent composite scores were used, structural damages can occur. For that purpose ultrasonography (US) appears to be the best way to assess real remission. Our principal aim was to investigate the validity of different RA remission scores using the US as the reference. Methods: An analytic diagnostic study of 30 RA patients in remission according to DAS28 and a control group with active RA was conducted between January and October of 2018. Among them, we identified patients in remission according to the SDAI, the CDAI, and the ACR/EULAR remission score. The validity of each activity score for remission was calculated using as a gold standard the absence of PD signal. Results: All patients were in remission according to DAS28 with an average score of 2.03 [1.13-2.6]. US examination showed PD signals in 57% of all patients. Twenty-six patients were in remission according to CDAI, a Doppler signal was detected in 58% of those cases. SDAI remission was accomplished in 19 patients with PD activity in 53% of cases. For the 14 patients in remission according to ACR/EULAR criteria, synovial hyper-vascularization was found in 64%. Considering true remission as the absence of PD signals, the most sensitive and specific score was DAS28 (93% and 68% respectively). Conclusion: Considering remission in RA as the absence of vascularized synovitis, the DAS28 was the most sensitive and the most specific score. Keywords: Rheumatoid Arthritis, remission, ultrasonography, validity

Complications of Paget Bone Disease: A Study of 69 Patients

INTRODUCTION

Paget bone disease (PBD) is characterized by a disorder in the bone remodeling activity at sites of involvement. This can produce dramatic alterations of local bone architecture and causes most of the complications. We aimed to focus on the characteristics of complications of PDB among hospitalized patients.

MATERIAL AND METHODS

A retrospective study was conducted, on PBD patients hospitalized in two rheumatology centers from 1994 to 2019. Characteristics of the PBD complications were studied.

RESULTS

Sixty-nine patients were collected with a sex ratio of 0.76 and a mean age of 75.4±6.4 years [43-101]. The diagnosis of PBD was established in the average age of 64.2±11.5 years. The primary reason for consultation was pain (78.3%). The PBD was localized in the pelvis (58%), lower limb (42%), spine (36.2%), skull (23.2%) and upper limb (5.8%). It was polyostotic in 44.9% of cases. Dosage of ALP was 324 [68-8390]. The PDB complication rate was 52.2% and it decreased over time. The main complication was osteoarthritis (23.2%), followed by deafness (17.4%), fracture (15.9%), hydrocephalus (7.2%), neurological disease (7.2%) and osteosarcoma (1.4%). The presence of complications was significantly associated with the polyostotic form (p=0.01), the skull localization (p=0.04), an increased ALP (p=0.02).

CONCLUSION

According to our study, the incidence rate of PBD among hospitalized cases is higher among elderly women and decreases over time. Complications related to PDB are frequent (52%). It concerns patients with a polyostotic form, skull localization and high ALP.

Zoledronate Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterised by sterile bone lesions. We report a case of a seven-year-old female patient who presented at a university hospital in 2010 and 2018 with CRMO. While the most promising results have been observed in patients under treatment with bisphosphonates (BPs), the initial decision to treat the current patient with a dose of zoledronic acid every six months was recalled as the patient developed tonic-clonic seizures immediately following the second dose BP administration. Following recall, the patient maintained a prompt response at follow-up and her disease remained controlled with non-steroidal anti-inflammatory drugs. The current case report speculates a possible relationship between BP use and a possible seizure threshold reduction, thereby emphasising the need for closer monitoring when BPs are used.

POS0634 DO BIOLOGICS IMPROVE FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Background:

Fatigue is a significant issue in rheumatoid arthritis (RA) with no accepted evidence-based management guidelines. Several studies suggested that biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) have a direct role on fatigue in RA.

Objectives:

This study aimed to compare fatigue between patients treated with bDMARDs and conventional synthetic Disease Modifying Anti-Rheumatic Drugs (cs DMARDs).

Methods:

We conducted a longitudinal study including patients with RA (ACR/EULAR 2010). Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Demographic data and the following disease-related parameters were collected: pain Visual Analog Scale (VAS), Global Patient Assessment (GPA), tender joint count (TJC), swollen joint count (SJC), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), Health Assessment Questionnaire (HAQ) and DMARDs used. Fatigue was assessed at baseline (T0), at 6 months (T6) and at 12months (T12) using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. A p value inferior to 0.05 was considered significant.

Results:

We included 100 RA patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. The mean disease duration was 87.3 months [1-360]. The mean pain VAS was 49 cm [0-100] and the mean GPA was 47.8 cm [0-100]. The mean TJC and SJC were 5.3 [0-36] and 1 [0-9] respectively. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33] and the mean HAQ score was 0.90 [0-2.75].

Eighty-three percent of patients used csDMARDs: Methotrexate (n=96), sulphasalazine (n=28), leflunomide (n=21), and hydroxychloroquine (n=12). bDMARDs were prescribed in 17% of patients: Rituximab (n=10), Infliximab (n=9), and Etanercept (n=5).

At baseline, the mean FACIT-F score was 27.1 [0-51]. Moderate fatigue was noted in 57% of cases and severe fatigue in 26% of cases. Patients on csDMARDs had a lower FACIT-F score when compared to patients on bDMARDs (26.89 versus 28.41), but the difference was not statistically significant (p=0.630).

The mean FACIT-F score was 27.41 in bDMARDs patients versus 29.80 in csDMARDs patients (p=0.497) at T6, and 32.35 versus 33.65 respectively at T12 (p=0.695).

The mean delta FACIT-F was 2.18 in bDMARDs patiens versus 2.73 in csDMARDs patients between T6 and T0 (p=0.815), and 3.94 versus 7.2 respectively between T12 and T0 (p=0.807).

When considering all patients, a significant positive correlation was noted between delta FACIT-F and delta DAS28 at T6 (r=0.418, p<0.001) and at T12 (r=0.338, p<0.001).

Conclusion:

RA patients treated with bDMARDs didn’t show significant improvement of fatigue in comparison with those treated with csDMARDs. Further studies are needed to determine if biologics improve fatigue, and whether the improvement results from a direct action on fatigue or indirectly through reduction in disease activity.

Disclosure of Interests:

None declared

AB0614 DENSITOMETRIC VERTEBRAL FRACTURE ASSESSMENT: FACTORS LIMITING GOOD VISIBILITY OF THE VERTEBRA

Background:

The radiograph of the spine is the gold standard for identifying vertebral fractures (VF). Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers that could assess VF. This technique offers the advantage of low irradiation over standard radiography but at the cost of lower image quality.

Objectives:

The aim of this study was to assess factors associated with good vertebra visibility when using VFA.

Methods:

This is a cross-sectional study including patients referred by their physicians for bone mineral density (BMD) measurement. Anthropometric data were recorded. BMD was measured using standard methods over the lumbar spine L1-L4, the total proximal femur. Results were expressed as T-scores using Dual-energy X-ray absorptiometry (DEXA). The screening for VF was performed by VFA. A professional operator analyses VFA scans and assessed the good visibility of the vertebra.

Results:

The study included 100 patients. The mean age was 61.7 ±12.6 years [18-83].The average body mass index (BMI) was 28.9 ± 24.2 kg/m2 [14.2-45.3]. The mean T-score at the vertebral site was -1.5 DS [-4.9-1.5] with a mean mass of 0.95g/cm2 [0.58-1.371]. Osteoporosis was found in 27.7 % of patients. A vertebral fracture was diagnosed in 25% of cases. The visualization of the vertebra was impaired in the upper thoracic region in 60% of cases. Poor visibility was observed in 19% of cases in the mid-thoracic spine and only in 2% of cases in the lumbar spine. No statistically significant correlation was found between good vertebral visibility and age (p=0.2), weight (p=0.5), or BMI (p=0.7). However, good visibility of the vertebra was associated with a lower height (1.7 m vs 1.5 m, p=0.03). A better vertebrae visualization was correlated neither to the BMD of the right hip (0.84 vs 0.87, p=0.4) nor to the left hip (0.85 vs 0.89, p= 0.3). Similarly, the absence of vertebral osteoporosis was not correlated with a better vertebral visualization (p=0.6).

Conclusion:

Visibility of the vertebra on VFA does not appear to be altered by the BMD and vertebral osteoporosis, suggesting safe use in the elderly. However, precautions may be taken when interpreting VFA in patients with high heights.

Disclosure of Interests:

None declared.

AB0184 SCREENING FOR DEPRESSION IN A GROUP OF TUNISIAN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Depression is thought to be common comorbidity in patients with rheumatoid arthritis (RA), which is one of the most frequent chronic inflammatory diseases.

Objectives:

This study aimed to screen for depression in RA patients, and study its relation to social and clinical parameters, as well as disease activity.

Methods:

Single-center cross-sectional study, involving patients with RA, according to ACR/EULAR criteria 2010, using the original Beck Depression Inventory (BDI) as a screening tool for depression: measures of 0–9 indicated that a patient was not depressed, 10–18 indicated mild to moderate depression, 19–29 indicated moderate to severe depression and 30–63 indicated severe depression.

Results:

Sixty-five patients were included (57 F / 8 M). The average age was 55 years [23-73]. The mean duration of the disease was 11.75 years [1-25]. Half of the patients had precarious socioeconomic conditions and no social security. Forty-two patients were unemployed. Seventeen percent of them experienced grief by losing a close family member. Both rheumatoid factor and anti-citrullinated peptides antibodies were positive in 83.1 % of cases. RA was erosive in 78.5% of cases, and deformed in 21.5 % of cases. Almost half of the patients (52.3 %) were followed for at least another chronic disease. Forty-eight percent of patients were on Methotrexate with an average weekly dose of 15.3 mg/week [10-22.5], 10% on Leflunomide, 10% on Sulfasalazine, and 45% on biotherapy. The analysis of BDI scores showed that 64.6 % of patients suffered from depression: mild to moderate in 35.4 % of cases, moderate to severe in 21.5% of cases and severe in 7.7% of cases. Depression was significantly associated with precarious socioeconomic conditions (p=0.018). A correlation between the BDI score and the Disease Activity Score (DAS28) as well as the Health Assessment Questionnaire was noted (p = 0.045 and p = 0.02, respectively). There were no statistically significant associations with the other studied data.

Conclusion:

Depression was frequent among RA patients. Our study suggests that better control of the disease may reduce the incidence of depression within this group of patients.

References:

[1]Beck, A.T., Ward, C., & Mendelson, M. (1961). “Beck Depression Inventory (BDI)”. Archives of General Psychiatry, 4, 561-571.

Disclosure of Interests:

None declared

POS1491-HPR MENTAL HEALTH OUTCOMES AMONG HEALTH CARE WORKERS DURING THE CORONAVIRUS-19 PANDEMIC

Background:

The coronavirus-19 (COVID-19) pandemic is having negative effects on societies’ mental health, particularly health care workers who are exposed to tremendous psychological stress.

Objectives:

To assess the magnitude of mental health outcomes among health care workers treating patients exposed to COVID-19.

Methods:

This cross-sectional study collected demographic data and mental health measurements from health workers in different hospitals using an online questionnaire. Participants were also asked to complete the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Insomnia Severity Index (ISI), and the 7-item Generalized Anxiety Disorder scale (GAD-7). The total scores of these measurement tools were interpreted as follows: PHQ-9 normal (0-4), mild (5-9), moderate (10-14), and severe (15-21) depression; ISI normal (0-7), mild (8-14), moderate (15-21), and severe (22-28) insomnia; GAD-7 normal (0-4), mild (5-9), moderate (10-14), and severe (15-21) anxiety.

Results:

A total of 155 health care workers with a mean age of 31.3 ± 25 years [26-45] and a sex-ratio of 0.3 completed the online questionnaire. All participants were directly engaged in diagnosing, treating, or caring for patients with or suspected to have COVID-19. Participants were divided into two groups: 79% medical (61% doctors in training and 18% hospital doctors) and 21% paramedical staff. Twenty-two participants (14.2%) had a chronic disease and 21(13.5%) had a history of depression. Nineteen (12.2%) of the participants were infected with COVID-19, 4 of whom contracted the infection in the hospital (50% during October 2020). A statement to the department of occupational medicine was made in 70% of cases. Ninety-one percent of the participants were fit for treating patients with COVID-19. The mean number of nightshifts in the COVID unit per month was 5.3. The mean number of hours of work in the COVID unit was 5 hours per day, 36 hours per week, and 62 hours per month. An increase in workload compared to the pre-epidemic was noted in 62.9% of cases. Thirteen percent of participants experienced the same anxiety level as the first time of taking care of COVID patients while 65% were rather at ease compared to the first time. Forty-seven percent of participants felt the need for psychological support and 16.7% of whom had consulted a psychiatrist. Participants were diagnosed with depression (9 cases), anxiety (13 cases), and burn-out (3 cases). The prescribed treatment was: antidepressants (5 cases), anxiolytic (10 cases), and psychotherapy (12 cases). Mild depression was detected in 13% of cases, moderate depression in 4% of cases, and severe depression in 2% of cases. Mild insomnia was detected in 41% of cases, moderate insomnia in 14% of cases, and severe insomnia in 9% of cases. As for anxiety, 33% of participants suffered from mild anxiety, 14% moderate anxiety, and 5% severe anxiety.

Conclusion:

Participants reported experiencing psychological burden and a high rate of anxiety, depression, and insomnia. It is important to protect health care workers and to promote mental well-being to survive this pandemic.

Disclosure of Interests:

None declared

AB0188 DO PATIENT-REPORTED OUTCOMES IN RHEUMATOID ARTHRITIS REFLECT DISEASE ACTIVITY?

Background:

Patient-reported outcomes (PROs) reflect the patient’s perspective and are used in rheumatoid arthritis (RA) routine clinical practice. However, PROs may be associated with other aspects of health, such as psychological distress or comorbidities, which leads to situations of discordance with objective RA assessments.

Objectives:

The aim of this study was to determine whether PROs were associated with objective assessment of disease activity.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data were collected. The following PROs were assessed: number of nocturnal awakenings, morning stiffness duration, estimation of spontaneous pain and fatigue by Visual Analog Scale (VAS), and global patient assessment (GPA). In addition, patients rated their current satisfaction with their disease state according to the Austrian school mark system (PATSAT: 1=excellent, 2=good, 3=average, 4=moderate (fair), 5=unsatisfactory). Disease activity was assessed using the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28 ESR) and C reactive protein (DAS28 CRP). We used Cohen’s kappa (κ) to determine the agreement between PATSAT and DAS28 ESR. The κ result was interpreted as follows: values ≤ 0 as indicating no agreement and 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement. A p-value inferior to 0.05 was considered significant.

Results:

We included 54 patients (45 women and nine men) with a mean age of 55±11 years old [23-69]. The mean disease duration was 9.9±5.9 years [0-20]. The mean number of nocturnal awakenings was 1.1 [0-4] and the mean morning stiffness duration was 25.1 minutes [0-120]. The mean GPA was 5.3±2.2 cm [0-10]. The mean pain VAS was 5.4±2.2 cm [0-10] and the mean fatigue VAS was 4±2.5 cm [0-8]. None of the patients described his disease state as ‘excellent’. It was considered ‘good’ in 23.1% of cases, ‘average’ in 36.5% of cases, and ‘moderate’ to ‘unsatisfactory’ in 40.4% of cases.

The mean ESR and CRP were 46.3±29.3 mm [5-120] and 15.8 mg/l [0.6-100] respectively. The mean DAS28 ESR was 4.68±1.35 [1.50-7.16] and the mean DAS28 CRP was 3.9±1.1 [1.02-6.05].

A significant positive correlation was noted between both DAS28 ESR and DAS28 CRP and, number of nocturnal awakenings (r=0.385, p=0.013 and r=0.448, p=0.002), morning stiffness duration (r=0.495, p=0.001 and r=0.617, p<0.001), GPA (r=0.485, p<0.001 and r=0.530, p<0.001), and pain VAS (r=0.594, p<0.001 and r=0.598, p<0.001). No correlation was found between the two scores and fatigue VAS.

No significant agreement was noted between PATSAT and DAS28 ESR (κ=0.077, p=0.478).

Conclusion:

PROs showed moderate to strong correlation with disease activity scores. The timely and effective use of PROs could encourage physicians to focus more on the impact of RA on patients and how patients are feeling. This in turn would facilitate shared decision making between patients and physicians.

Disclosure of Interests:

None declared

AB0770 A RARE CASE OF SYNOVIAL METASTASIS REVEALED BY KNEE PAIN

Background:

Intra-articular masses are not frequently encountered in clinical practice. However, the differential diagnosis can be broad. Synovial metastasis is a rare presentation that carries a poor prognosis with a poor survival rate.

Objectives:

Here by a case of synovial metastasis of the knee joint in a patient diagnosed with an adenocarcinoma of the lung.

Methods:

A 60-year-old man with no remarkable past medical history presented to our department of rheumatology with right knee pain. He described a dull ache and swelling in his right knee with a dragging sensation, waking him up at night on a regular basis. The symptoms lasted from 6 months and were partially improved by analgesics and anti-inflammatory drugs. On examination, temperature was normal. The knee was edematous, erythematous, and warm with a range of motion of <90°. Laboratory investigations showed high acute phase reactants, the erythrocyte sedimentation rate was 75 mm. A plain radiograph of the left knee demonstrated a lytic lesion of the upper tibia. A magnetic resonance imaging of the right knee showed diffuse enlargement of the joint space due to a tissue infiltration within the synovium. These structures demonstrated heterogeneously increased T2 signal and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyper enhancing synovium. At that time, differential considerations included severe inflammatory arthritis and synovial chondromatosis rather than unusual metastasis.

Results:

Biopsy concluded to synovial metastasis from primary adenocarcinoma. Further investigations were necessary. Chest tomography showed a tumor process of left lower lobe associated with mediastinal lymphadenopathy. The patient was treated with palliative external radiotherapy to the right knee. The evolution was marked by the appearance of multiple tracheobronchial fistulas. The patient died 3 months later due to the progression of the disease.

Conclusion:

We report a rare case of synovial metastasis concomitant to a lung adenocarcinoma. It is important to make a rapid diagnosis as early recognition of malignant infiltration into joints ensure appropriate multidisciplinary management decisions.

Disclosure of Interests:

None declared

AB0672 PSYCHOLOGIC STATE OF PATIENTS WITH RHEUMATIC DISEASES AFTER THE OUTBREAK OF SARS-COV2

Background:

The ongoing Coronavirus-19 disease epidemic is a public health emergency of international concern which could pose a challenge to psychological resilience. This is mainly the case of patients with rheumatic diseases (RD).

Objectives:

The aim of this study was to establish the prevalence of psychiatric symptoms in patients with RD and to identify factors associated with psychological stress.

Methods:

A cross-sectional study was conducted among patients with RD. They were invited to respond to a survey designed to assess their psychological response after the outbreak of the SARS-COV2 pandemic. Mental health status after the Covid-19 was evaluated using the Depression and Anxiety Scale (DASS-21). The total depression subscale score was divided into normal (0–9), mild depression (10–12), moderate depression (13–20), severe depression (21–27), and extremely severe depression (28–42). The total anxiety subscale score was divided into normal (0–6), mild anxiety (7–9), moderate anxiety (10–14), severe anxiety (15–19), and extremely severe anxiety (20–42).The Impact of Event Scale-Revised (IES-R) is a 22-item self-administered questionnaire that assesses the post-traumatic state (PTS). A cut-off point of 33 provided the best diagnostic accuracy for PTS. The level of significance was fixed at 0.05.

Results:

Sixty patients were included (42 with rheumatoid arthritis and 18 with spondylarthritis) with a mean age of 51.3 ± 13.1 years [18-75]. The majority of patients were women (63.3%), married (81.7%), with a household size of 3–5 people (67.9%). The mean disease duration was 11.9 ±5.6 [1-23] years.

According to DASS depression score almost half of the patients (47%) suffered from depression, which was classified as severe in 10% of cases. The mean DASS anxiety subscale was 12.6 ± 8.2 [1-35]. The level of anxiety was mild in 23% of cases, moderate in 25% of cases, and severe in 23.3% of cases. The mean ILES-R score was 20.4 ± 10.2 [20-38]. Women experienced more PTS than men (26.3% vs 22.7%) without reaching a statistically significant correlation (p=0.9). Patients with higher education had lower IES-R, depression, and anxiety subscale scores as compared to those who were illiterate without a statistically significant correlation (p=0.5, p=0.2, p=0.4 respectively). A positive correlation was found between anxiety score and IES-R (p=0.00). Other sociodemographic variables including disease duration, parental status, marital status, and household size were not associated with IES-R and DASS subscale scores (p>0.05).

Conclusion:

Our study showed that many of our patients with RD experienced anxiety, depression, and PTS after the outbreak of Covid-19. Professional status as well as other sociodemographic data was not associated with psychological stress.

Disclosure of Interests:

None declared

POS0159-HPR IMPACT OF SLEEP DISTURBANCES ON ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Sleep disturbances have been reported in various rheumatic diseases especially in the elderly. It may be caused by pain and depressive mood. However, reports on the impact of sleep problems in rheumatoid arthritis (RA) activity and functional status were limited.

Objectives:

To assess sleep quality in elderly patients with RA and its impact on disease activity and functional status.

Methods:

This cross-sectional study included 70 RA patients aged ≥ 65 years fulfilling the ACR/EULAR criteria. Sociodemographic data were collected. RA activity was assessed with the Disease Activity Score (DAS28) and functional status with the Health Assessment Questionnaire (HAQ). Sleep quality was assessed using Arabic translated versions of two indexes: the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). An ISI score of [8-14], [15-21], and [22-28] determined respectively mild, moderate, and severe insomnia. A PSQI score > 5 determined poor sleep quality. ANOVA test was used to assess the relationship between DAS28 erythrocyte sedimentation rate (ESR), HAQ, and sleep quality indexes.

Results:

This study included 52 females and 18 males with a mean age of 68.3 ± 25 years [65-81]. Seventy percent of patients were married, 27% were widowed and 2% were divorced. Seventy-one percent of patients were illiterate, 18% had primary education and 11% had secondary education. Eighteen percent of patients were employed whereas 34.7% were retired. A history of depression was noted in 16.5% of patients. The mean duration of RA was 17.4 ± 5.2 years. Eighty-five percent of patients were on conventional synthetic DMARD whereas 15% were treated with biologic treatment. The mean patient’s global assessment of disease activity was 5.2 ± 1.3. The mean tender joint count and mean swollen joint count were 8 ±1.5 and 5 ±1 respectively. The mean DAS28 ESR was 4.7 ±0.9. The mean HAQ was 2.4 ± 0.45. Poor sleep quality was detected in 84% of cases according to the PSQI score. Mild insomnia was detected in 46% of cases, moderate insomnia in 34% of cases, and severe insomnia in 12% of cases. RA activity was higher in patients with poor sleep quality: the mean DAS28 ESR was 5.2 in patients with severe insomnia, 4.82 in moderate insomnia, and 4.13 in mild insomnia; p= 0.00 respectively. The mean ESR was 31.5 mm in patients with severe insomnia, 22.1 mm in moderate insomnia, and 10.6 mm in mild insomnia; p= 0.01 respectively. Furthermore, the higher the PSQI was, the higher DAS28 ESR is (p =0.01). However, no association was found between poor sleep quality and joint count, swollen joint count, CRP, and HAQ.

Conclusion:

Disease activity was a major contributor to poor sleep quality in elderly patients with RA. Functional status however wasn’t associated with insomnia. Physicians should include sleep in the clinical assessment of RA patients to improve their quality of life.

Disclosure of Interests:

None declared

AB0698 CORONAVIRUS 19 DISEASE VACCINE: PERCEPTIONS AND INTENTIONS OF TUNISIAN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Coronavirus disease 2019 (covid-19) has now spread to millions of persons worldwide to become a global pandemic. Covid-19 is asymptomatic for some individuals and for others it can cause symptoms ranging from flu-like to acute respiratory distress syndrome, pneumonia and death. Several vaccine candidates are now available, and patients with chronic inflammatory disease such as rheumatoid arthritis (RA) are encouraged to get vaccinated.

Objectives:

The aim of this study was to determine perceptions of RA patients about the covid-19 vaccine.

Methods:

We conducted a cross-sectional study including Tunisian patients with RA (ACR/EULAR 2010). Demographic and disease parameters were collected: age, gender, educational status, disease duration, erythrocyte sedimentation rate (ESR), disease activity score (DAS28), and treatments being used. All patients responded to a questionnaire on their perceptions and concerns about the covid-19 vaccine, and whether they intended to get vaccinated or not. A p value inferior to 0.05 was considered significant.

Results:

We included 54 patients (45 women and nine men) with a mean age of 55±11 years old [23-69]. Thirty-one percent of patients were illiterate. The mean disease duration was 9.9±5.9 years [0-20]. The mean DAS28 ESR was 4.68±1.35 [1.50-7.16].

NSAIDs were used in 13% of patients, corticosteroids in 63% of patients at a mean daily dose of 8mg [2.5-20] of prednisone equivalent, methotrexate in 63% of patients, sulphasalazine in 13% of patients, leflunomide in 3.7%, and biologics in 22.2% of patients.

None of these patients had contracted the covid-19. Seventeen percent of patients had been in close contact with someone positive for the disease. All the patients reported that they respected the preventive measures. Fifteen percent of patients had stopped their treatment because they were afraid of the covid-19: Methotrexate (n=4), sulphasalazine (n=1), tocilizumab (n=2), and rituximab (n=1).

More than half of patients (67.7%) reported that they didn’t want to get vaccinated against covid-19. The reasons given by these patients were: presumed adverse events (100%), religious beliefs (86.7%). presumed inefficiency (83.3%), no recommendation from their doctor (80%), fear that the vaccine would interact with their treatment (76.7%), lack of trust in the pharmaceutical laboratories (76.7%), fear from vaccines in general (53.3%), fear that the vaccine would make RA worse (50%), and presumed overprice of the vaccine (30%).

A significant association was noted between educational status and, religious beliefs (p=0.001), lack of trust in the pharmaceutical laboratories (p=0.007), fear that the vaccine would make RA worse (p=0.008) or interact with other treatments (p=0.022), and presumed overprice of vaccine (p<0.001).

Conclusion:

Most of RA patients expressed their unwillingness to get vaccinated against covid-19. Doubts about the vaccine’s efficiency and security and religious beliefs were the main reasons for this choice.

Disclosure of Interests:

None declared