Incidence of Discharge Against Medical Advice in Queensland Hospital Emergency Departments Among Indigenous Patients from 2016 to 2021

BACKGROUND

The incidence of discharge against medical advice (DAMA) in emergency departments (EDs) among Indigenous people is a growing concern in Australia. This study aimed to determine the incidence of ED DAMA in public hospitals in Queensland (QLD) from 2016 to 2021 and investigate the disparities in ED DAMA between Indigenous and non-Indigenous patients. The study also assessed the impact of the COVID-19 pandemic on the incidence of ED DAMA.

METHODS

A descriptive epidemiological study was conducted using aggregated data from QLD public hospital EDs. The data was retrieved from Clinical Excellence QLD, Healthcare Improvement Unit, in the QLD Health Open Data Portal for the period 1 January 2016 to 31 December 2021. Incidence rates and unadjusted odds ratios were calculated and compared using the chi-square test to identify differences between Indigenous and non-Indigenous patients.

RESULTS

The annual incidence of DAMA in EDs was 7.7% among Indigenous patients, compared to 4.8% among non-Indigenous patients, with the highest rate (8.9%) reported in 2021 among Indigenous patients. The incidence of ED DAMA was higher for Indigenous patients in major cities (20.0%) than in very remote areas (7.4%). Patients in triage categories 4 (10.0%) and 3 (7.3%) accounted for the vast majority of ED DAMA events among Indigenous patients. The acute group A hospitals had the highest incidence of ED DAMA (10.9% for Indigenous patients and 6.5% for non-Indigenous patients). The COVID-19 pandemic had no impact on the incidence of ED DAMA.

CONCLUSION

Indigenous patients experience a disparity in ED DAMA incidence. Addressing this issue requires collaborative efforts from healthcare providers, policymakers, and community organizations.

Association of Sociodemographic Factors with Physical Activity and Sleep Quality in Arab and Non-Arab Individuals of Both Sexes during the COVID-19 Pandemic

We explored the association of sociodemographic and anthropometric factors with self-reported physical activity (PA) and sleep quality in Arab and non-Arab individuals of both sexes during the COVID-19 pandemic. In this cross-sectional study, 638 participants (those recovered from COVID-19 = 149, and non-infected = 489) of both sexes aged 18-55 years were recruited. Their sociodemographic and anthropometric information, PA (self-reported using the International Physical Activity Questionnaire Short-form [IPAQ-SF)]) and sleep quality (self-reported using the Pittsburgh Sleep Quality Index [PSQI]) were documented. The association between participants' characteristics, PA levels, and sleep quality were determined using the chi-squared test. Variables significantly associated with IPAQ and PSQI in bivariate analyses were included in a multivariate binary logistic regression model. Men were more active than women (odds ratio [OR] = 1.66, p = 0.010), and non-Arab participants were more active than Arab ones (OR = 1.49, p = 0.037). Participants ≥40 years, men, non-Arab participants, and those who were working were more likely to have a good sleep quality than those ≤40 years (OR 1.70, p = 0.048), women (OR 1.10, p = 0.725), Arab individuals (OR 1.95, p = 0.002), and unemployed people (OR 2.76, p = 0.007). Male and non-Arab participants seemed to have a better self-reported PA and sleep quality compared to female and Arab participants, during the pandemic.

Incidence Characteristics and Histological Types of Head and Neck Cancer among Adults in Central Sudan: A Retrospective Study

Head and neck cancers (HNCs) are prevalent in Sudan, but the reasons for this and the incidence of different types of HNCs are not well understood. A cross-sectional retrospective study was conducted to provide baseline data on the epidemiology of HNCs among patients treated at the National Cancer Institute (NCI) in central Sudan. All cancer cases from 2016 to 2020 were retrieved from the NCI records. Of the 9475 new cancer patients who were registered at the NCI during the study period, 1033 (11%) had HNCs, of whom 767 (74.2%) were adults. The mean age of the adult patients was 54.5 years (standard deviation 15.8) and 449 (58.5%) patients were male. The annual incidence in adults was 4/10⁵ population. The most common HNC sites were the nasopharynx (25.3%), hypopharynx (22.8%), and oral cavity (22.2%). Carcinoma was the most common diagnosis (87.6%), followed by lymphoma (5.6%). Most patients' tumors were at a locally advanced (22%) or metastatic stage (47%) of HNCs at the time of presentation. Further studies to identify risk factors for HNCs, particularly for the most prevalent types in central Sudan, are needed. In addition, Sudan requires capacity building for cancer, including a national cancer registry.

Migraine awareness, prevalence, triggers, and impact on university students: a cross-sectional study

Background

Migraine is a public health concern, and university students have been found to be particularly susceptible to stress and other factors that trigger migraines. The objective of this study was to determine the prevalence, awareness, and impact of migraine on University of Sharjah students.

A cross-sectional study was conducted using a self-administered questionnaire. The diagnosis of migraine was made according to the International Headache Society (IHS) criteria and the impact on life was calculated through the Migraine Disability Assessment (MIDAS) score.

Results

The overall migraine prevalence was 26.35% with 25.3% of migraineurs were unaware of having migraine. The most common reported symptoms during a migraine headache attack were one side headache (82.7%) and pulsating headache (66%). Sleep deprivation (74.7%), stress (58%), and hunger or skipping meals (57.3%), were the most common triggering factors. Almost 60% of the migraineurs had a disability ranging from moderate to severe and hospital admission was needed by 30%.

Conclusions

The prevalence of migraine was high among university students, wherein some students might be unaware of having migraines. Migraine has a deleterious impact on students’ productivity and wellbeing. Well-designed interventions such as screening programs might be needed to help in proper diagnosis and management of migraine attacks as well as special educational programs to raise awareness about migraine.

Evaluation of Variations in Root Canal Anatomy and Morphology of Permanent Maxillary Premolars among the Emirate Population using CBCT

Background:

Many types of research have revealed that root canal anatomy differs by race and country based on various national populations, but no study has been conducted on the UAE population.

Objectives:

Identifying the most common morphology of the upper premolars in a group of local and non-local people in the UAE.

Methods:

Cone-beam computed tomography (CBCT) images of 215 intact maxillary premolars were analyzed. The Pearson Chi-squared test and the two samples t-test were applied.

Results:

Most of the maxillary first premolars were two-root formed (90%). Single-rooted teeth were less common (8%). Three-rooted maxillary first premolars represented a low frequency of 1.9%. Most of the maxillary second premolar teeth studied in this research (52%) had two roots. Almost all local and non-local populations had two canals for both first and second maxillary premolar. Only two maxillary first premolars (0.2%) had the three-canal morphology. The most frequent canal morphology in the maxillary first premolar group among local UAE and non-local was type V. The maxillary second premolar group among local UAE was type II (32%). In non-local UAE, type V (25%). In addition, six types of uncommon canal anatomic variants (types 1-2-3, 2-3-2, 3-2-1, 1-2-3-2, 2-1-2-1, and 3-2) were discovered in 3.7% of local UAE and 36.3% of non-local UAE.

Conclusion:

The results suggest a more quantitative approach to maxillary first and second premolar access cavity preparation in the UAE population to prevent errors and iatrogenic damage when identifying the canals.

Neuropathic arthropathy of the shoulder as a presenting feature of Chiari malformation with syringomyelia: a case report with a systematic literature review

BACKGROUND

Neuropathic arthropathy (NA) of the shoulder is a chronic progressive process characterized by joint destruction in the presence of a neurosensory deficit. Syringomyelia, a spinal cord disease, is the leading cause of NA in the upper extremity.

OBJECTIVE

We present a systematic review of NA with syringomyelia cases alongside a case report of an adult with NA of the shoulder that occurs a few 4 years after a revelation and surgical management of a Chiari malformation with syringomyelia.

METHODS

A systematic review was conducted following PRISMA guidelines. A PubMed, Scopus, Isiknowledge, and manual search through references of relevant publications were used to identify all published case reports of NA. Data were collected from each case report on patient characteristics.

RESULTS

The systematic review identified 56 publications and 85 patients (including ours): nearly the same number of males (n = 41) and females (n = 44). The mean age was 50,69. Presentations included reduction of mobility (n = 66), swelling (n = 61) and sensory disorder (n = 63). The pain was absent in 41 cases. In the majority of reported cases 56 (65.1%), syringomyelia was revealed by neuropathic arthropathy, and eleven patients (12.9%) had a history of syringomyelia. Treatment was categorized into non-operative management (37[43.5%]), operative management (27[31.7%]). Following-up was non-reported in 31 (36%) cases. Improvement was reported more with patients who underwent a surgical approach than medical one 28.5% versus 8.1%.

CONCLUSION

Physicians need to be more aware of this destructive joint disease, rare, and often misdiagnosed. Also, it is imperative to integrate clinical, pathological, and imaging findings for accurate diagnosis and for delivering appropriate therapy.

AB0204 DOES THE PRESENCE OF COXITIS IN RHEUMATOID ARTHRITIS CHANGE THE DISEASE SEVERITY PROFILE?

Background

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by intra-articular manifestations affecting small and large joints. Hip involvement is not common but it can predict a severe disease course [1].

Objectives

Our study aimed to investigate the prevalence of coxitis in RA patients and to compare patients with RA coxitis (+) and RA coxitis (-) according to their clinical, biological outcomes and their therapeutic findings.

Methods

This was a retrospective and comparative study, which include patients diagnosed with RA according to the ACR/EULAR 2010. Sociodemographic, clinical, biological, and therapeutic data were collected. The diagnosis of coxitis was made on plain x-rays or MRI.

Results

Among 255 RA, there were 30 RA coxitis (+) (11.8%). Coxitis was unilateral in 28 patients and bilateral in 2 patients. The mean delay onset of coxitis was about 11.6 ± 8.4 years (1-27). The mean age was 57.5 ± 12.2 years for RA coxitis (+) and 59.1 ± 10.5 years for RA coxitis (-) (p=0.5). The gender distribution was (70% female and 30% male) for RA coxitis (+) and (85% female and 15% male) for RA coxitis (–) (p= 0.04). The mean Body Mass Index was 24.8 ± 4.8kg/m2 in RA coxitis (+) and 28 ± 5.8 kg/m2 in RA coxitis (-) (p= 0.03). Comorbidities were present in 46% of RA coxitis (+) and 48% of RA coxitis (–) (p=0.8). Extra articular manifestations were noted in 76% RA coxitis (+) and 66% RA coxitis (–) (p=0.8). RA was seropositive in 76% RA coxitis (+) and in 82% RA coxitis (–) (p=0.4). RA was immunopositive in 51% RA coxitis (+) and 69% RA coxitis (–) (p=0.04). The mean DAS28 (CRP) was respectively 4.6± 1.1 in RA coxitis (+) vs 4.8 ± 1.1 RA coxitis (-) (p=0.7). Atlanto-axial dislocation was noted in 60% RA coxitis (+) and 22% RA coxitis (–) (p<10-3).

The use of corticosteroid was noted in 92% RA coxitis (+) and in 90% RA coxitis (–) (p=0.7). Biologic drugs were prescribed in 43% RA coxitis (+) and in 25% RA coxitis (–) (p=0.04).

Conclusion

Our study showed that coxitis in RA patients is associated with a higher risk of Atlanto-axial dislocation and a more frequent use of biologic drugs reflecting a more severe and mutilating disease. We highlight the importance of an early diagnosis and treatment to prevent complications.

References

[1]Bajraktari IH, Krasniqi B, Rexhepi S, Bexheti S, Bahtiri E, Bajraktari H, Luri B. Prevalence of Coxitis and its Correlation with Inflammatory Activity in Rheumatoid Arthritis. Open Access Maced J Med Sci. 2018;6(2):336-339.

Disclosure of Interests

None declared

AB0852 Assessment of endothelial dysfunction in spondyloarthritis

Background

Endothelial dysfunction is the earliest step in the pathogenesis of atherosclerosis, preceding structural vascular alterations. Few studies have focused on the endothelial dysfunction in spondyloarthritis.

Objectives

The aim of our study was to assess endothelial dysfunction using Flow-Mediated dilatation (FMD) in patients with spondyloarthritis.

Methods

Forty-seven consecutive patients meeting ASAS 2009 criteria for spondyloarthritis and 47 matched healthy subjects were included in the study. Subjects with traditional cardiovascular risk factors were excluded. Sociodemographic, clinical, biological and radiological features related to the disease as well as therapeutics were recorded. FMD was assessed ultrasonographically according to guidelines of American college of cardiology (ACC) (1).

Results

Spondyloarthritis group included 47 patients with a sex ratio of 2.35 and a median age of 36 years (IQR: 28-46). Median body mass index (BMI) was 24.5 kg/m2 (IQR 25-75%: 20.7-26.8) with no significant difference compared with the control group (p=0.238). Physical examination showed normal values of blood pressure (BP) with a median systolic BP of 121 mmHg (IQR 25-75%: 110-130) and a median diastolic BP of 71 mmHg (IQR 25-75%: 67-78). In laboratory findings, total cholesterol and triglyceride levels were increased in 2 and 3 patients respectively.

Median age at onset of SpA was 20 years (IQR 25-75%; 18-32). For disease activity, median CRP level was 6.45 mg (IQR 25-75%: 1.45-19.9) and median ASDAS-CRP and BASDAI were respectively 2.18 (IQR 25-75%: 1.62-2.91) and 2.6 (IQR 25-75%: 1.8-3.8). Median MASES score was 0 (IQR 25-75%; 0-0). Median BASFI and BASMI were 3 (IQR 25-75%; 1.5-5.1) and 1.5 (IQR 25-75%: 0-4). Regarding treatment, 92% of patients were using NSAIDs, csDMARDs (51%) and 38% were on TNF inhibitors.

Patients with spondyloarthritis exhibited significantly lower FMD values than healthy age and gender matched controls with a median value of FMD 14.6% (IQR; 9-24) versus 18.8% (IQR; 12.8-23.1%); p=0.008.

Conclusion

Our study demonstrates impairment of endothelial function in patients with spondyloarthritis compared with healthy population, confirming the accelerated atherosclerosis in spondyloarthritis.

References

[1]Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J. 2019 Aug 7;40(30):2534–47.

Disclosure of Interests

None declared

AB1220 CHARACTERISTICS OF INFECTIOUS SPONDYLODISCITIS IN ELDERLY

Background

Infectious spondylodiscitis is a rare but growing disease. It is a serious infection that can compromise both the functional and vital prognosis especially on elderly subjects.

Objectives

The purpose of this study was to compare the clinical, bacteriological and evolutionary characteristics of elderly patients admitted for management of infectious spondylodiscitis with a case-control group of young subjects.

Methods

Retrospective, descriptive study carried out in the rheumatology department of the Charles Nicolle Hospital from 2010 to 2019. Adult patients hospitalized for infectious spondylodiscitis were included. Clinical, bacteriological and evolutionary data were analysed and comparing those over 65 years of age with young case-control subjects.

Results

Of the 78 patients included, 33 patients belonged to the elderly group and 45 to the control group. The duration of evolution was shorter for the control group (123 vs. 181 months for the elderly; p=0,71). The progressive mode of onset characterised the elderly group (P<0.05). Spinal pain was constant. Neurological abnormalities, night sweats, and altered general condition were more present in the elderly (p<0.05). Spinal stiffness was more present in the control group (p<0.05). There was no difference between the two groups in terms of the presence of fever and radiculalgia. Spinal biopsy was performed in 72% of the elderly subjects and in 80% of the control group. The most common germ in the elderly group was tuberculosis and brucellosis in the control group (p<0.05). A favorable evolution was noted in 75% of the cases in the control group compared to 66% of the elderly subjects (p<0.05). Neurological complications and mortality were more common in the elderly (p<0.05).

Conclusion

Infectious spondylodiscitis on elderly is characterised by an insidious onset, a confusing clinical picture and a more severe presentation than young people with significant complications and mortality.

Disclosure of Interests

None declared

AB0835 INFLUENCE OF SOCIODEMOGRAPHIC PARAMETERS ON ATHEROSCLEROSIS IN SPONDYLOARTHRITIS PATIENTS

Background

The increased risk of atherosclerosis is most likely multifactorial in patients with Spondyloarthritis (SpA). Ultrasound measurements of Intima Media Thickness and (IMT) Flow Mediated Dilation (FMD) can be used to investigate infra-clinical atherosclerosis [1].

Objectives

We aimed to investigate the relationship between socio-demographic parameters in SpA patients with the IMT and FMD.

Methods

It was a case control study conducted over a period of 12 months and including patients with SpA, aged less than 50 years old and without cardiovascular disease, and age and sex matched healthy controls. Sociodemographic and clinical features were recorded in our patients. All subjects had Doppler ultrasound with measurement of carotid IMT and FMD.

Results

There were 47 SpA patients and 47 controls. The median age was 36 years for patients group (18-50) and 32 years for controls (18-50). For the patients group: there were 14 female (28.8%) and 33 male (70.2%). The median duration of the disease was 11 years (1-32). For the marital status, 55.32% were single, 40.43% were married, and 4.26% were divorced. Thirty seven patients (79%) were living in an urban area. For the education level, 17% had a primary education, 64% a secondary education, and 19% were university graduates. Occupational status was recorded as follows: 17% unemployed, 11% students, and 72% employed.

The median IMT was 0.55 millimeters (mm)(0.32 -0.83). We found a higher mean, right and left IMT (p<0.0001) in SpA patients compared with controls. Carotid IMT was positively correlated with age (p<0.0001; r=0,578). The analysis by 10-year age group showed a statistically significant difference in the IMT between patients (p=0.004). Median IMT increased significantly with age (every 10 years). IMT was significantly associated with occupational status (p=0.036); unemployed patients had the higher IMT (0.58 mm).

The median FMD was 14.6% (2-32%). A significantly lower FMD (p=0.008) was noted in SpA patients compared with controls. FMD were negatively correlated with age (p=0.017; r=-0,347). FMD was also associated with sex (p=0.036), and with the marital status (p=0.013). The median FMD was significantly lower in male 13.8% (IQR;8-17.5) vs 22.5% (IQR; 10-25), and married patients (10%; 6-18). There was no significant difference with the other sociodemographic variables (living environment, educational level, occupation). In multiple regression analysis, age was an independent predictor of increased carotid IMT (B=0.004; T=3.146; p=0.003; CI 95% 0.001-0.006].

Conclusion

Our study showed that subclinical atherosclerosis in patients with SpA was strongly associated with age, although we included young patients with a limit age at 50 years.

References

[1]Yuan Y, Yang J, Zhang X, Han R, Chen M, Hu X, et al. Carotid Intima-Media Thickness in Patients with Ankylosing Spondylitis: A Systematic Review and Updated Meta-Analysis. J AtherosclerThromb. 2019;26(3):260-271.

Disclosure of Interests

None declared

AB0351 IMPACT OF FCGR2A, FCGR3A AND FCGR3B POLYMORPHISM ON RITUXIMAB EFFICACY IN RHEUMATOID ARTHRITIS

Background

Identifying reliable biomarkers of response to biologics in rheumatoid arthritis (RA) is necessary to improve responsiveness, preserve functions and structure of joints, as well as to reduce treatment’s cost. Single nucleotide polymorphisms (SNP’s) of Fc-gamma receptors genes (FCGRs), by inducing a variation of receptors’ affinity to Fc fragment of Gamma immunoglobulin, might influence the efficacy of therapeutic monoclonal antibodies by modifying their clearance.

Objectives

The aim of this study was to investigate whether FCGR2A, FCGR3A and FCGR3B SNP’s were predictive factors of response to rituximab (RTX) in Tunisian RA patients.

Methods

A cross-sectional, observational and analytic multicentric cohort study was conducted in a group of patients suffering from RA treated with RTX. Treatment outcome was evaluated after 6 months, using DAS28 variation from baseline and EULAR response criteria. R131H-FCGR2A, F158V-FCGR3A and NA1/NA2-FCGR3B SNPs were studied using PCR-SSP and direct sequencing process.

Results

Thirty-four patients were enrolled with a sexe ratio M/F=5/29. The mean age at inclusion was 54,24±11,78 years [29-77]. All patients received at least one cs-DMARDS priorly to the prescription of RTX. Concomitant treatment with methotrexate was pursued in 77,3% of patients. As shown in Table 1, an association, that tend to signification, was found between R/R FCGR2A receptors and a greater variation in DAS28 score (p=0,053). This association was also found using EULAR criteria, since all patients with R/R genotypes had a good or moderate response to RTX but was not significative (p=0,131).

Table 1.

Correlation of FCGR SNPs with response to rituximab at 6 months of treatment

Genetic studyΔDAS28CRPpΔDAS28ESRpEULAR (R-) (n=7)EULAR (R+) (n=27)PFCGR2A R131H*0,1380,7610,301GenotypesRR2,53±1,560,0531,83±0,750,4800(0)7 (100)0,131HH2,05±2,510,8682,29±1,640,6831 (33,3)2 (66,7)0,576RH1,09±1,360,062,00±1,730,8556 (25)18(75)0,324AllelesR1,45±1,520,8681,96±1,490,6836 (0,194)25(0,806)0,576H1,17±1,430,0532,1±1,600,4807 (0,259)20(0,741)0,131FCGR3A F158V*0,4280,8730,370GenotypesFF1,35±1,570,8601,91±1,860,7052 (16,7)10(83,3)0,676VV0,95±0,980,2882,85±0,320,6371 (10)9(90)0,324FV2,06±1,830,2371,84±1,5114 (33,3)8(66,7)0,175AllelesF1,72±1,700,2881,87±1,560,6376 (0,25)18(0,75)0,324V1,56±1,570,8602,13±1,330,7055(0,227)17(0,773)0,676FCGR3B NA1/NA2*0,2170,4850,645GenotypesNA1NA12,29±1,810,092,13±1,080,7152(22,2)7 (78,8)0,888NA2NA20,79±1,300,3290,60,3432 (33,3)4 (66,7)0,395NA1NA21,23±1,360,3912,28±2,070,3453 (15,8)16(84,2)0,436AllelesNA21,15±1,330,091,95±1,950,7155 (0,20)20(0,80)0,888NA11,60±1,580,3292,19±1,450,3435 (0,179)23(0,821)0,395

DAS: disease activity score,ΔDAS: mean variation of DAS at 6 months, *:Comparison of the global distribution of the 3 genotypes,**: p while comparing the prevalence of R/R genotype to R/H and H/H genotypes,R+: good or moderate EULAR response,R-: bad EULAR response

Conclusion

The low affinity receptor R/R FcgRIIa might be predictive of good response in RA patients treated with RTX. More studies need to be conducted in larger cohorts to confirm this association, with the aim of identifying reliable biomarkers of response to biologics to improve responsiveness, preserve joints functions and structure, as well as reduce treatment’s cost.

Disclosure of Interests

None declared

AB0958 The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis: ultrasound study

Background

It has been shown that there is an anatomical link between the distal interphalangeal joint (DIP) extensor tendon enthesitis and the nail changes in psoriatic arthritis (PsA) [1].

Objectives

To evaluate the relationship between nail involvement and enthesopathy at DIP level in PsA patients using ultrasonography (US).

Methods

We included patients with PsA. According to OMERACT, the following elemental lesions were dichotomously (presence/absence) evaluated on greyscale US assessment at extensor tendon insertion at distal phalanx of DIP joints: abnormally hypoechoic, enthesophytes, and erosions. We also measured the tendon thickness. Increased abnormal vascularization at entheseal level was also assessed using PD technique. We also performed an US assessment of the finger nails that included the study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT) and adjacent skin (ST).

Results

We included 33 PsA patients (323 DIP). Eleven patients (34 %) presented psoriatic onychopathy (45 fingernails) with a mean NAPSI 7 (IQR (25,75)) [2 -18]. US study of the nails revealed dystrophy in 75 nails (23%).

At patient level, the mean NPT, NBT and SK were 1.90±0.22, 0.38±0.09, and 2.33±0.62, respectively.

None of the patients had clinical involvement of DIP.

Using US, we examined 325 extensor tendon. The mean thickness of the tendon was 0.63mm ±0.1 mm. The tendon was abnormally hypoechoic in two fingers (0.61%).

Erosions were present in 16 DIP (4.9%).

We found enthesophytes in 82 DIP joints at insertion of extensor digitorum tendon (25.23%).

We did not observe increased abnormal vascularization at entheseal level.

At finger level, the extensor tendon thickness was higher in the presence of US nail dystrophy (0.70 mm vs 0.60, p=0.01). Erosions were more common in fingers with US nail involvement (14.6 % vs 1.9%, p=0.00).

Osteophytes were present in 20% of fingers with US nail involvement and 26.3% of fingers without US nail involvement (p=0.166).

The thickness of DIP digital extensor tendons was correlated with the NBT(r = 0.412, p = 0.00), the NPT (r = 0.310, p = 0.00), and the thickness of the adjacent skin (r = 0.509, p = 0.00).

Conclusion

The presence of US nail dystrophy was associated with thicker extensor tendon and more erosions. The thickness of the tendon was correlated with the thickness of the nail parts.

This might be explained by the close relationship between nail and enthesis and supports the theory of the enthesis as an extended organ beyond the tendon bony attachment.

References

[1]Tan, A. L .et al (2006). Rheumatology, 46(2), 253–256.

Disclosure of Interests

None declared

AB0287 INFLUENCE OF COPING ON RHEUMATOID ARTHRITIS RELATED PAIN

Background

Most patients with rheumatoid arthritis (RA) have chronic pain. Nowadays dealing with pain is no more focused on traditional treatment only.

Objectives

Our study aimed to assess the impact of coping strategies on the chronic pain in RA subjects.

Methods

We performed a 6-month study including patients followed for RA according to ACR / EULAR 2010 criteria. The visual analogue scale (VAS) was used to assess the perception of pain. Coping was assessed by the Brief COPE questionnaire according to which five grouped strategies were identified: Problem solving that includes active coping and planning. Cognitive restructuring that combines humour, acceptance and positive reinterpretation. Support seeking that combines the search for instrumental support, the search for emotional support and religion. Avoidance that includes denial, blame, substance use and behavioural disengagement. Distraction that includes distraction and expression of feelings.

Results

We included 65 RA patients with 58 women and 7 men, the sex ratio was 0, 12 H/F. Mean age of the patients was 58, 6 [24 – 73 years]. Disease duration was superior to 10 years in 66, 2% of patients. RA was immunopositive in 87, 7% of cases and erosive in 83, 1 % of cases. The DAS28 (ESR) was on average 3, 4(IQR 25-75: 2, 8- 4, 6). The average of VAS was 5 ± 2,2. The perception of pain was positively associated with coping strategies based on problem solving, negatively associated to cognitive restructuring and distraction (Table 1).

Table 1.

Impact of coping strategies on chronic pain RA subjects

BpProblem solving0,4110,001Cognitive restructuring-0,3710,002Support seeking-0,0950,452Avoidance0,2430,252Distraction-0,2920,018

Conclusion

Our study revealed that having coping strategies based on problem solving increased the perception of pain whereas strategies based on distraction and cognitive restructuring decreased it.

Disclosure of Interests

None declared

AB0223 COXITIS AND ATLANTOAXIAL SUBLUXATION IN RHEUMATOID ARTHRITIS: IS THERE A LINK?

Background

Rheumatoid arthritis (RA) is an autoimmune chronic inflammatory disease that can over time be debilitating and life threatening vital prognosis through Atlantoaxial subluxation(ASS) and functional prognosis through coxitis.

Objectives

The aim of this work was to determine the correlation between coxitis and AAS in RA.

Methods

We performed a cross-sectional comparative study including 182 patients with RA meeting the ACR-EULAR 2010 criteria in a rheumatology department during the period from 2000 to 2021. The socio-demographic, clinical and radiological features were collected.

Results

Among the 182 patient enrolled, 16.4% (n=30) of patients had coxitis: unilateral in (90.24%; n = 27) and bilateral in (9.76%; n = 3). The coxitis was significantly found in males with a percentage of 40% vs 13.5% in females (p=0.01).

As it for the AAS, it was noted in 13.3% of our patients more frequently in males 41.2% vs 17.8% in females (p=0.044).

The discovery of AAS on standard radiographs was fortuitous in 70.4% of cases (systematic radiographic assessment for structural assessment of RA) and in 29.6% of cases presenting an inflammatory neck pain.

Cervical MRI was pathological in 63.4%. The abnormalities observed on MRI were: C1 – C2 synovitis (47.6%), confirmed LAA (42.9%) and basilar impression (9.5%).

C1-C2 instability was presumed anterior (90.9%), lateral (6.1%) and rotatory (3%). Two patients had basilar impression.

The occurrence of an atlantoaxial subluxation was significantly correlated to the anterior presence of a coxitis (p=0.000).

Conclusion

Our study suggest that in RA, the presence of a coxitis;mostly in males; can be a predictive factor for the occurrence of AAS but further studies are needed to confirm these results.

Disclosure of Interests

None declared

AB0833 Epicardial fat thickness: a novel marker of subclinical atherosclerosis in spondyloarthritis patients

Background

Chronic inflammatory process seems to be the underlying cause contributing to atherosclerosis in spondyloarthritis. Epicardial adipose tissue (EAT) which is the accumulation of visceral fat between the myocardium and the visceral layer of pericardium, is actually considered a novel cardiometabolic risk predictor (1). Recent studies have shown its association with the development of coronary atherosclerosis.

Objectives

The aim of our study was to assess the epicardial fat thickness (EFT) in patients with spondyloarthritis (SpA) in comparaison with healthy subjects.

Methods

We performed a prospective study including 47 patients meeting ASAS 2009 criteria for SpA compared to 47 healthy controls matched for age, gender and body mass index (BMI). Patients with history of cardiovascular risk factors or diseases were not included. Sociodemographic, clinical, biological and radiographic features related to the disease were recorded. All subjects underwent transthoracic echocardiography with measurement of EFT.

Results

SpA group included 33 men and 14 women, with a median age of 36 years (IQR: 28-46). Median BMI was 24.5 kg/m2 (IQR: 20.7-26.8). Median systolic (SBP) and diastolic (DBP) blood pressure were respectively 121 mmHg (IQR: 110-130) and 71 mmHg (IQR: 67-78).

Median disease duration was 11 years (IQR: 5-16). Median disease activity scores BASDAI and ASDAS-CRP were 2.6 (IQR: 1.8-3.8) and 2.18 (IQR: 1.62-2.91) respectively. Median CRP level was 6.45 mg/l (IQR: 1.5-19.9). Median BASFI and BASMI were 3 (IQR: 1.5-5.1) and 1.5 (IQR: 0-4) respectively. Coxitis was found in 53% of patients. SpA patients received: NSAIDs (92%), csDMARDs (51%) and TNF inhibitors (38 %).

EFT was significantly increased in SpA patients compared with healthy controls; median EFT value was 3.1 mm (IQR: 2.5-4) versus 2.4 mm (IQR: 2-3) (p=0.001).

Conclusion

As an early marker of atherosclerosis, EFT was significantly higher in SpA patients, supporting clinical evidence of increased cardiovascular risk in SpA. Thus, more studies that involve larger samples should be conducted, using EFT to cardiovascular risk stratification in SpA.

References

[1]Katsiki N, Mikhailidis DP. Epicardial fat: a novel marker of subclinical atherosclerosis in clinical practice? Anatol J Cardiol. 2017 Jan;17(1):64–5.

Disclosure of Interests

None declared

AB0956 To what extend is nail ultrasound discriminative between psoriatic arthritis and healthy subjects?

Background

Clinical physical examination can detect superficial nail changes in psoriatic patients. However, the nail matrix and bed are not accessible for clinical assessment. Recently, ultrasonography (US) has emerged as a useful tool to assess nail involvement in psoriatic arthritis (PsA) patients.

Objectives

To assess the discriminative utility of nail features detected by B-mode (BM) and color Doppler (CD) ultrasound (US) between patients with psoriatic arthritis (PsA) and healthy controls (HC).

Methods

This was a cross-sectional study including PsA patients and HC.

All patients and controls underwent an US assessment of the fingernails that included the study of morphological changes based on Wortsman’s description [1]: focal hyperechoic involvement of the ventral plate without involvement of the dorsal plate (type I), loosening of the borders of the ventral plate (type II), appearance of wavy plates (type III) and loss of definition on both plates (type IV), blood flow disturbances and measurement of the thickness of nail bed (NBT), nail plate (TNP) and adjacent skin.

Results

A total of 536 nails were examined (PsA:326 nails, HC:210). Patients with PsA had significantly more morphological changes of the nails than healthy controls (23% vs 3.33%, p = 0.006).

In PsA patients, the most frequently observed aspect was type III (47 nails, 14.4%), followed by type II (40 nails,12.3%) and type IV (38 nails, 11.6%). In HC, the only observed type was type (type II). US detected subclinical nail involvement in 37 healthy nails among PsA patients (11.34%). On the other hand, seven nails with clinical involvement did not demonstrate US changes: perionyxis (n=1), pitting (n=2), onycholyses (n=3), hemorrhage (n=1).

The power Doppler signal of the nail bed and matrix was comparable between the groups (54% vs 61%, p= 0.603 and 41% vs 37.1%, p=0.432, respectively).

NBT and skin thickness were higher in the HC group than the PsA group (1.90±0.22 mm vs 2.07±0.34 mm, p=0.047 and 2.25±0.69 vs 2.59±0.31 mm, p=0.002, respectively). While NPT was similar between the groups (0.38±0.09 vs 0.36±0.07mm, p=0.239).

Conclusion

Us detected morphological changes in clinically healthy fingernails in both PsA patients and healthy controls. However subclinical involvement was more common in PsA patients.

Loosening of the borders of the ventral plate (type II) was the only aspect observed in HC. This would suggest that this type is not a specific feature of psoriatic nail.

With regards to nail plate thickness, the measurements were similar between PsA patients and HC as previously reported by Mondal et al [2].

However, unlike previous studies, we showed that the nail bed and skin thickness were significantly higher in healthy controls than PsA patients [3].

References

[1]Wortsman X, Jemec GB. Ultrasound imaging of nails. Dermatol Clin. 2006;24(3):323‑8.

[2]Mondal S et al. Rheumatol Int. 2018;38(11):2087‑93

[3]Idolazzi L, et al. Clin Rheumatol .2019;38(3):913‑20

Disclosure of Interests

None declared

AB0869 Importance of screening of traditional cardiovascular risk factors in spondyloarthritis

Background

Epicardial adipose tissue has been associated with the development of coronary artery disease and recently suggested as a novel marker for evaluating subclinical atherosclerosis.

Objectives

The aim of our study was to assess the relationship between EFT and cardiovascular risk parameters in patients with spondyloarthritis (SpA).

Methods

We performed a case control study including patients meeting ASAS 2009 criteria for SpA, and healthy controls. Subjects were aged less than 50years old and without traditional cardiovascular risk factors. Clinical features related to the disease were recorded. Anthropometric data (body mass index (BMI), waist circumference and hip circumference) and arterial blood pressure of the patients were also recorded. Blood specimens were collected after 12 hours of fasting and total cholesterol, HDL, LDL, triglyceride and fasting glucose were measured. Total cholesterol to HDL ratio and LDL to HDL ratio were calculated. All subjects underwent Doppler echocardiography with measurement of EFT by an experienced cardiologist.

Results

We enrolled 47 SpA patients and 47 controls. Subjects were age, sex and BMI matched (p=0.267, p=0.589 and p=0.238 repectively). Median disease activity scores BASDAI and ASDAS-CRP were 2.6 (IQR 25-75%: 1.8-3.8) and 2.18 (IQR 25-75%: 1.62-2.91) respectively. Median waist and hip circumference were 88 cm (IQR 25-75%: 82-97) and 100 cm (IQR 25-75%: 91-97), respectively. Median systolic (SBP) and diastolic (DBP) blood pressure were respectively 121 mmHg (IQR 25-75%: 110-130) and 71 mmHg (IQR 25-75%: 67-78). Laboratory findings showed a median fasting glucose level (FG) of 4.93 mmol/l (IQR 25-75%; 4.55-5.1). Median total cholesterol (CT), HDL, LDL and triglyceride levels were respectively 3.66 mmol/l (IQR 25-75%: 3.18-4.28), 1.08 mmol/l (IQR 25-75%: 0.92-1.2), 2.17 mmol/l (IQR 25-75%: 1.78-2.6) and 0.84 mmol/l (IQR 25-75%: 0.79-1.15). CT/HDL ratio and LDL/HDL ratio were 3.48 (IQR 25-75%: 2.95-3.97) and 1.99 (IQR 25-75%: 1.54-2.48), respectively.

Median EFT was significantly increased in patients compared to controls (3.1 mm (IQR: 2.5-4) versus 2.4 mm (IQR: 2-3), p=0.001).

A positive correlation was found between EFT and SBP (p=0.028; r=0.323) and triglyceride level (p=0.022, r=0.349). In contrast, EFT was not associated with DBP (p=0.069, r=0.270), BMI (p= 0.223, r=0.181), waist circumference (p=0.114, r=0.234), hip circumference (p=0.451, r=0.113), CT (p=0.127; r=0.236), HDL (p=0.587; r=0.085), LDL (p=0.342; r=0.149), FG (p=0.104, r=0.248), CT/HDL ratio (p=418; r=0.128) and LDL/HDL ratio (p=0.683;r=0.064).

In multivariate linear regression, triglyceride level was identified as an independently predictor of increased EFT (B=0.676; 95% confidence interval = 0.209-1.143; p= 0.006).

Conclusion

The importance of our results that we identified a traditional cardiovascular risk factor as a predictor of subclinical atherosclerosis in SpA without cardiovascular risk factor and with normal triglyceride level. This finding highlights the importance of regular screening for traditional cardiovascular risk parameters even if the disease in low activity.

Disclosure of Interests

None declared

POS0361-PARE THE MEDIATING EFFECT OF PAIN CATASTROPHIZING ON WORK PRODUCTIVITY

Background

Work disability is a major patient outcome for spondyloarthritis (SpA) patients since SpA mostly appears in younger adults.

Objectives

we examined the influence of catastrophizing as a negative psychological factor on work productivity and activity impairment in SpA.

Methods

We conducted a cross-sectional study over a 3 months period. We included patients treated with SpA (Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria). Patients related data, and disease characteristics were collected. Pain catastrophizing were assessed by the pain catastrophizing score (PCS). Work productivity and activity impairment were evaluated by Work productivity and Activity Impairment Questionnaire (WPAI). WPAI score examined four aspects of the patient’s life: Absenteeism due to SpA and presenteism at work, work productivity loss and activity impairment.

Results

Sixteen SpA patients were enrolled (22 females and 38 males). Mean age was 39,4 years ± 11,08. Mean disease duration was 11,37 years ±7,23; 28 were unemployed. Among workers, absenteeism due to SpA was reported in 7 cases (21,9%). Mean absenteeism rate was 2,35% [0-20]. Both mean work productivity loss and mean activity impairment were 50,23% [20-90].

Mean PCS was 15,73 ± 13,893. Thirteen patients (21,7%) had PCS >30 which indicates a clinically relevant level of catastrophizing, and only two of them reported absenteeism at work. PCS score was higher in patients with absenteeism (mean score=26), compared to patients without absenteeism (mean score=16,96), (p=0,166). Presenteeism was lower in patients with higher pain catastrophizing scores, without reaching a significant difference (p=0,066). A higher PCS was significantly correlated with a greater work productivity loss (p= 0,036, r=0,371) and greater activity impairment (p=0,005, r=0,36).

Conclusion

In our series, pain catastrophizing affected work productivity and daily activity in patients with SpA.

Disclosure of Interests

None declared

POS0620 RHEUMATIC DISEASE COMORBIDITY INDEX: IT IS A PREDICTOR OF OUTCOMES IN RHEUMATOID ARTHRITIS?

Background

Comorbidities are frequent among patients with rheumatoid arthritis (RA). They influence clinical outcomes and treatment response. Comorbidity indices are developed to study their impact on different outcomes [1].

Objectives

The aim of our study was to assess comorbidity among RA patients and to explore the association between comorbidities and the clinical profile of the rheumatic disease.

Methods

We conducted a retrospective study in our rheumatology department including 255 patients with established RA according to the ACR/EULAR 2010 criteria. The Disease Activity Scale (DAS28) and the functional impairment (HAQ) were noted. Comorbidities were collected. Rheumatic Disease Comorbidity Index (RDCI) was calculated for each patient. It is rated from 0 to 9 and comprises 11 comorbid conditions including lung disease, cardio-vascular disease, hypertension, diabetes, fracture, depression, cancer, and gastrointestinal ulcer [2].

Results

There were 255 RA with sex ratio M/F at 0.2. The mean age was 58.92 ± 10.72 years [25-85]. The mean age at onset of disease was 43.78 ± 14.28 years [13-81]. The mean disease duration was 16.32 ± 14.3 [1-72]. Identified comorbidities were: hypertension (31.4%), lung disease (27.1%), diabetes (19.6%), cardio-vascular disease (16.8%), gastrointestinal ulcer (9.2%), depression (8.8%), and chronic renal failure (8%).

The mean RDCI was 1.14 ± 1.25 [0-6]. A statistically significant correlation was found between RDCI and age (p<10-3, r=0.277), RDCI and age at disease onset (p<10-3, r=0.3). RDCI was not correlated to the disease duration (p=0.27). RDCI was not associated with the DAS28 (p=0.5) nor with the HAQ (p=0.4). RCDI was not significantly different in terms of sex (female: 1.2 vs male: 1.3, p=0.09). This comorbidity index was associated with the presence of extra articular manifestation (presence: 1.4 vs absence: 0.8, p=0.004). It was associated with pulmonary involvement (presence: 1.7 vs absence: 0.6, p<10-3). There was an association between the presence of radiographic erosions and RDCI (1.2 vs 1, p=0.001). RDCI was also associated with atlanto-axial dislocation (p=0.009) and with coxitis (p=0.009). Comorbidity index was statistically different between patients on biologic drugs and patients without biologic drugs (1.6 vs 0.9, p<10-3).

Conclusion

Our study showed that comorbidity index was associated with a severe disease and signs of poor prognosis (erosions, coxitis, andatlanto-axial dislocation). This confirmed the hypothesis that comorbidity can be a threat to the improvement in the long-term prognosis in RA patients.

References

[1]Aslam F, Khan NA. Tools for the Assessment of Comorbidity Burden in Rheumatoid Arthritis. Front Med. 2018; 5:39.

[2]England BR, Sayles H, Mikuls TR, Johnson DS, Michaud K. Validation of the rheumatic disease comorbidity index. Arthritis Care Res (Hoboken). 2015;67(6):865-72.

Disclosure of Interests

None declared

AB0834 Epicardial fat thickness is associated with patient-reported outcomes in Spondyloarthritis

Background

Epicardial adipose tissue (EAT) is a metabolically active visceral fat located between the myocardium and the visceral pericardium. Increased epicardial fat thickness (EFT) has been shown as a novel cardiovascular risk factor in some recent studies (1), (2) and have been suggested as a marker for cardiovascular risk stratification. Few studies have studied EFT in patients with SpA.

Objectives

The aim of our study was to assess the relationship between EFT and Patient-Reported Outcomes (PROs) in SpA patients.

Methods

We conducted a case control study over a 12 months period. Patients diagnosed with SpA according to ASAS 2009 criteria and age and sex matched controls were included. All subjects were aged less than 50 years old and without cardiovascular risk factors. Clinical data related to the disease were collected. Patient-Reported Outcomes (PROs): morning stiffness duration, nocturnal awakenings, pain visual analog scale (VAS) and patient global assessment (PGA) were recorded. BASG-s (Bath Ankylosing Spondylitis-Global score) was also raised. All patients underwent echocardiographic examination with measurement of EFT.

Results

We included 94 subjects (47 patients and 47 controls), sex ratio was 2.35, and median age was 36 years (IQR: 18-32). Median disease duration was 11 years (IQR: 5-16). Median disease activity scores BASDAI and ASDAS-CRP were 2.6 (IQR: 1.8-3.8) and 2.18 (IQR: 1.62-2.91) respectively. Regarding Patient-Reported Outcomes (PROs); median duration of morning stiffness was 5 minutes (IQR: 0-180) and median number of nocturnal awakenings was 0 (IQR: 0-2). Median VAS pain and median PGA were 50 (IQR: 30-60) and 40 (IQR: 30-60), respectively. Median EFT was significantly increased in SpA patients 3.1 mm (IQR: 2.5-4) compared with healthy controls 2.4 mm (IQR: 2-3) (p=0.001).

EFT was positively correlated with VAS pain (p=0.012; r=0.363) and BASG-s (p=0.025; r=0.327). No significant association was found between EFT and Morning stiffness duration (p=0.164; r=0.206), Nocturnal awakenings (p=0.463; r=0.11) and PGA (p=0.07; r=0.267).

In multivariate linear regression analysis, pain visual analog scale was found to be independently associated with EFT (B=0.126; 95% Confidence Interval: 0.017-0.236; p=0.025).

Conclusion

EFT measurement as an early marker of atherosclerosis was associated with pain and BASG score.

References

[1]Mahabadi AA, Lehmann N, Kälsch H, Robens T, Bauer M, Dykun I, et al. Association of epicardial adipose tissue with progression of coronary artery calcification is more pronounced in the early phase of atherosclerosis: results from the Heinz Nixdorf recall study. JACC Cardiovasc Imaging. 2014 Sep;7(9):909–16.

[2]Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al. Pericardial Fat, Visceral Abdominal Fat, Cardiovascular Disease Risk Factors, and Vascular Calcification in a Community-Based Sample. Circulation. 2008 Feb 5;117(5):605–13.

Disclosure of Interests

None declared

AB0960 Ultrasonographic assessment of distal interphalangeal joints in psoriatic arthritis

Background

Distal interphalangeal (DIP) joint involvement is frequent in Psoriatic arthritis (PsA). Ultraousnd (US) may help identify subclinal DIP arthritis.

Objectives

We aimed to assess by US the DIP joint involvement in PsA in comparison with healthy controls (HC).

Methods

This was a cross-sectional study including 33 PsA patients and 21 matched-healthy controls (HC).

An US scan of all DIP joints was performed in order to look for erosions, synovitis (B-mode and doppler) and extensor tendon enthesopathy.

Results

We included 33 patients with PsA and 21 HC.

There was no difference between the two groups regarding the age (51.2 ±12.5 vs 53±11.8 years, p=0.5), sex-ratio (0.65 vs 0.61, p=1), manual activity (p=1) and smoking status (23.8% vs 18%, p=0.433).On clinical examination,we did not find any tender nor swollen DIP joints in both groups. Eleven PsA patients (34 %) had psoriatic onychopathy (45 fingernails) with a mean NAPSI 7 (IQR (25,75)) [2 -18].

In the PsA group, a total of 323 DIP joints were examined by US, synovitis of the DIP joints was detected in ten DIP joints (3.1%)(right hand: seven, left hand:three), six of them had PD (right hand:four, left hand:two). Eosions were found in 16 DIP joints (4.95%) (right hand:seven, left hand: nine). Enthesophytes were seen in 82 DIP joints (25,2%).

At patient level, six PsA patients had at least one US synovitis (18.1%), seven had at least one erosion (21.2%) and 22 had at least one DIP joint with enthesophytes (66.6%)

Compared to HC, PsA patients had more synovitis (3.1% vs 0, p=0.001),more erosions (4.95% vs 0.4%, p=0,03), and more enthesophytes (25.2% vs, 17%, p=0,002)

The was no difference between the two groups regarding the thickness of the extensor tendon (0.63 mm vs 0.61 mm, p=0.594).

In the PsA group, the patients with nail dystrophy had more osteophytes (24% vs 10%, p<0,001), more erosions (14.6% vs 1.96%, p=0.000), and more synovitis (6%, vs 1.9%, p=0.037).

Conclusion

Subclinical involvement of DIP joints is common in PsA patients, notably in the presence of nail dystrophy.

Disclosure of Interests

None declared

AB0211 FOOT IMPAIRMENT IS NOT A BARRIER TO PHYSICAL ACTIVITY IN RHEUMATOID ARTHRITIS

Background

Physical activity is increasingly promoted for patients with Rheumatoid arthritis (RA) and strongly recommended. However, adherence to regular physical activity remains low. Identifying the barriers to physical activity is a key element to understanding physical activity behavior in RA.

Objectives

Our objective was to assess the impact of foot involvement on physical activity among patients with RA.

Methods

We conducted a cross-sectional study including patients with RA, fulfilling the ACR-EULAR 2010 criteria. We collected the socio-demographic data and disease characteristics. Regarding the foot involvement, we assessed the presence of foot static disturbances and foot deformities through clinical examination, and radiographic damage. Physical activity was assessed by the Arabic version of validated International Physical Activity Questionnaire (IPAQ). According to this questionnaire, patients were subdivided into three groups: low, moderate and high physical activity.

Results

We included 94 RA (60 rheumatoid factor (RF) positive RA and 57 Anti Citrullinated Peptides Antibodies (ACPA) positive RA) patients. Eighty-six were females, mean age 52,12 ±9,743 years. The mean disease duration was 14,78 years ± 9,425. RA was erosive in 81 cases. Sixty-four patients had extra articular manifestations: pulmonary (n=15), dry syndrome (n=46), rheumatoid nodules (n=7) and osteoporosis (n=25). Mean DAS28CRP score was 3,67 ±1,58 and mean HAQ score was 0,88 ± 0,65. Eighty patients were treated by cs-DMARDS and 31 by biologics: infliximab (n=3), etanercept (n=3), adalimumab (n=2), golimumab (n=3), certolizumab (n=1), tocilizumab (n=11), rituximab (n=4).

Forty-six patients complained of fore foot pain, 34 of mid foot pain and 19 of hind foot pain. Mean visual analogue scale for foot pain was 3,6 ±3,05, and no significant correlation was shown with IPAQ score (p=0,19, r=0,138). Foot static disturbances were present in 66 patients: bilateral flat foot (n=31), hallux valgus (n=59), claw toes (n=33) calcaneal valgus (n=25), peroneal tenosynovitis (n=24), tibialis posterior tenosynovitis (n=18), ankle arthritis (n=15) and mid-foot arthritis (n=18). We didn’t find a significant association between lower IPAQ score and foot deformities (p=0,235), the presence of peroneal tenosynovitis (p=0,438) and tibialis posterior tenosynovitis (p=0,113).

As regards X-rays findings, bone erosions were found in 58 patients, joint narrowing in 65 patients, and dislocation of the MTP joints in 17 patients. No positive association with lower IPAQ score was found with structural damage: erosions (p=0,938); joint narrowing (p=0,258) and dislocation of the MTP joints (p=0,884). DAS28 was higher among patients with low physical activity (mean DAS28crp among this population was 4,16 compared to 3,63 among patients with high physical activity), but without reaching a significant threshold (p=0,432, r=-0,85).

Conclusion

Increasing physical activity in RA patients is an ongoing challenge. In this study, no association was found between foot involvement in RA and a lower IPAQ score.

Disclosure of Interests

None declared

AB1218 AURICULOTHERAPY AS A TREATMENT FOR CHRONIC NECK PAIN: AN INTERVENTIONAL COMPARATIVE STUDY

Background

Data indicates promising benefits of auriculotherapy (AT) in pain management of several pathologies. Common cervical pain (CCP) is recurrent plaint often resistant to standard treatment. And use of auriculotherapy as a therapeutic solution in neck pain has not been well explored.

Objectives

The aim of our study is to evaluate efficacy of a single session of AT in the management of CCP’s pain and disability.

Methods

We conducted an interventional comparative study. Fifty patients with CCP consulting were divided in two group of 25: group A underwent a session of AT, group P had a placebo treatment using a detuned ultrasound machine. Evaluation of the patients was performed before, and right after the intervention. The Neck and Pain Disability Scale (NPDS) questionnaire. It includes 3 areas: F1 for functional disability, F2 for movement-induced pain and F3 for pain in static position.

Results

We enrolled 32 women and 18 men with an average age of 47. Epidemiological, clinical and radiographic features were comparable for both groups, except for the standard of living and the consumption of analgesics, which were significantly higher in the group A (p=0.027and p<0.001, respectively). Initially, NPDS total score and F1, F2, F3 sub scores were comparable in both groups.

After the intervention, all scores had decreased significantly. In the A group: NPDS total went from 34.3 to 22.9 (p<0.001), F1 went from 9.5 to 6.2 (p<0.001), F2 went from 16.5 to 11.9 (p<0.001), F3 from 8 to 5.4 (p<0.001). In the P group: NPDS total decreased from 28.9 to 26 (p=0.001), F1 from 6.3 to 5.7 (p= 0.001), F2 going from 14.4 to 13.3 (p =0.013), F3 went from 8 to 7.3 (p=0.006).

When we compared the scores after the intervention, the improvement was statistically higher in the A group for all scores (p<0.001 for total, F1 and F2, and p=0.002 for F3 sub score).

Conclusion

Our study revealed that a single session of auriculotherapy is effective on short term in the treatment of pain and disability related to CCP. This alternative technique may gain its place in the therapeutic management protocol to overcome disability of chronic neck pain.

Disclosure of Interests

None declared

AB0291 COMORBIDITIES PROFILES IN SEROPOSITIVE RHEUMATOID ARTHRITIS VERSUS SERONEGATIVE RHEUMATOID ARTHRITIS

Background

Patients with seropositive rheumatoid arthritis (RA) (positive Rheumatoid Factor (RF)) are more susceptible to extra-articular manifestations [1]. The role of RF in the occurrence of comorbidity is not clear.

Objectives

We aimed to compare comorbidities among patients with seropositive RA versus patients with seronegative RA.

Methods

We conducted a retrospective study in our rheumatology department including 255 patients with established RA according to the ACR/EULAR 2010 criteria. Patients were divided in two groups according to their Rheumatoid Factor (RF) profile: seropositive RA (positive RF), seronegative RA (negative RF). Comorbidities were investigated and compared between the two patients groups.

Results

There were 206 seropositive RA and 49 seronegative RA. Gender distribution was similar in the two groups: 82% female and 18% male in seropositive RA; 85% female and 15% male in seronegative RA (p=0.5). Smoking was noted in 15% patients with seropositive RA and in 11% patients with seronegative RA without any difference (p=0.5).

Comorbidities were noted in 49% of seropositive RA and in 45% of seronegative RA without any significant difference (p=0.6). Obesity (BMI ≥ 30kg/m2) was noted in 31% of seropositive RA and in 36% of seronegative RA (p=0.7). Diabetes was noted in 18 % seropositive RA and in 26% seronegative RA patients (p=0.1). Hypertension was noted in 31% seropositive RA patients and in 30% seronegative RA (p=0.8). Heart disease was present in 6% seropositive RA and in 7% seronegative RA (p=0.9). Dyslipidemia was noted in 40% seropositive RA and in 20% seronegative RA (p=0.1). Gastrointestinal comorbidities were observed in only seropositive RA patients (11%). Respiratory comorbidities were noted in 27% seropositive RA and in 28% seronegative RA without any significant difference (p=0.6). Regarding mental health problems, depression was noted in 7% seropositive RA and in 14% seronegative RA without any significant difference (p=0.4).

Conclusion

Our study showed that comorbidities were comparable in seropositive and seronegative RA. It seems that RF does not influence the prevalence of comorbidities in RA patients.

References

[1]Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kërliu S, Rexhepi M. Extra-Articular Manifestations of Seronegative and Seropositive Rheumatoid Arthritis. Bosn J Basic Med Sci. 2010;10(1):26–31.

Disclosure of Interests

None declared

AB0859 Assessment of self-esteem and reintegration to normal living in Spondyloarthritis patients

Background

Spondyloarthritis is a chronic inflammatory disease involving sacroiliac joints and spine. It mainly affects young patients typically of working age. Pain, reduced spinal mobility and deformities may lead to psychological distress.

Objectives

The aim of our study was to assess self-esteem and social reintegration in spondyloarthritis patients in comparaison with healthy controls.

Methods

Fifty patients diagnosed with spondyloarthritis and 50 healthy controls aged less than 50 years old, were included in our study. Clinical, biological and radiological data related to disease were recorded. All subjects completed Reintegration to Normal Living Index (RNLI) and Rosenberg self-esteem scale (SES) questionnaires.

Results

Our study population included 39 men (78%) and 11 women (22%) with a mean age of 36.8 years [17-50]. Mean disease duration was 11.3 ± 8.2. Mean disease activity scores BASDAI, ASDAS-CRP and ASDAS-ESR were respectively 4.45 ± 1.84, 3.03± 1.06 and 2.74 ± 1. For inflammatory markers, mean CRP and ESR levels were respectively 29.3 ± 41.8 mg/l and 46.5 ± 35.3. Mean BASFI and BASRI scores were respectively 5.21 ± 2.24 and 5.5 ± 2.38. Forty eight pour cent of patients had an extra-articular feature and 47% had coxitis. Regarding treatment, 47% were on TNF inhibitors.

Mean SES was 30.6 [25-36]. Fifty six per cent of patients had a low self-esteem (SES<31) and 12% had high self-esteem (SES>34). Self-esteem was within the normal ranges (SES between 31 and 34) in 32% of patients. Mean reintegration to normal life (RNL) adjusted score was 72.8 ± 9.3.

Significant association was found between RNL adjusted score and BASDAI (p=0.02, r=0.126) and BASFI (p=0.034, r=0.235). There was no significant association between RNL adjusted score and disease duration (p=0.747), CRP (p=0.213), ESR (p=0.818), ASDAS-ESR (0.747) and ASDAS-CRP (p=0.330) and BASRI scores (p=0.413). No association was found between SES score and disease duration (p=0.447), activity scores BASDAI (p=0.178), ASDAS-ESR (p=0.929) and ASDAS-CRP (p=0.940), ESR (p=0.417) and CRP levels (p=0.828), as well as BASFI (p=0.295) and BASRI (p=0.470).

In comparaison with healthy controls, adjusted RNL score was significantly lower in patients with spondyloarthritis (72.8 versus 77.65; p=0,017). In contrast, no significant difference was found between the two groups when comparing SES score (31.4 in spondyloarthritis patients versus 30.6 in healthy controls, p=0.283).

Conclusion

In our study, spondyloarthritis patients had lower RNL score in comparaison with healthy subjects. Reintegration to normal living was associated with disease activity and functional impairment. In contrast, self-esteem was similar between the two groups.

Disclosure of Interests

None declared

AB1544-HPR CLINICAL COMORBIDITY PHENOTYPE IN KNEE OSTEOARTHRITIS IS ASSOCIATED WITH HIGHER INTENSITY SCORES

Background

Knee osteoarthritis (OA) is a common osteoarticular disease. Its prevalence increases with age as well as the coexistence of other chronic diseases. Recent researches have revealed an association between OA and cardiovascular diseases. However, association between knee OA and comorbidities has not been fully studied.

Objectives

The purpose of this study was to investigate the association between knee OA and comorbidities.

Methods

In this cross-sectional study, patients with knee OA were enrolled. Sociodemographic data as well as comorbidities were collected. Grading of knee OA was performed using the Kellgren-Lawrence (KL) grading system. Functional impact of knee OA was assessed by KOOS-Physical Function Shortform (KOOS-PS).

Results

This study assessed 104 patients with knee OA (10 men and 94 women). Mean age was 65.83 ±11.08 years. Mean VAS pain was 6.56 ± 1.72. Mean KOOS-PS was 15.58 ± 6.73. Up to 81 patients (77.9%) had severe knee OA according to the KL grading system. Comorbidity was noted in 92 cases (88%). The most frequent comorbidities were obesity (62.5%), hypertension (61.5%) and dyslipidemia (43.3%). Comorbidities in knee OA were associated with age (p=0.04), neuropathic pain component (p=0.02) and VAS pain (p=0.04). Our study also showed a significant correlation between comorbidities and structural grading of knee OA (p=0.04). However, comorbidities were not correlated with KOOS-PS score (p=0.06).

Conclusion

The accumulation of comorbidities is significantly associated with higher intensity scores in knee OA. Physicians should additionally pay close attention to the prevention and the treatment of comorbidities in the management of OA.

Disclosure of Interests

None declared

POS1540-HPR CENTRAL SENSITIZATION PLAYS A PROMINENT ROLE IN DISEASE ACTIVITY, FUNCTIONAL IMPAIRMENT AND QUALITY OF LIFE IN PATIENTS WITH SPONDYLOARTHRITIS

Background

Pain in rheumatic diseases is substantially due to an excess of nociception in response to chronic inflammation. However, the share of nociplastic pain in these disorders shouldn’t be overlooked. Different tests have been evaluated but some of them require expensive equipment.

Objectives

to assess The Central Sensitization in young patients with spondyloarthritis (SpA) using a simple and validated tool: The Central Sensitization Inventory (CSI).

Methods

We conducted a cross-sectional study including patients with SpA, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. For all patients, we collected the following data: age, age at onset of SpA, disease duration, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing spondylitis quality of life score (ASQOL) and functional statement by Bath ankylosing spondylitis functional index (BASFI). Nociceptive pain was assessed by VAS pain, neuropathic pain was assessed by DN4 and nociplastic pain was assessed by CSI.

Univariable and multivariable linear regression analyses were used to investigate the association between CSI scores, patient-related parameters and disease characteristics.

Results

Sixteen SpA patients (50 axial SpA, 8 axial and peripheral SpA, 1 psoriatic arthritis and 1 SpA associated with inflammatory bowel disease) were enrolled. There were 22 females and 38 males. Mean age was 39,4 years ± 11,08, mean age at onset was 23,61 years± 8,5 and mean disease duration was 11,37 years ±7,23. Mean night awakenings was 0,92 [0, 3], mean VAS pain was 5,27 [1, 9]. Mean BASDAI was 3,53 ± 3,34, mean BASFI was 4,01 ± 2,53, mean ASQOL was 6,3 ± 5,128 and mean DN4 was 1,72 [0, 7].

Mean CSI score was 20,38 ± 18,657. Six patients (10%) had a CSI score≥ 40, which indicates a central sensitization. CSI score>40 was not associated with the gender (p=0,659), nor axial presentation of SpA (p=0,644), nor the presence of coxitis (p=0,217). CSI score was not correlated with disease duration (p=0,306) nor age at onset (p=0,376). It was however associated with a BASDAI>4 (p=0,039).

A positive correlation was found between higher CSI score and higher ASQOL (p<0,001, r=0,744), VAS pain (p=0,061, r=0,282), more frequent night awakenings (p=0,009, r=0,433), higher BASDAI (p=0,006, r=0,379) and higher BASFI (p=0,055, r=0,270).

Conclusion

Higher CSI score was associated with higher disease activity, more frequent night awakenings, poorer quality of life and greater functional impairment. A global and comprehensive management including these factors as well as nociplastic pain should help the patient achieve better outcomes.

Disclosure of Interests

None declared

AB0777 Influence of TNF inhibitors on subclinical atherosclerosis in Spondyloarthritis patients

Background

Spondyloarthritis is a chronic inflammatory disease associated with increased cardiovascular morbidity and mortality due to accelerated atherosclerosis. Recent studies have reported the benefit of TNF inhibitors in reducing the risk of cardiovascular events and its association with changes in lipid profile. Nevertheless, it remains controversial.

Objectives

We aimed to investigate the effect of TNF inhibitors on subclinical atherosclerosis assessed with carotid intima-media thickness (CIMT) and flow mediated dilatation (FMD) in patients with spondyloarthritis (SpA).

Methods

We performed a cross sectional study including 47 patients meeting ASAS 2009 criteria for SpA. Patients with traditional cardiovascular risk factors were excluded. We collected clinical data, therapeutic modalities and biological tests including total cholesterol, HDL, LDL and triglyceride after 12 hours of fasting. FMD and mean CIMT (mean value of right and left carotid artery) were measured with a Mindray Resona 7 ZST+ ultrasound machine by an experienced radiologist.

Results

Among the 47 subjects, 18 patients (38%) were receiving TNF inhibitors for a median duration of 36 months (IQR 25-75%: 24-72) (9 were on Etanercept, 7 were on Adalimumab, one patient was on Infliximab and one was on Golimumab). The group treated with TNF inhibitors had a median age of 43 years (IQR 25-75%: 36-46.5) and a median duration of the disease of 12 years (IQR 25-75%: 9.5-22). Median ASDAS and BASDAI scores were 2.40 (IQR 25-75%: 1.48-3.1) and 2.60 (IQR 25-75%: 1.55-3.75) respectively. On the other hand, patients naïve to TNF inhibitors had a median age of 32 years (IQR 25-75%: 55-42), median disease duration of 7 years (IQR 25-75%: 3-12.5), median ASDAS of 2.13 (IQR 25-75%: 1.61-2.91), and median BASDAI of 2.40 (IQR 25-75%: 1.55-3.75).

When comparing the two groups, there was no significant difference regarding disease activity scores ASDAS (p=0.431) and BASDAI (p=0.793) as well as biochemical variables; total cholesterol (p=0.483), HDL (p=0.395), LDL (p=0.263) and triglyceride (0.092). In contrast, patients on TNF inhibitors were significantly more aged (p=0.009) and had a significantly higher duration of the disease (p=0.004).

Doppler ultrasound examination showed a median CIMT of 0.56 mm (0.48-0.64) in patients treated with TNF inhibitors versus 0.55 mm (0.48-0.60) in patients naïve to TNF inhibitors with no significant difference (p=0.238). Patients on TNF inhibitors had lower values of FMD (with a median of 12.5 (6.7-16) versus 15.5 (10-24.5)). However this difference was not significant (p=0.182).

Conclusion

In our study, biological treatment with TNF inhibitors did not affect endothelial function and subclinical atherosclerosis in patients with spondyloarthritis. Given the small size of our study population and its heterogeneity in terms of age and duration of the disease, no conclusions can be drawn. Further longitudinal studies that involve larger samples are necessary.

Disclosure of Interests

None declared

AB0845 IMPORTANCE OF WEIGHT MANAGEMENT ON ENDOTHELIAL FUNCTION IN SPONDYLOARTHRITIS

Background

Subclinical atherosclerosis is not rare in spndyloarthritis (SpA) patients. Endothelial dysfunction is the first step of atherosclerosis process. Obesity is a major traditional cardiovascular risk factor.

Objectives

The purpose of our study was to determine the association of anthropometric measures with endothelial dysfunction in non-obese SpA patients.

Methods

This was a prospective study conducted over 12 months and including 47 SpA free cardiovascular disease patients and aged less than 50 years. The following anthropometric parameters were collected for each patient: weight, height, Body Mass Index (BMI), hip and waist circumferences. Endothelial dysfunction was assessed by the ultrasound evaluation of the Flow Mediated Dilatation (FMD).

Results

There were 14 female (28.8%) and 33 male (70.2%). The median age was 36 years (IQR; 18-50). The median disease duration was 11 years (IQR; 1-32). The median weight, height and BMI were 69 (IQR; 43-95), 170 cm (IQR; 144-193) and 24.5 kg/m2 (IQR; 16.33 - 29.41), respectively. Overweight (BMI: 25-29 kg/m2) was noted in 40% of patients. The median hip and waist circumferences were respectively 100 cm (IQR; 84-116) and 88 cm (IQR; 70-114). Median FMD was 18.18% (IQR; 12.8-23.1). We didn’t found correlation between anthropometric parameters and FMD: weight (p=0.225; r=-0.180); height (p=0.273; r=-0.163), BMI (p=0.437; r=-0.116); waist circumference (p=0.22; r=-0.182) and hip circumferences (p=0.142; r=-0.217).

Conclusion

Our study showed that anthropometric parameters do not influence endothelial function in non-obese and young SpA patients. This highlights the importance of weight management and maintaining a healthy weight in SpA patients.

Disclosure of Interests

None declared

AB0309 ASSOCIATION BETWEEN RHEUMATIC DISEASE COMORBIDITY INDEX AND PULMONARY INVOLVEMENT IN RHEUMATOID ARTHRITIS

Background

Pulmonary involvement is one of the primary contributors of morbi-mortality among patients followed for Rheumatoid Arthritis (RA) [1]. Comorbidities are also independent factors of poor outcomes on those debilitated population.

Objectives

We aimed to assess association between comorbidity and pulmonary involvement in rheumatoid arthritis

Methods

We conducted a retrospective study in our rheumatology department including patients with established RA according to the ACR/EULAR 2010 criteria. Rheumatic Disease Comorbidity Index (RDCI) was calculated for each patient. Clinical characteristics, radiological findings, and respiratory function tests (PFTs) for pulmonary involvement were collected.

Results

There were 255 patients: 212 female (83.1%) and 43 male (16.9%). The mean age was 58.92 ± 10.72 years [25-85]. The mean RDCI was 1.14 ± 1.25 [0-6]. Pulmonary involvement was noted in 115 patients (45.3%). It was asymptomatic in 50.6% of cases. Reported clinical symptoms were dyspnea (36.1%), chronic cough (8.4%), and dyspnea with chronic cough (4.8%).

PFT showed a restrictive syndrome in 34.9% of cases, an obstructive syndrome in 4.8%, a mixed syndrome 3.6% and was normal in 56.6% of patients. Non-specific interstitial pneumonia was noted in 26.6% of patients, followed by nodular lung disease in 11.4 %, usual interstitial pneumonia in 11.4%, BOOP in 6.3%, and then pleural nodules in 6.3%.

An association was noted between RDCI and pulmonary involvement (presence: 1.7 ± 1.3 vs absence: 0.6 ± 0.8, p<10-3).

Conclusion

In conclusion, there was an elevated comorbidity index in patients with pulmonary involvement. Comorbidities may be a predictive factor of extra-articular manifestations. The early management may improve outcomes in RA patients.

References

[1]Hyldgaard C, Hilberg O, Pedersen AB, Ulrichsen SP, Løkke A, Bendstrup E, et al.A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis. 2017;76(10):1700–1706.

Disclosure of Interests

None declared

POS1541-HPR PAIN CATASTROPHIZING IS FREQUENT AND IMPACTS THE LIFE AND FUNCTION OF PATIENTS WITH SPONDYLOARTHRITIS

Background

Psychological care for patients with spondyloarthritis (SpA) should be standard practice if we aim to achieve better outcomes. In fact, pain catastrophizing, anxiety, and depression are to look for when the patient remains unsatisfied despite the clinicobiological control of the disease.

Objectives

To assess the presence of pain catastrophizing among patients with SpA.

Methods

We conducted a cross-sectional study including patients with SpA, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. For all patients, we collected the socio-demographic data and disease characteristics, the following scores: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath ankylosing spondylitis functional index (BASFI), the Ankylosing spondylitis quality of life score (ASQOL) were used to evaluate respectively disease activity, functional status and quality of life. The presence of pain catastrophizing was assessed by the arabic validated version of Pain catastrophizing score (PCS) and nociplastic pain by Central Sensitization Inventory (CSI).

Results

We included 60 SpA patients (sex ratio=1,72). Mean age was 39,4 years ± 11,08. Mean disease duration was 11,37 years ±7,23. Mean BASDAI score was 3,53± 3,34, mean BASFI was 4,01 ±2,53 and mean ASQOL score was 6,3 ±5,12. Mean PCS was 15,73 ± 13,893. thirteen patients (21,7%) had PCS >30 which indicates clinically relevant level of catastrophizing. PCS was significantly higher in men (mean PCS was 19,29 in men versus 9,59 in females), p=0,003. Clinically relevant level of catastrophizing (PCS>30) was significantly associated with age: mean age was 45,61 years in patients with PCS>30 compared to 37,47 in patients with lower PCS (p=0,022). Higher PCS was correlated with greater central sensitization assessed by the CSI (p<0,0001, r=0,621), poorer quality of life assessed by the ASQOL (p<0,0001, r=0,818) and greater functional impairment appraised by BASFI (p=0,009, r=0,347). No correlation was shown between PCS and age (p=0,640, r=0,062), age at disease onset (p=0,580, r=-0,84), disease duration (p=0,805, r=0,037), patient’s global assessment (p=0,211, r=0,197), CRP value (p= 0,425, r=-0,130) and BASDAI score (p=0,073, r=0,244).

Conclusion

Pain catastrophizing was not influenced by inflammation parameters. PCS was correlated with greater central sensitization, poorer quality of life and greater functional impairment. Therefore, psycho-education should be investigated among patients with SpA.

Disclosure of Interests

None declared

AB0857 Increased carotid intima-media thickness is correlated with renal function in spondyloarthritis

Background

Cardiovascular diseases are the main cause of mortality in spondyloarthritis and seem to be multifactorial. Due to its easy application and reproductibility, carotid intima-media thickness (CIMT) is increasingly used for assessment of subclinical atherosclerosis and cardiovascular risk stratification.

Objectives

The aim of our study was to investigate the relationship between CIMT and renal function in patients with spondyloarthritis (SpA).

Methods

We performed a cross sectional study including 47 patients with SpA and no history of cardiovascular disease. Clinical and biological data were recorded. Data related to renal involvement and creatinine level were extracted. CIMT was measured in the right and the left common carotid artery by an experienced radiologist; than mean CIMT was calculated.

Results

Our study included 33 men and 14 women with a sex ratio of 2.35, a median age of 36 years (IQR 25-75%: 28-46) and a median duration of the disease of 11 years (IQR 25-75%: 5-16). Renal involvement was found in 6 patients (13%): kidney stones (n=2), tubulo-interstitial nephritis (TIN) (n=2), IgA nephropathy (n=1) and AA amyloidosis (n=1). Median creatinine level was 63 μmol/l (IQR 25-75%: 58.5 - 64). No patient had kidney failure.

Ultrasound examination found median right, left and mean (CIMT) of 0.54 mm (IQR 25-75%: 0.50-0.63), 0.55 mm (IQR 25-75%: 0.49-0.61) and 0.55 mm (IQR 25-75%: 0.48-0.62) respectively. Increased CIMT values were found in 8 patients (17%). No patient had atherosclerotic plaque.

Patients with renal involvement had significantly higher values of CIMT (0.64 mm (IQR 25-75%: 0.56-0.70) vs 0.53 mm (IQR 25-75%: 0.47-0.59); p= 0.045). Significant positive correlation was also detected between CIMT values and creatinine level (p=0.002; r=0.445).

In multivariate linear regression, creatinine level was identified as independent predictor of increased CIMT (B=0.002; 95% confidence interval=0.000-0.005; p=0.035).

Conclusion

Although all patients included have normal creatinine level, we identified creatinine level as independent predictor of subclinical atherosclerosis in SpA patients. This finding highlights the monitoring of this parameter.

Disclosure of Interests

None declared

AB0849 Assessment of Carotid Intima-Media Thickness in Spondyloarthritis patients

Background

Cardiovascular morbidity and mortality are increased in spondyloarthritis (SpA) (1), which is attributed to accelerated atherosclerosis. Recognition of subclinical atherosclerosis in asymptomatic population is important for risk stratification and optimal management. Due to its simplicity and non-invasive nature, carotid intima-media thickness (cIMT) is actually widely used for identifying subclinical atherosclerosis.

Objectives

The aim of our study was to investigate the presence of subclinical atherosclerosis in SpA patients compared with healthy controls, by evaluating cIMT.

Methods

We performed a case control study including 47 patients and 47 age and gender matched healthy controls. All subjects were included without history of cardiovascular disease or cardiovascular risk factors. Sociodemographic features, disease characteristics, radiographic structural damage and therapeutics were recorded. cIMT was measured with Mindray Resona 7 ZST+ ultrasound machine, from the right and the left carotid artery; than mean cIMT was calculated. We considered that cIMT was increased if the measurements were between 0.7 mm and 1.5 mm. Measurements higher than 1.5 were defined as an atherosclerotic plaque.

Results

Fourty seven patients with a sex ratio of 2.35 were included in our study. Median age was 36 years (IQR: 28-46) and median duration of the disease was 11 years (IQR: 5-16). Median BASDAI and ASDAS-CRP scores were 2.6 (IQR: 1.8-3.8) and 2.18 (IQR: 1.62-2.91) respectively. Of the 47 patients, 10 (21%) had an active disease according to BASDAI and 19 (40%) had an active disease according to ASDAS. Median BASFI score for functional impairment was 3 (IQR: 1.5-5.1). Median BASRI and mSASSS scores were 3 (IQR: 2-4) and 10 (IQR: 4-15) respectively. Regarding treatment, 92% of patients were using non-steroidal anti-inflammatory drugs (NSAIDs), 51% were on csDMARDs and 38% were on anti-TNF alpha drugs.

Median right, left and mean cIMT were respectively 0.54 mm (IQR: 0.50-0.63), 0.55 mm (IQR: 0.49-0.61) and 0.55 mm (IQR: 0.48-0.62) respectively. Increased cIMT values were found in 8 patients (17%). No patient had atherosclerotic plaque.

Median values of cIMT were significantly higher in patients with spondyloarthritis than the control subjects (p<0.0001) as shown in Table 1.

Table 1.

Comparaison of carotid intima-media thickness values between spondyloarthritis patients and control subjects.

SpondyloarthritisPatientsControl grouppRight cIMT (mm)*0,54 (0,50-0,63)0,45 (0,42-0,50)< 0.0001**Left cIMT (mm)*0,55 (0,49-0,61)0,47 (0,45-0,50)<0.0001**Mean cIMT (mm)*0,55 (0,48-0,62)0,46 (0,43-0,50)<0.0001**

cIMT: carotid intima-media thickness; mm: millimeters; *: median value (IQR 25-75%); **: p < 0.05 denotes statistical significance.

Conclusion

Our study demonstrated increased cIMT in patients with SpA compared with healthy population; which attests higher risk for subclinical atherosclerosis and cardiovascular atherosclerotic events.

References

[1]Bai R, Zhang Y, Liu W, Ma C, Chen X, Yang J, et al. The Relationship of Ankylosing Spondylitis and Subclinical Atherosclerosis: A Systemic Review and Meta-Analysis. Angiology. 2019 Jul;70(6):492–500.

Disclosure of Interests

None declared

Prevalence and associated risk factors of hypertension and pre-hypertension among the adult population: findings from the Dubai Household Survey, 2019

BACKGROUND

Minimal data is available on the prevalence and correlates of hypertension and prehypertension in Dubai. The study aims to measure the prevalence of hypertension and pre-hypertension and the associated socio-demographic characteristics, behavioral risk factors and comorbidities among the adult population of Dubai.

METHODS

This study used data from the Dubai Household Health Survey, 2019. A cross-sectional population survey based on a complex stratified cluster random design. The total eligible sample included 2530 adults (18+). Sociodemographic and behavioral factors were considered as independent covariates. The main study outcome variables, pre-hypertension and hypertension, were ordinal, with normotension as the reference group.

RESULTS

The overall prevalence of hypertension in adults was 32.5% (38.37% in males and 16.66% in females). Prehypertension was prevalent in 29.8% of adults in Dubai (28.85% in males and 32.31% in females). The multivariate logistic regression analysis revealed that age groups, gender, occupation, and high Body Mass Index were significantly associated with a higher risk of hypertension at the level of P < 0.05. No clear trend toward a higher correlation of hypertension was noted with the increase in age, except after the age of 50 years. Males were five- times more likely to be hypertensive than females. Participants enrolled in skilled and service works had a five times higher risk of hypertension, compared with the reference group (professionals). Obese subjects had a 5.47-times greater correlation of hypertension compared with normal-weight subjects. Physically active individuals were less likely to develop hypertension. For the correlates with prehypertension in the present analysis, skilled and service workers and those working in elementary jobs had a higher risk of prehypertension, compared with the reference group (professionals) Individuals with a status of overweight were associated with a higher prevalence of prehypertension compared with people of normal weight.

CONCLUSIONS

This study showed a high prevalence of prehypertension and hypertension among adults in Dubai. Some socio-demographic and behavioral risk factors were correlated with prehypertension and hypertension among the studied population. Interventions aiming at increasing public awareness about such risk factors are essential.

Prevalence of Metabolic Syndrome and Associated Risk Factors in the United Arab Emirates: A Cross-Sectional Population-Based Study

Aims

To estimate the prevalence of metabolic syndrome (MetS) and its associated risk factors among the United Arab Emirates (UAE) residents.

Methods

A cross-sectional population-based study was conducted among adults living in Sharjah and Northern Emirates using the UAE National Diabetes and Lifestyle Study (UAEDIAB) data. Anthropometric measurements and fasting blood samples were obtained. The National Cholesterol Education Program's Adult Treatment Panel III (NCEP/ATP III) guidelines were used to define metabolic syndrome (MetS).

Results

A total of 3,212 subjects (74.1% men, 25.9% women, mean age 39 ± 11.3 years old) were included in this study. The overall prevalence of MetS was 37.4% (32.7% in women and 39% in men). The prevalence was 33.6% in the Emirati population (38.7% in women and 28.8% in men), 34.5% in the Arab non-Emirati population (29.8% in women and 36.3% in men) and 40.7% in the Asian non-Arab population (25.8% in women and 43.1% in men). Age, gender, ethnicity, educational level, marital status and body mass index were positively associated with MetS.

Conclusions

This study indicates a high burden of MetS in the UAE, particularly among Emirati women and Asian non-Arab men. The young adult population in the UAE has a high prevalence of MetS compared to global estimates in the same age group. Aggressive intervention strategies targeting the whole population as well as individuals at a high risk are recommended to prevent the development of cardiovascular diseases.

Concordances and correlations between anthropometric indices of obesity: a systematic review

OBJECTIVES

The pandemic of overweight and obesity has become a major clinical and public health concern worldwide. Anthropometric indices are indirect and quantitative tools used to identify individuals at increased risk of body fat-related morbidity. The aim of this systematic review was to assess the concordances and correlations between anthropometric indices of obesity in adults and whether these indices can be used interchangeably.

STUDY DESIGN

Systematic review.

METHODS

A literature search was conducted in three databases of peer-reviewed publications (PubMed, Scopus, and Embase). Further, the first 10 pages of Google Scholar were also searched for relevant studies.

RESULTS

There were strong correlations between body mass index (BMI) and waist circumference (WC) and between BMI and waist-to-height ratio (WHtR), and a weak correlation between BMI and neck circumference (NC). There was a very strong correlation between WC and WHtR and a moderate correlation between WC and NC. There were moderate concordances between BMI and WC and between BMI and WHtR and good concordance between WC and WHtR.

CONCLUSION

BMI, WC, and WHtR indices can be moderately used interchangeably with caution. More studies in adult populations using statistical tests of concordance and adjusting for differences in ethnicity, age, gender, and weight quantiles are needed.

A hypertension risk score for adults: a population-based cross-sectional study from Dubai Household Survey 2019

OBJECTIVES

The aim of this study was to develop a risk score model for predicting hypertension specific to the population of Dubai in the United Arab Emirates (UAE) to facilitate prevention and early intervention.

METHODS

A retrospective analysis of data from the Dubai Household Health Survey 2019 was conducted. Demographic and physical parameters, as well as blood glucose levels, were included in the data. The risk factors for hypertension were identified using bivariate analysis. A risk score model was developed using the enter method, where all significant predictors of hypertension in bivariate analyses were entered in a single step with the primary outcome of hypertension status (yes/no). The model was validated internally by splitting the data into Emirati and non-Emirati populations.

RESULTS

A total of 2,533 subjects were studied. The significant risk factors for hypertension identified were male sex, older age (≥40 years), education level, body mass index, diabetes mellitus, and dyslipidaemia. The model showed a high discrimination ability between individuals with and without hypertension, with an area under the curve of 0.77 (95% confidence interval [CI], 0.75 to 0.79), excellent sensitivity (81.0%; 95% CI, 71.9 to 88.2) and moderate specificity (56.0%; 95% CI, 45.7 to 65.9).

CONCLUSIONS

The model developed by this study is simple, convenient, and based on readily available demographic and medical characteristics. This risk score model could support initial hypertension screening and provide an effective tool for targeted lifestyle counselling and prevention programs.

Significance and agreement between obesity anthropometric measurements and indices in adults: a population-based study from the United Arab Emirates

BACKGROUND

The rates of overweight and obese adults in the United Arab Emirates (UAE) have increased dramatically in recent decades. Several anthropometric measurements are used to assess body weight status. Some anthropometric measurements might not be convenient to use in certain communities and settings. The objective of this study was to assess the agreement of four anthropometric measurements and indices of weight status and to investigate their associations with cardiometabolic risks.

METHODS

The study design was a cross-section population-based study. Adults living in the Northern Emirates were surveyed. Fasting blood samples, blood pressure readings and anthropometric measurements were also collected.

RESULTS

A total of 3531 subjects were included in this study. The prevalence of obesity/overweight was 66.4% based on body mass index (BMI), 61.7% based on waist circumference (WC), 64.6% based on waist-hip ratio (WHR) and 71% based on neck circumference (NC). There were moderate agreements between BMI and WC and between WC and WHR, with kappa (k) ranging from 0.41 to 0.60. NC showed poor agreement with BMI, WC and WHR, with k ranging from 0 to 0.2. Overweight and obesity based on BMI, WC and WHR were significantly associated with cardiometabolic risks.

CONCLUSION

Overall, there was a moderate to a poor agreement between BMI, WC, WHR and NC. Particularly, NC showed poor agreement with BMI, WC and WHR. BMI and WC showed better performance for identifying cardiometabolic risks than WHR and NC.

The Impact of Knowledge, Anxiety and Fear on Psychological Distress during COVID-19 among Residents of the United Arab Emirates

Objectives: COVID-19 has become a global concern, affecting both physical and mental health. In this study, we measured knowledge, fear, anxiety, and psychological distress related to COVID-19 among residents of the United Arab Emirates (UAE). Methods: A total of 1053 adult participants completed a Web-based cross-sectional survey. Results: Our data revealed 75.7% of the sample to be knowledgeable about COVID-19, 15.3% had experienced anxiety and 50.4%, psychological distress about COVID-19. Being knowledgeable about COVID-19 was significantly associated with having spent one to 2 hours reading about COVID-19. There was also an association between being knowledgeable about COVID-19 and low levels of anxiety and psychological distress. Psychological distress was associated with a history of mental illness (76.2%), anxiety (85.1%), and fear of COVID-19 (21±6.6). Age, history of mental illness (OR = 3.70, 95% CI = 2.35-5.82, p < .001), and COVID-19 anxiety (OR = 2.48, 95% CI = 1.48-4.13, p < .001) and fear (OR = 1.17, 95% CI = 1.14-1.20, p < .001) were risk factors for psychological distress. Conclusion: Our results showed significant psychological distress in the UAE population. Providing pre-recorded workshops and continuous telemedicine on biopsychosocial perspectives of COVID-19 may enhance the COVID-19 insight and reduce the COVID-19 anxiety and psychological distress.

Helicobacter pylori Infection in Tripoli, North Lebanon: Assessment and Risk Factors

Helicobacter pylori (H. pylori) infection occurs among half of the general population worldwide, with high geographic variability. Even though H. pylori is the leading cause of several gastric diseases, ranging from gastritis and peptic ulcers to gastric malignancies, such as gastric cancer and mucosa-associated lymphoid tissue lymphoma, most of the infections remain asymptomatic. Early detection and eradication of H. pylori can definitely prevent severe long-term gastric diseases associated with H. pylori. In Lebanon, the prevalence of H. pylori is not well documented, especially in healthy subjects. The aim of this study is to assess H. pylori infections and the associated risk factors in Tripoli, North Lebanon. A cross-sectional study was conducted on 300 healthy Lebanese volunteers, including both children and adults. The H. pylori stool antigens were detected using the Premier Platinum HpSA test. The socio-demographic data, lifestyle characteristics, and gastrointestinal characteristics of all participants were analyzed. Out of the 300 tested volunteer subjects, 31% were found to be positive for H. pylori. A multivariate binary logistic regression analysis for factors associated with H. pylori infection revealed a significant association between H. pylori infection and gastrointestinal disturbances, the crowding index, and occupation. A significant statistical correlation was found between sheesha smoking (p = 0.001) and H. pylori infection. These findings highlight the need for the development of preventive approaches and strategic indications for the appropriate treatment of H. pylori infections in Tripoli, North Lebanon.

AB0190 LIVER INVOLVEMENT IN RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) can be associated to extra-articular manifestations and comorbidities, including hepatic disturbances. It can be related to an underlying viral, metabolic or immune disease, or to a medical treatment toxicity [1].

Objectives:

We aim to study liver involvement in a group of RA patients.

Methods:

We performed a cross sectional study in 249 RA patients responding to the ACR/EULAR 2010 criteria for RA diagnosis. Hepatic enzymes, B and C hepatitis viruses screening tests, abdominal ultrasonography, biliary tract MRIs, fibrotests and fibroscans if available were collected and analysed.

Results:

Two hundred and forty-nine patients were included with 83.8% of women. The mean age was 59±11.67 years. The mean age at diagnosis was 47±14.9 years with a mean disease evolution of 11±8.83 years.

The mean disease activity (DAS28) was 4,66 with levels ranging from 0.12 to 7.78.

Liver abnormalities were found in 68 patients (27.3%).

Viral disease represented 32.3% of liver abnormalities and was found in 8.8% of the total number of patients. Positive anti-HBc antibodies with negative HBs antigen were found in 8.4% of the patients, no viral reactivation with conventional or biological disease-modifying anti-rheumatic drugs was noted.

Besides, 4 of the 249 patients had positive HCV antibodies tests; one of them had a reactivation of a hepatitis C infection after treatment with leflunomide, one had a chronic C hepatitis with chronic liver disease, one had an old B and C hepatitis infection and the last one had an associated liver nodule for which an exploration was triggered. One patient had post hepatitis C cirrhosis associated with a hepatocellular carcinoma treated with surgery and an association of ledipasvir and sofosbuvir with a negative serology.

Medical treatment toxicity was responsible for 25% of liver abnormalities. Paracetamol caused both hepatic cholestasis and cytolysis in 5 patients, and isolated cholestasis in 2 patients. NSAIDs caused both hepatic cholestasis and cytolysis in 2 patients, and isolated cholestasis in one patient. Methotrexate was responsible for isolated cholestasis in 2 patients, isolated hepatic cytolysis in one patient and both cholestasis and cytolysis in one patient. An interaction between methotrexate and fluconazole caused one case of hepatic cholestasis and cytolysis. Treatment of a latent tuberculosis with isoniazid and rifampicin was responsible for cholestasis in one patient.

Immune hepatic disease was present in 3 patients: 2 patients had a primary biliary cholangitis that manifested with a cholestasis and one patient had an auto-immune hepatitis that manifested with cytolysis and cholestasis.

The prevalence of hepatic steatosis was of 4.8%, assessed with ultrasonography or microscopic examination of a liver biopsy. Hepatic enzymes test was normal in 2%, showed isolated cholestasis in 2% and both cholestasis and hepatic cytolysis in 0.8% of the patients.

One patient had a secondary hemochromatosis to multiple transfusions for sickle cell anaemia, causing cholestasis and cytolysis.

No aetiology was found for hepatic cholestasis and/or cytolysis in 7.2% of patients.

Conclusion:

Liver involvement in RA is common and has different aspects. A careful monitoring of liver enzymes tests is crucial to detect hepatic disease and prevent its evolution to a chronic liver disease and cirrhosis. On the other hand, screening for viral hepatitis B and C is necessary to prevent an aggravation of a chronic infection and a reactivation of a latent one [2].

References:

[1]Sellami M, Saidane O, Mahmoud I, Tekaya AB, Tekaya R, Abdelmoula L. Etiological Features of Liver Involvement in Rheumatoid Arthritis. Curr Rheumatol Rev. 2020;16(4):332-6.

[2]Karadağ Ö, Kaşifoğlu T, Özer B, Kaymakoğlu S, Kuş Y, İnanç M, et al. Viral hepatitis screening guideline before biological drug use in rheumatic patients. Eur J Rheumatol. mars 2016;3(1):25-8.

Disclosure of Interests:

None declared

AB0731 CERVICAL SPINE INVOLVEMENT IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background:

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. In contrast to adult rheumatoid arthritis, where numerous studies have shown a high prevalence of involvement of the cervical spine, few studies have been published examining this entity in JIA.

Objectives:

We aimed to analyze clinical and radiological findings of cervical spine involvement in patients with JIA.

Methods:

A retrospective study including 35 patients was conducted between 2010 and 2019. The patients enrolled met the ILAR criteria for the diagnosis of JIA. Clinical, biological, and radiological data were collected. Patients had a radiological evaluation that included cervical spine x-rays in antero-posterior, lateral and lateral views with flexion.

Results:

Thirty-five patients were enrolled. The mean age of the disease onset was 9 years [3-15]. The mean age of the patients at the time of the study was 37.8 years [17-69]. The mean duration of the disease was 27 years [2-56]. These patients were assigned to discrete JIA categories: rheumatoid factor positive polyarthritis (43.5%), rheumatoid factor negative polyarthritis (21.7%), enthesitis-related arthritis (17.4%), oligoarthritis (13%) and psoriatic arthritis (4.4%). Sixteen patients (45%) reported neck pain. Cervical spine involvement occurred on average 7 years [0-13] after the JIA onset. Cervical spine radiographs showed anterior atlantoaxial subluxation (> 5mm) in 8 patients. Magnetic-resonance imagining was performed in 9 patients that had abnormal neurological examination showing a pannus formation of C1-C2 junction (3 cases), a basilar invagination (4 cases) and erosions of the odontoid process (2 cases). A cervical collar has been used for immobilization in patients with significant cervical spine damage. A C1-C2 arthrodesis was proposed to 4 patients.

Conclusion:

These findings suggest that the presence of cervical involvement in JIA patients is frequent. Radiologic assessment of cervical spine should be systematically performed for early detection and to prevent its complications.

Disclosure of Interests:

None declared

AB0517 THE HIDDEN FACE OF SMOKING IN AXIAL SPONDYLOARTHRITIS

Background:

The deleterious effect of smoking on spondyloarthritis has been studied for several decades. Indeed, smoking increases inflammation and disease activity, hence, promotes bone damage.

Objectives:

The aim of our study was to evaluate the clinical, biological and radiological impact of smoking on axial spondyloarthritis (axSpA).

Methods:

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

The following parameters were collected: age, smoking, ASDAS, BASDAI, and BASFI. We also measured inflammatory biomarkers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)).

Results:

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

Fifty-one of our patients were smokers (37%). They were 48 men and 3 women. The mean pack-year was 45 ± 17.15.

Smokers had a significantly younger age of the disease onset (25.21 ± 11.37 versus 31.96 ± 12.67, p=0.009).

Moreover, patients who smoke Tabaco had developed significantly more ankylosis compared to patients who don’t (p=0.026).

Osteoporosis was also more frequent in smoking patients (p=0.032).

However, no association was found between smoking and ESR, CRP, ASDAS-CRP, BASDAI and BASFI.

Conclusion:

Our results reveal that smoking can be responsible of a younger axSpA onset, and can lead to more severe structural damages regardless the disease activity. This highlights the importance of smoking cessation in preventing early bone damage in axSpA.

Disclosure of Interests:

None declared.

AB0730 HIP INVOLVEMENT IN JUVENILE IDIOPATHIC ARTHRITIS

Background:

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases that have in common an onset before the age of 16 years, more than 6-month duration, and the presence of arthritis for at least 6 weeks with no identifiable cause. Hips are the commonly affected joints in severe destructive JIA. Hip disease develops in 20% to 50% of children with JIA.

Objectives:

We aimed to analyze the epidemiological, clinical, and radiological aspects of hip involvement in Tunisian JIA.

Methods:

A retrospective study including 35 patients was conducted between 2010 and 2019. The patients enrolled met the ILAR criteria for the diagnosis of JIA. Clinical, biological and radiological parameters relating to the hip involvement were collected.

Results:

Thirty-five patients were enrolled. The mean age of the disease onset was 9 years [3-15]. The mean age of the patients at the time of the study was 37.8 years [17-69]. The mean duration of the disease was 27 years [2- 56]. These patients were assigned to discrete JIA categories: rheumatoid factor positive polyarthritis (43.5%), rheumatoid factor negative polyarthritis (21.7%), enthesitis-related arthritis (17.4%), oligoarthritis (13%) and psoriatic arthritis (4.4%). A biological inflammatory syndrome was noted in 52% of patients. Hip involvement was noted in 43.5% of patients. Coxitis occurred on average 15 years after the JIA onset [[4-37]. Thirty four percent of the patients had bilateral hip involvement. The mean Lequesne index was 14. Joint space narrowing and erosions were noted in respectively 68% and 34% of cases. The majority of patients (82.6%) received medical treatment combining nonsteroidal anti-inflammatory drugs (NSAID) and rehabilitation. In the other cases, a total hip replacement was necessary. Coxitis was significantly correlated with rheumatoid factor positive polyarthritis subtype (p=0.02) and with the presence of biological inflammatory syndrome (p=0.03).

Conclusion:

Hip involvement is a major and highly prevalent issue in our JIA patients.

Disclosure of Interests:

None declared

POS0497 A RELIABILITY EXERCISE USING CONSENSUAL DEFINITIONS FOR THE ULTRASONOGRAPHY OF THE SHOULDER IN RHEUMATOID ARTHRITIS

Background:

Although numerous clinical tests for the diagnosis of painful shoulder are available, differentiating articular from periarticular lesions may be difficult in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA benefited from a reliable imaging modality to detect its exact origin as ultrasonography (US).

Objectives:

This study aimed to assess the intraobserver and interobserver reliabilities of the ultrasonographic findings for patients with established RA having shoulder pain in a patient-based exercise among maghrebian rheumatologists experts on US.

Methods:

A total of 7 operators examined 10 patients in 2 rounds independently and blindly of each other.

Each patient underwent a US scanning of the painful shoulder in four 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 a subdeltoid or subcoracoid bursitis or the presence of transfixiant tear of the suprasupinatus were notified if present. Intra and inter-observer reliabilities were calculated.

Results:

Intraobserver reliability was excellent for GS synovitis in subscapularis and posterior recesses (k=0.91 for both) and for subcoracoid bursitis (k=0.81). It was good in case of presence of a subdeltoid bursitis (k=0.79), transfixiant tear of the suprasupinatus (k=0.65), GS synovitis and effusion in LHB (k=0.67 and 0.6 respectively) and subdeltoid bursitis (k= 0.79). Interobserver reliability was good for PD for LHB signals searched longitudinally (k=0.78) and transversally (k=0.78). It was moderate for GS for LHB synovitis (k=0.55). Interobserver agreement was poor for effusion and GS synovitis for subscapularis, posterior and axillary recesses. It was very poor and/or absent for PD signals in these recesses.

Conclusion:

US is a reliable imaging tool for shoulder in RA especially with regard to LHB effusion, GS and PD synovitis. Interobserver reliability of subscapularis, posterior and axillary recesses could be optimized by standardization of sites to assess.

References:

[1]Bruyn G a. W, Naredo E, Möller I, Moragues C, Garrido J, de Bock GH, et al. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann Rheum Dis 2009;68:357–61.

Disclosure of Interests:

None declared

AB0158 COMPARISON OF CLINICAL EXAMINATION AND ULTRASOUND OF HAND AND WRIST JOINTS IN RHEUMATOID ARTHRITIS

Background:

Ultrasound (US) is an accessible and non-invasive tool to assess joint involvement in rheumatoid arthritis (RA). It is used for diagnostic and prognosis purposes and for following of RA patients by evaluating the disease activity and therefore the response to treatment.

Objectives:

This study investigates agreement between US of hand and wrist findings and the clinical examination and biological inflammatory parameters in RA patients.

Methods:

We performed a cross sectional study including patients responding to the ACR/EULAR 2010 criteria for RA diagnosis. We collected US findings assessing synovitis and doppler signal in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) articulations, and concomitant clinical examination assessing synovitis and pain in the same joints along with C reactive protein (CRP) levels and disease activity score (DAS28). The power Doppler US score (PDUS) from 6 simplified synovial sites (wrists, bilateral second and third MCP joints) was calculated [1].

Results:

Forty-three patients were included with 91.7% of women. The mean age was 62±12.95 years old. The mean age at diagnosis was 52±14.79 years with a mean disease evolution of 8±8.57 years. Rheumatoid factor and anti-citrullinated antibodies were positive in respectively 78% and 83.9% of cases.

The mean disease activity (DAS28) was 1,52 with levels ranging from 1.5 to 7.33.

Right wrist was the articulation in which US synovitis was most frequently detected (60.5% of patients), followed by the left wrist (53.5%). Power doppler signal was detected as frequently in the right as in the left wrist articulations (41.9%). Subsequently, clinical synovitis was most frequently detected in right and left wrist with 39,5% and 41,5% respectively. These joints were the most frequently painful, in 51.2% and 48.8% at right and left respectively.

US synovitis of the first interphalangeal joint was found in only 2.3% and 4.7% in the right and left hand respectively, with positive power doppler signal in 2.3% of the patients in the same articulations.

The overall agreement between US and clinical examination in detecting synovitis of wrist, MCP and PIP joints was of 67.3%. It was of 71.4% in wrists, 54.7% in MCP joints and 87% in PIP joints. This suggests the presence of infra-clinical synovitis. All sites combined, US synovitis were correlated to clinical synovitis (p=0.03).

A positive correlation was found between PDUS from 6 simplified joint sites and CRP levels (p value of 0.02). No correlation was found with disease activity score (DAS28).

Conclusion:

US of hands and wrist articulations is more performant than clinical examination in detecting synovitis. The most frequently involved joints with clinical and US synovitis, pain and positive power doppler signal were the wrist joints. CRP level is predictive of the presence of a high simplified power doppler score which is related to clinical activity of the disease as reported by Kawashiri et al. [1].

References:

[1]Kawashiri S, Kawakami A, Iwamoto N, Fujikawa K, Satoh K, Tamai M, et al. The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis. Rheumatology (Oxford). mai 2011;50(5):962-5.

Disclosure of Interests:

None declared