Metabolic Disorders During Prolactinomas

The metabolic profile during prolactinoma may be subject to significant changes. We aimed to describe the different metabolic aspects in patients monitored for prolactinoma and to study the correlations between the size of the prolactinoma and the metabolic parameters. We conducted a retrospective, descriptive, and analytical study of 77 cases of prolactinomas collected and monitored at the endocrinology and diabetology department of the Hedi Chaker Hospital in Sfax between 2000 and 2017. Our patients were divided into three groups according to the size of their prolactinomas. Statistical correlations were sought between tumor size and clinical and biological parameters. The mean age of our patients was 38.3 ± 14.2 years. They were divided into 51 women (66.2%) and 26 men (33.7%). Pituitary tumor syndrome was the most common circumstance of discovery in our population (62.3%). The clinical examination revealed an average waist circumference of 95.71 cm. Android fat distribution was observed in 25 women (49%) and 12 men (46.1%). A statistically significant positive correlation was objectified between waist circumference and tumor size (r = 0.29 and P = 0.019). The average body mass index was 28.08 kg/m2. Obesity was noted in 56 cases (72.7%). Glucose tolerance disorders and hypertriglyceridemia were also more evident each time prolactinoma size increased in contrast to the level of high-density lipoprotein cholesterol which decreased with adenoma size. Our study highlighted the metabolic and hormonal repercussions of prolactinomas. Metabolic syndrome was more common in patients with larger prolactinoma. These results should guide the initial assessment and therapeutic management of prolactin adenomas.

Characteristics of adult-onset auto-immune type 1 diabetes

BACKGROUND

Classically described as a disease of childhood and adolescence, diabetes mellitus type 1 (T1DM) can occur in adulthood. Adult-onset T1DM is poorly documented and is often misdiagnosed. This study aims to describe the epidemiological aspect of T1DM with adult-onset and detail its clinical, paraclinical, and therapeutic characteristics.

MATERIALS AND METHODS

A 9-year retrospective longitudinal study (2011-2019) was conducted including adult patients (age >20 years) with confirmed diabetes and at least one of the auto-antibodies (auto-Abs) to glutamic-acid-decarboxylase (GAD), to islet-tyrosine-phosphatase 2 (IA2) or islet-cell-antibodies (ICA) positive.

RESULTS

A total of 166 patients were included (sex-ratio M/F: 1.34; mean age: 28.6 years [20-56 years]). At the onset, 50.6% of patients presented with diabetic ketosis and 13.3% with diabetic ketoacidosis. Cardinal symptoms of diabetes were present in 30.7% of patients only at diagnosis, while the discovery was fortuitous in 5.4% of cases. 27.7% of patients developed an additional auto-immune disease mainly autoimmune thyroid disease. The risk of developing another AUTO-IMMUNE DISEASE was highest in females (p = 0.010) and increased with age (p = 0.011). GAD-Abs, IA2-Abs, and ICA were positive in 98.2%, 13.3%, and 17.4% of cases respectively. Only GAD-Abs were found positive in 73.1%. Upon diagnosis, 75.9% of patients were treated with insulin, while 24.1% of patients were initially put on oral anti-diabetic drugs before requiring insulin within an average of 7.42 months.

CONCLUSIONS

Adult-onset T1DM has a different clinical course (slower onset, less abrupt symptoms, more insidious presentation, and more prolonged progression to insulin) that has to be known. Misdiagnosis of adult-onset T1DM can have serious consequences.

Diagnosis and management of pituitary apoplexy: a Tunisian data

BACKGROUND

Pituitary apoplexy (PA) is defined as the hemorrhage or the infraction of a pituitary adenoma. Aiming to determine the epidemiological, clinical, paraclinical characteristics as well as management and outcomes of PA in our population, we conducted this cross-sectional study.

METHODS

This cross-sectional study was conducted at the Department of Endocrinology of Hedi chaker university hospital, Sfax. Data was collected from medical charts of patients with pituitary apoplexy admitted in our department between 2000 and 2017.

RESULTS

We included 44 patients with PA. Their mean age was 50 ± 12.6 years. Among them, 31.8% had a known pituitary adenoma, and it was in all cases a macroadenoma, predominantly a prolactin secreting tumor (42.8%). A triggering factor of PA was encountered in 31.8% of cases and it was mainly: head trauma, dopamine antagonists, and hypertension. The clinical presentation of PA encompassed headaches (84.1%), visual disturbances (75%), and neurological signs (40.9%). Gonadotropin deficiency was the most frequent form of hypopituitarism noted (59.1%), followed by corticotropin deficiency (52.3%), thyrotropin deficiency (47.7%), and somatotropin deficiency (2.3%). Hormonal assessment at PA onset, concluded that 23 had a secreting adenoma: 18 prolactinomas, 3 ACTH-secreting adenomas, and 2 GH-secreting adenomas. In the 21 remaining cases, the tumor was non-functioning (47.7%). Pituitary MRI was performed in 42 cases (95.5%), revealing infraction and or hemorrhage in the pituitary gland in 33 cases; a heterogenous signal or a fluid level within the adenoma, in nine cases. Urgent administration of intra venous hydrocortisone was required in 19 cases. Mannitol administration was mandatory in a patient who had severe intracranial hypertension. Surgical management of the PA was imperative in 24 patients (54.5%): 15 suffered from severe visual impairment, 4 had an intracranial hypertension, 2 cases demonstrated an impaired consciousness, 2 patients experienced a tumor enlargement and one case had a severe Cushing's disease. Operative complications found were rhinorrhea attributable to cerebral spinal fluid leakage, insipidus diabetes associated with rhinorrhea, isolated insipidus diabetes, and hydrocephalus in one case each. Long-term follow-up concluded that headaches persisted in five cases, owing to the tenacity of a macroprolactinoma regardless of cabergoline treatment in one case, the recurrence of an adenoma in two cases and its persistence despite the medical and the surgical treatment in two patients. Concerning the visual acuity defects, only two patients had persistent diminished visual acuity at long-term follow-up. Among 25 patients, 13 were diagnosed with definitive thyrotropin deficiency. Similarly, 14 patients had persistent corticotropin deficiency (CD). Additionally, CD was de novo diagnosed in two patients. Otherwise, gonadotropin deficiency prevailed in all cases. Persistent prolactin deficiency was seen in two patients. Disappearance of the pituitary tumor was encountered in 11 out of 24 cases at long-term follow-up. Overall, surgery was associated with better outcome than conservative management. Pituitary apoplexy is a challenging condition due to its variable course, its diagnosis difficulty and management, as gaps remain to determine the best approach to treat this condition.

CONCLUSIONS

To conclude, pituitary apoplexy is a challenging condition due to its variable course, its diagnosis difficulty and management, as gaps remain to determine the best approach to treat this condition. Further studies are thus needed.

Insulinoma with equivocal imaging

Summary

A 55-year-old patient was admitted to our department for the management of a repetitive alteration of consciousness. Biological investigation results were consistent with endogenous hyperinsulinemic hypoglycemia. Insulinoma was therefore suspected. Abdominal computed tomography and endoscopic ultrasound showed no obvious pancreatic mass.Somatostatin receptor scintigraphy showed abnormal radioactive uptake in both the pancreatic tail and the uncinate process. Contrariwise, abdominal magnetic resonance imaging showed a unique lesion in the pancreas tail. The patient was then proposed for pancreatic surgery. Both intraoperative manual palpation and intraoperative ultrasonography of the pancreas showed a single corporal lesion of 1.5 cm. No lesion was found in the uncinate process. After a left pancreatectomy, the lesion was histopathologically confirmed to be a well-differentiated neuroendocrine tumor. The symptoms of the patient resolved almost immediately following the surgery. The follow-up is one and a half years to date.

Learning points

The exact preoperative localization of the pancreatic mass remains the most challenging part of insulinoma diagnostic workup. The radiologist's experience is the best warrantor to a precise localization of the tumor. 111In-DTPA-octreotide uptake in the pancreatic uncinate process may be physiological and its interpretation must, therefore, be vigilant. Manual palpation along with intraoperative ultrasonography is considered as the most effective method for the localization of insulinomas during open surgery.

Case report: Management challenges of late diagnosed 17-alpha hydroxylase deficiency

Herein we report the intriguing case of a 42-year-old woman presenting with grade three hypertension, severe hypokalemia and primary amenorrhea, which revealed to be the complete form of 17 alphahydroxylase deficiency. We also discuss the challenging therapeutic approach as well as the outcomes and the follow-up of this patient.

AB1115 COVID-19 VACCINE HESITANCY AMONG RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGICS

Background

Vaccine hesitancy is defined by the OMS as ”a delay in acceptance or refusal of vaccines despite availability of vaccination services” [1], and it is considered as one of threats to global health. This hesitancy emerges around Covid-19 vaccination. Patients on biologic Disease-Modifying Anti-Rheumatic Drug (bDMARD) are vulnerable to Covid-19 infection and their perception to vaccination is unknown.

Objectives

The aim of our study was to identify Covid-19 vaccine hesitancy among rheumatoid arthritis (RA) patient on bDMARD.

Methods

We conducted a monocentric, cross-sectional study, including patients with RA who met the ACR/EULAR 2010 criteria. All patients were on bDMARD with or without conventional synthetic (Cs) DMARD for at least 3 months. Disease activity was assessed using the Disease Activity Score (DAS) 28 (CRP) and the functional impairment using the Health Assessment Questionnaire (HAQ). A structured interview was done using a prepared questionnaire evaluating their vaccine hesitancy behavior.

Results

We enrolled 60 patients: 10 male (16.7%) and 50 females (83.3%). Their average age was 58.16±9.04 years [34-80]. For the education level; 38.5% of patients were illiterate, 34.6% had primary education, 23.1% had secondary education, and 3.8% have a university degree. Forty-four patients (73.3%) had no occupation, 13 patients (21.7%) were employed, and 5% were retired. The majority of patients lived in urban areas (85%) and 98.2% with their families. The average duration of RA was 15.23±8.92 years [2-39]. The average DAS28 (CRP) and the average HAQ were 4.05±1.22 [1.5-7.2] and 0.7±0.4 [0-2.4], respectively. Fifteen patients (25%) had a high disease activity and seven (11.7%) were in remission. When asking patients about their Covid19 infection and vaccination status; 15% had caught the virus and 61.7% have already received the vaccine. One third (35.6%) believed that they had enough information about vaccination. Their main sources were their family, friends, and the media. More than half of the asked patients (68.3%) reported vaccine hesitancy. Reasons of vaccine hesitancy were divided into three categories: lack of confidence (66.7%, p<0.005) (63.3% fear related to side effects, 10% conspiracy theory, 6.7% lack of confidence in the provider), complacency problem (16.7%, p=0.01) and lack of convenience (8.6%). There was no association between vaccine hesitancy and sociodemographic data. The existence of comorbidities had no influence on vaccine hesitancy (p=0.4). This hesitancy was not associated with DAS28 (CRP) (p=0.6) and with HAQ (p=0.7). Patients with moderate to high disease activity were more likely to deny the usefulness of Covid-19 vaccination (p=0.09). Regarding to the therapeutic data, there was no association between corticotherapy and vaccine hesitancy (p=0.1). There was no influence on the type of the current bDMARD (p=0.3) or of the rate of administration (p=0.4). The route of administration was associated with hesitation (53.65% intravenous vs 46.34% subcutaneous, p=0.04).

Conclusion

Our study showed that Covid-19 vaccination coverage among RA patients on bDMARDs was not optimal with a high percentage of hesitancy. The reasons are complex and they may be related to a lack of awareness. Rheumatologists should play a key role in the vaccine company.

References

[1]MacDonald NE, SAGE Working Group on Vaccine Hesitancy Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161–4.

Disclosure of Interests

None declared

AB1222 POSITIVE DIAGNOSIS OF TUBERCULOUS SPONDYLODISCITIS: CT-GUIDED PERCUTANEOUS BIOPSY OF SPINAL LESIONS VERSUS CLINICAL, BIOLOGICAL AND IMAGING ARGUMENTS

Background

Tuberculosis is still endemic in Tunisia. Although pulmonary localization is the most common, other localizations, including osteo-articular involvement, are increasingly diagnosed. Spinal or «Pott’s Disease» is the most common expression. A bundle of clinical, paraclinical and evolutionary arguments or a disco-vertebral biopsy puncture (DVBP) contribute to the positive diagnosis.

Objectives

Our aim was to assess the real contribution of DVBP compared to clinical-biological and imaging arguments for the diagnosis of tuberculous spondylodiscitis (SPDT).

Methods

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Diagnosis SPDT was retained based on the results of the DVBP in 15 patients (28.8%); and it was strongly suspected in front of the presence of clinico-biological and imaging arguments in 37 patients (71.2%). Among the clinical arguments suggestive of SPDT were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contributive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging (MRI). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. Once the diagnosis was retained for these patients, the first week noted a most significant clinical improvement (56.8%) in patients diagnosed with a range of suggestive arguments (p = 0.002). During the second week, clinical improvement was most marked in patients diagnosed with suggestive clinical and paraclinical arguments (70.3%) but with no statistically significant difference (p = 0.1). The improvement was statistically greater during the fourth week (66.7%) and the third month (60%) in patients diagnosed with histological examination (p < 0.001).

Figure 1.

SPDT Diagnostic Strategy

SPDT= Tuberculous spondylodiscitis, CBC= Cell blood count, NNA= Normochromic normocytic anemia, CRP= C reactive protein, SR= Sedimentation rate, BK= koch’s bacillus, SPDI= infectious spondylodiscitis, SPDNT= Non-tuberculous spondylodiscitis

Conclusion

Tuberculous spondylodiscitis is a frequent condition that needs to be treated rapidly. A range of highly suggestive clinical, paraclinical and evolutionary arguments contribute in the majority of cases to the positive diagnosis with a comparative clinical evolution to that of the DVBP which remains an invasive exam with variable sensitivity depending on studies.

Disclosure of Interests

None declared

AB1369 DISCO-VERTEBRAL BIOPSY VERSUS INDIRECT DIAGNOSTIC TOOLS IN BRUCELLAR SPONDYLODISCITIS

Background

The diagnosis of brucellar spondylodiscitis can be made by serological examinations or by isolating the germ on disco-vertebral biopsy (DVB).

Objectives

We aimed to study the interest of DVB and other less invasive diagnostic tools in brucellar spondylodiscitis.

Methods

A retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis.

Results

Eighteen cases were collected (13 men and 5 woman).

Nine patients had a DVB. In all cases, microbiological study did not reveal the causative agent (Brucella). A case of superinfection with Staphylococus Xylosus was noted. Histopathological examination was performed in eight patients. It showed osteitis and chronic spondylodiscitis lesions in 4 cases, a non-specific inflammatory infiltrate in 3 cases, and a progressive infectious spondylitis in one case. Wright’s serodiagnosis and the rose bengal test were positive in 7 out of 8 cases performed. As for the diagnosis by indirect immunofluorescence made in 6 cases, it was positive in 5 cases.

For the other nine cases who did not undergo DVB, Wright’s serodiagnosis and rose bengal test were positive in 9 and 6 patients respectively, indirect immunofluorescence made in 5 patients was positive in 4 cases.

Conclusion

Serological examinations in brucellar spondylodiscitis seem more profitable and less invasive than DVB. Other studies with a larger population seem to be necessary to compare the different methods and complete this preliminary study.

Disclosure of Interests

None declared

AB0951 Entheseal involvement in healthy subjects: What can lower limb ultrasonography tell us?

Background

Over the past few years, ultrasonography (US) has been a very useful tool in the detection of subclinical enthesopathy especially in spondyloarthritis patients. However, could US entheseal involvement detection by US in healthy subjects be predictive of evolution to an inflammatory rheumatic disease?

Objectives

To identify by US the prevalence of entheseal abnormalities at the lower limb of healthy subjects and associated risk factors.

Methods

US assessment was performed on 400 entheses of 40 healthy volunteer subjects along with clinical examination. Exclusion criteria: Enthesitis on the physical examination, personal of family history of inflammatory rheumatic disease and previous surgery or procedural interventions in the knees and/or ankles. Quadriceps, patellar and calcaneal tendons, and plantar fascia entheses were scanned. Depending on lesion type, inflammation (thickening, hypoechogenecity, bursitis and Doppler signal) and chronic damage (calcifications, enthesophytes and erosions) scores (0= absent, 1=present) were calculated per entheseal site and per participant. Total score was obtained by adding these two scores. Data about age, gender, body mass index (BMI) and physical activity according to the short form of the International Physical Activity Questionnaire score (IPAQ-SF) were collected.

Results

The mean age of participants was 52.3±14.83 [20-78] and the ratio of males to females was 3:2. Fourteen participants had US subclinical enthesopathy (35%). Among 400 scanned entheses, thickening was the most frequent inflammatory lesion observed in 4 % (n=16) of the entheses, followed by hypoechogenecity (0.5 %, n=2). Enthesophytes were the most frequent chronic damage lesions detected in 1.25% (n=5) of the entheses followed by erosions (0.5%, n=2). The highest total US scores per entheseal site were observed at the calcaneal enthesis [mean (SD) 0.27(0.59)], followed by plantar fascia [0.18(0.50)] and distal patellar tendon origins [0.10 (0.37)]. Age was not associated to higher scores (total, inflammation, chronic damage; p=0.339, p=0.412, p=0.531). Female participants had higher inflammation scores than males (mean inflammation scores (SD) 0.69 (1.44) versus 0.39 (0.71), p=0.044). The BMI was correlated to higher inflammation score (p=0.020, r=0.368) but not to chronic damage nor to total scores (p=0.478, p=0.104). Intense physical activity was associated to higher chronic damage score comparing to moderate physical activity (mean chronic damage scores (SD) 0.30(0.67) versus 0.003(0.00), p=0.058) and to low physical activity (mean chronic damage scores (SD) 0.30(0.67) versus 0.0018(0.00), p=0.043). No association between physical activity and inflammation score had been observed.

Conclusion

Our study demonstrates that US changes within the enthesis are associated with higher BMI and physical activity. These results support the effect of biomechanical forces on the entheses that should be considered when differentiating by US pathological from healthy entheses.

Disclosure of Interests

None declared

POS1568-PARE THE BRIEF-ILLNESS PERCEPTION QUESTIONNAIRE: A METHOD FOR ASSESSING THE COGNITIVE REPRESENTATION OF RHEUMATIC DISEASE

Background

The common-sense model proposes that illness perception (IP), is how patients make sense of their illness and respond emotionally to it, influencing the way they cope with the illness and subsequently illness outcomes. This proposition has gained considerable empirical support, and the relevance of IP in understanding illness-related behaviors or outcomes has also been supported in patients with rheumatic diseases (RD). The Brief Illness Perception Questionnaire (B-IPQ) was designed to provide a simple and rapid assessment of IP. This questionnaire has been widely used in diverse ages, illness types, countries, and languages.

Objectives

This study aimed to examine the construct of IP as measured by the B-IPQ in patients with RD.

Methods

A cross-sectional study was conducted at a Tunisian rheumatology department on 80 patients with RD. Sociodemographic, disease-related variables were reported. Participants completed a questionnaire on illness beliefs (B-IPQ).

Results

Subjects were aged 22-74 years (mean 51 years), 61.6 % were female. Diagnoses included Rheumatoid arthritis (RA) (63%), axial spondylarthritis (AS) (37%). The mean disease duration was 11 years and 7 years for RA and AS respectively. The proportion of physical comorbidities was higher in RA patients (36%) versus AS patients (11%). Disease activity was low in 28.8% of patients. All patients were on medications for their rheumatic disease, and 34,6 % were on biological therapy.

In both diseases, the participants perceived their rheumatic illness as a chronic condition (9.4) that could be controlled by treatment (6.6) but not strongly influenced by personal actions (4.3). Overall, Rheumatic disease was seen as having an important impact on their life (7.9) without significant difference between patients with low or high activity disease (p=0.23). The majority believe that they have a moderate understanding of their illness (6.6). The frequency of symptoms was highly evaluated in RA patients than AS patients (7.3 vs 5.6) (p=0.01). In RA patients, 76% were extremely affected emotionally by their disease, however, the majority of AS patients were moderately affected emotionally with a significant difference (p=0.02). In addition, RA patients considered their disease mainly a result of psychological factors (66.8%). On the other hand, AS patients (73%) attributed their illness to various risk factors (especially physical overexertion).

Conclusion

High scores of B-IPQ shown in our studies, encourage the design of psychotherapeutic trials targeting disease-related cognitions in AS and RA in an attempt to improve patients’ reported outcomes and disease outcomes.

Disclosure of Interests

None declared

AB1454 CLINICAL AND BIOLOGICAL FACTORS CORRELATED WITH MAGNETIC RESONANCE IMAGING RESULTS IN TUBERCULOUS SPONDYLODISCITIS

Background

Tuberculosis is still endemic in Tunisia. Although pulmonary localization is the most common, other localizations, including osteo-articular involvement, are increasingly diagnosed. Tuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). Magnetic resonance imaging (MRI) is the most sensitive (95-100%) and the most early abnormal exam.

Objectives

Our aim was to study the correlation of contributing factors, epidemiological, clinical, biological, radiological and therapeutic data with positive signs of spinal MRI.

Methods

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. Epidemiological, clinical, biological, radiological, and therapeutic data were analyzed. Each patient had spinal MRI. Positive signs have been individualized, represented by intervertebral disc involvement, vertebral body involvement and visualization of a paravertebral abscess.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The positive diagnosis of tuberculous spondylodiscitis was facilitated by the spinal MRI. Positive signs were sought in our patients which are represented by: the achievement of the intervertebral disc with diffuse T2 hypersignal (56.5%) and diffuse or circumferential increase of the signal in sp T1 Gadolinium (50.9%), Involvement of the vertebral body with moderate and extensive condensation (60.4%), macrogeodes (60.4%) and heterogeneous increase in spT1 Gado signal (52.8%) and visualization of a paravertebral abscess (51.9%). Correlations made between the favouring factors, epidemiological, clinical, biological, radiological and therapeutic data and the positive signs of spinal MRI, objecting that six parameters had a statistically significant correlation with MRI signs strongly suggestive of the diagnosis of SPDT: Hospitalization duration was correlated with the diffuse T2 disk hypersignal (p= 0.02; r= - 0.38), Hemoglobin rate was correlated with the diffuse or circumferential increase in T1 disk sp signal (p= 0.03; r= - 0.34), the initial rate of lymphocytes was correlated with the paravertebral abscess (p= 0.04; r= - 0.47). The extra-vertebral tuberculosis location was correlated with the diffuse T2 disc hypersignal (p= 0.03; r= -0.96), the moderate condensation and the extent of vertebral body (p < 0.001) and vertebral body macrogeodes (p < 0.001). The neurological clinical signs were correlated with the heterogeneous increase in vertebral body T1 sp signal (p= 0.04; r= -0.33) and the surgical treatment (p < 0.001).

Conclusion

Tuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Spinal MRI is the first-line exam in case of suspicion. Clinical, biological and therapeutic parameters were correlated with the MRI images highly suggestive of positive diagnosis.

Disclosure of Interests

None declared

AB1576-PARE RHEUMATOID ARTHRITIS ASSESSMENT KNOWLEDGE QUESTIONNAIRE (RAKE) IN TUNISIAN POPULATION

Background

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that has a very high burden on patients their families, and society. So that it is important that RA patients receive education about their disease. The knowledge of RA patients in Tunisia regarding their disease has not yet been assessed.

Objectives

The purpose of the study was to evaluate disease-specific knowledge of patients with rheumatoid arthritis by using the RAKE questionnaire (Rheumatoid Arthritis assessment Knowledge Questionnaire).

Methods

This was a cross-sectional study. Adults with RA fulfilling the ACR/EULAR criteria were asked to participate by responding to RAKE Questionnaire in the short version.

Results

A total of 28 RA patients were included: 23 females (82%) 5 mens (18%). The mean age was 58.5 years with a range of 31 to 79 years. The mean disease duration was 9.8 years. The disease duration was 0-5 years in 5 (17.8%) patients, and more than 5 years in 23 (82.2%) cases. Twenty patients were housewives. Thirteen (46.4%) patients were from rural areas. Almost all of the patients didn’t follow education programs for their RA. Twenty-two (78.5%) patients obtained information’s RA from their rheumatologist. Six patients (21.5%) from other sources (neighbors, nurses, other RA patients, social media). The mean time for answering the questionnaire was11.6 min (9-15 min).The RAKE total score was11.8/32 [3-22]. For the initial part of the questionnaire, related to the general aspects of RA, the mean score was 4.3/8 [0-6]. The mean score of the second component of the questionnaire concerning medications and non-pharmacological management, was respectively 4.3/11 [0-7] and 2.3/5 [0-4]. For comorbidities, the mean score was 0.6/1. The fourth component includes auto-management, pain, and tiredness the mean score was1.4/3 [0-3]. The last component covers psychosocial, occupational, and health system coping skills. Its mean score was 2.1/4. The mean score of unknown answers was 6.7/32 [4-16].

Conclusion

In our study, the knowledge patients of RA was low in all domains of RAKE questionnaire at various degrees. These findings can be used for improving current patient education programs and better disease control.

Disclosure of Interests

None declared

AB1079 INFECTIOUS SACROILIITIS ACCORDING TO THE GERM: ABOUT 42 CASES

Background

Infectious sacroiliitis is a rare rheumatological emergency. Its semiology is misleading due to the deep location of the joint. The responsible germs play an important role in its semiology.

Objectives

The objective of this work was to identify the germs responsible for infectious sacroiliitis and their effect in the sacroiliac joint.

Methods

We conducted a retrospective study, including 42 patients hospitalized for infectious sacroiliitis over a period from 2000 to 2020. Demographic, clinical, biological and radiographic data were collected.

Results

A total of 42 Patients were enrolled (11 men and 31 women). The mean age was 36,7 years [29-76]. Low back pain with difficulty walking were the most common manifestations (88%). The inflammatory syndrome was present in 70% of cases.

Standard radiographs showed loss of cortical margins with erosion of the sacroiliac joints in 34 cases and were normal for the rest of the patients.

MRI and CT scan were performed to confirm the diagnosis in 28 and 13 cases respectively.

A puncture guided by ultrasound or scanner was performed in 24 patients. In the cases of absence of germ on the conventional examinations, we performed a sacroiliac biopsy and histological examinations.

Pyogenic germs were responsible for 46% of infectious sacroiliitis: Staphylococcus Aureus in 11 cases (28%), Escherichia Coli in 7 cases (16 %) and Streptococcus in one case (2%). Tuberculosis and Brucella were responsible for 38% and 7% of the cases respectively. A subcutaneous abscess was associated with tuberculous sacroiliitis in 4 patients.

The outcome was favorable in 36 cases (86%) under appropriate antibiotic therapy. Eight patients presented a treatment-related complication. Progression to multifocal bone tuberculosis and chronic brucellosis was noted in one case each. In 3 cases, rapid ankylosis was found on radiological control.

Unfortunately, one patient died from septic shock.

Conclusion

Common germs are most responsible for infectious sacroiliitis and seem to have the best prognosis. Tuberculosis is responsible for various complications and its treatment has a high iatrogenic risk. Chronicity is the most feared development, mainly during Brucella sacroiliitis and would be related to a loss of antibiotic efficacy.

Disclosure of Interests

None declared

AB1364 IMAGING DIAGNOSIS OF BRUCELLAR SPONDYLODISCITIS

Background

Spondylodiscitis is the most common location in the musculoskeletal involvement of brucellosis.

Objectives

The aim of this study is to describe magnetic resonance imaging (MRI) and computed tomography scan (CT) results in patients with brucellar spondylodiscitis.

Methods

A retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis and having benefited from a CT scan and/or an MRI of the spine.

Results

Eighteen patients were included. In all cases spinal pain was reported, associated with radiculalgia in 8 patients. Low back pain was the most common symptom, present in 17 cases, associated with back pain in 3 cases including one case with neck pain. Isolated neck pain was noted in one patient.

Neurologic examination was normal in all cases.

Standard Radiographs showed disc narrowing in 14 cases, erosions in 9 cases and hazy changes of the vertebral end plate in 2 cases.

A CT scan was performed in 11 cases. It showed disc narrowing in 6 cases, erosions in 3 cases and endplate destructions in 5 cases. Abscesses were found in 4 patients.

Complementary MRI was performed in three of the patients who had already undergone CT. The MRI results were consistent with those of the CT scan, except for one patient in whom it revealed spondylodiscitis while the CT scan revealed degenerative lesions.

Eleven patients underwent MRI in total. It showed unifocal and multifocal spondylodiscitis in 5 and 6 cases respectively, epiduritis in 6 cases, spinal cord compression in 2 cases and abscesses in 4 cases.

Conclusion

Our study showed that CT and spinal MRI allow early diagnosis of spondylodiscitis. They help to identify asymptomatic lesions and neurological complications.

Disclosure of Interests

None declared

AB1224 NON-CONTIGUOUS MULTIFOCAL SPONDYLODISCITIS: A RETROSPECTIVE OBSERVATIONAL STUDY

Background

Non-contiguous multifocal spondylodiscitis (mSpD) is a serious infection. Although literature data highlight the opportunity to miss a non-contiguous spondylodiscitis (SpD), recommendations for which cases an MRI of the entire spine should be performed are missing.

Objectives

The aim of the study was to assess the clinical features of mSpD to reveal risk factors underlining the need for screening a multifocal spine involvement

Methods

We retrospectively evaluated the data of patients with confirmed non-contiguous multifocal spondylodiscitis

Results

Twelve patients suffered from mSpD were included (6 males, 6 females). The mean age was 60 years. Four patients had underlying chronic comorbidity, Diabetes (n=3), hepatitis C virus (n=1). Most patients had spine pain (11 patients,), radiculalgia in one patient, neurologic deficit (3 patients), worsening health status (7 patients). Symptoms onset was acute (n=1) or sub-acute (n=3) or long term (n=8) before admission. The mean duration between the diagnosis and the onset on symptoms was 9,6 months. Tubercular spondylodiscitis was the most detected etiology (n=8), confirmed by histological analysis (n=3) then brucellar, confirmed by serlology lab test, and pyogenic SpD in two patients each. Non-contiguous multi-level involvement in the lumbar, thoracic, and cervical spine was detected in one patient for each region. Seven patients suffered from a lumbar and thoracic spine involvement and SpD occurs in the three regions in two patients. Elevated inflammatory biomarkers (CRP and ESR) were present in all cases. Entire spine MRI was performed for almost all patients, confirmed the diagnosis, showed para-vertebral abscess (n=3), epidural inflammation (n=6), and spinal cord compression (n=3). The majority of cases showed a favorable evolution with appropriate antibiotic therapy. One patient maintain a neurologic deficit, and one suffered from a severe degree of pain. Surgical approach was not indicated.

Conclusion

In our study, mSpD did not appear to be associated with a particular pattern. Tuberculosis was the dominant etiology. That suggests, an MRI of the entire spinal column should be performed for each patient with suspicious SpD, especially when tuberculosis is evocated

Disclosure of Interests

None declared

AB0342 EVALUATION OF SELF-CARE SAFETY SKILLS AND THERAPEUTIC KNOWLEDGE OF RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC DRUGS

Background

The management of rheumatoid arthritis (RA) was revolutionized by the use of biologic therapies (bDMARD). Nevertheless, bDMARDs may carry some specific risks such as infection. However, data about self-care safety skills are poor [1]. An assessment of the level of information and education is therefore essential for patients followed for RA.

Objectives

The purpose of our study was to assess knowledge and safety skills of RA patients under bDMARDs.

Methods

We conducted a descriptive, bi-centric, and cross-sectional study, including RA patients receiving intravenous (IV) or subcutaneous (SC) bDMARD for at least 3 months. Sociodemographic, clinical, and paraclinical data were collected. Knowledges and self-care safety skills were assessed by a pre-specified questionnaire.

The questionnaire was divided into three domains:

- Five questions about general theoretical knowledge domain: assessing patient’s knowledge of the name of the current bDMARD, duration and rate of intake, and a question on annual cost estimation.

- Three questions about the current bDMARD management: assessing cold chain compliance and management of the biologic in SC emphasizing adherence to the steps to be taken prior to giving the injection.

- Tow questions about knowledge regarding safety skills in special situations: infection, cough, contraception, surgery, vaccination, and regarding the need to inform others about the use of bDMARD.

Based on the data analysis, patients were divided into 3 groups according to their knowledge level:

- Group A (low knowledge level: percentage of correct answers <40%)

- Group B (moderate knowledge level: percentage of correct answers >40% and <60%)

- Group C (high level of knowledge: percentage of correct answers > 60%).

Results

Seventy-five patients with RA were collected. Their mean age was 56.92 ± 9.06 years [34-80]. The mean duration of bDMARD was 37.17 ± 39.44 months [4-248] with a mean rank of 1.41 ± 0.9 [1-5]. The SC route was used in 41 patients (54.7%) followed by the IV route in 34 patients (45.3%)

The most prescribed molecules were Infliximab, Certolizumab and Tocilizumab (22.7% respectively). The average order of the current biologics was 1.41 ± 0.9 [1-5] in combination with a csDMARD in 48 patients (64%).

Safety skills were low in 24 patients (32%), moderate in 36 patients (48%), and high in 15 patients (20%).

The mean percentage of correct answers for each domain was respectively: 56.53 ± 18.4% [20-100] for general theoretical knowledge domain, 68.44 ± 26.21% [0-100] for the management of current biologic treatment domain, and 40.8 ± 16.87% [6.67-80] for knowledge regarding safety skills in special situations.

Safety skills levels were significantly related to occupational status (p=0.001), DAS28 CRP (p=0.04), joint deformities (p=0.01) and radiographic erosions (p=0.006), number of previous bDMARDs (p=0.009), and the rank of the current bDMARD (p=0.009).

Conclusion

The major finding of our study was the insufficient level of knowledge and safety skills of RA patients under bDMARDs. We highlight the importance of involving patients in the decision-making process and emphasize the role of the therapeutic patient education programs.

References

[1]Orefice D, Beauvais C, Gossec L, Flipon E, Fautrel B, Marguerie L, et al. Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease. Joint Bone Spine. 2014;81(6):502‑7

Disclosure of Interests

None declared

AB0338 BELIEFS ABOUT BIOLOGIC DRUGS AMONG RHEUMATOID ARTHRITIS PATIENTS

Background

Rheumatoid arthritis (RA) is a chronic inflammatory disease requiring a long-term follow-up and the use of chronic therapies. The management of this disease is based on a multidisciplinary care, requiring total patient involvement. Previous personal experiences, the experiences of others and the daily impact of the disease on patients fuel their perceptions of the treatment especially biologic one. There are few studies evaluating patient’s beliefs about these drugs [1,2].

Objectives

The aim of our study was to investigate beliefs about biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) among patients with RA and to identify factors related to specific beliefs.

Methods

We conducted a bi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARDs associated or no to conventional synthetic (sc) DMARDs. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ).

Results

There were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. The mean age was 56.92 ± 9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed. Sixty-four patients (85.3%) were married. The mean disease duration was 14.85 ± 8.5 years [2-39]. Thirty-three patients had joint deformities. Twenty-seven patients had extra-articular manifestations and thirty-six patients had comorbidities. The mean disease activity scale (DAS28 CRP) was 3.94 ± 1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low disease activity, and 19% were in remission. The mean functional impairment scale (HAQ) was 0.64 ± 0.48 [0-2.2]. Twelve patients had moderate to severe disability and only one patient had severe to very severe disability. The mean duration of the current bDMARD was 37.17 ± 39.44 months and the mean rank of the current biotherapy was 1.41 ± 0.9 [1-5].

Regarding the BMQ, the mean score for General Overuse was 14 ± 2.37 [6-20]. The mean score for General Harm was 10.82 ± 4.42 [4-20].

The mean score of patients’ specific beliefs regarding the necessity of taking the current bDMARD (Specific Necessity) was 20.62 ± 5.71 [5-25]. The mean Specific Concerns score regarding the current bDMARD was 10.33 ± 3.29 [5-25]. Necessity about taking bDMARD was reported by 77.3% patients in the present and 61.3 % patients consider maintaining the bDMARD in the future.

There were 4% of patients who reported concerns about taking bDMARD. Twenty four percent of patients reported concerns about long term effects, and 16% about becoming too dependent on bDMARD.

Beliefs about the necessity to stop occasionally chronic therapies were reported by 13.3% of patients.

Specific necessity was correlated to the current bDMARD duration (p=0.01), Patient Global Evaluation (p=0.03), VAS pain scale (p<10-3), the number of nocturnal awakenings (p=0.01), tender joint count (p<10-3), swollen joint count ((p<10-3), HAQ (p=0.005), DAS28 (CRP) (p<10-3). Specific concerns were correlated to the actual bDMARD rank (p=0.01).

Conclusion

Our study showed stronger beliefs in the necessity of taking biologic drugs if indicated. Disease activity parameters and functional impairment influence those beliefs. Further studies are required to evaluate the impact of beliefs on biologic drug adherence.

References

[1]Cea-Calvo L, Raya E, Marras C, Salman-Monte TC, Ortiz A, Salvador G, et al. The beliefs of rheumatoid arthritis patients in their subcutaneous biological drug: strengths and areas of concern. Rheumatol Int. 2018;38(9):1735‑40.

[2]Heuckelum M van, Linn AJ, Vandeberg L, Hebing RCF, Dijk L van, Vervloet M, et al. Implicit and explicit attitudes towards disease-modifying antirheumatic drugs as possible target for improving medication adherence. Plos One. 2019;14(8):e0221290.

Disclosure of Interests

None declared

AB0365 BELIEFS AND ADHERENCE IN RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC DRUGS

Background

Patients with chronic rheumatic diseases play an important role in their disease management. Adherence to their long-term therapies may depend on their therapeutic beliefs [1].

Objectives

The purpose of our study was to investigate the relationship between beliefs and adherence among patients with rheumatoid arthritis (RA) on biologic therapies (bDMARDs).

Methods

We conducted a multi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARD. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ) and about their therapeutic adherence.

Results

There were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. Their mean age was 56.92±9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed (15%). The mean disease activity scale (DAS28 CRP) was 3.94±1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low activity, and 19% were in remission. The mean duration of the current bDMARD was 37.17±39.44 months [4-248]. The mean Specific Necessity score was 21.02±5.38 [5-25] for adherent patients and 13.5±7.54 [5-19] for non-adherent patients.

The mean Specific Concerns score was 10.07±3.13 [5-15] for adherent patients and 15±2.82 [5-20] for non-adherent patients.

A statistically significant association was found between Specific Concerns beliefs and adherence behavior (p=0.009) and between Specific Concerns beliefs and adherence behavior (p=0.003). No statistically significant association was noted between general beliefs (General Harm and General Overuse) and adherence behavior (p=0.4 and p=0.6 respectively).

Conclusion

Beliefs about therapeutic were identified as a key factor of adherence among rheumatic disease patients. Practitioners should detect negative patient beliefs and perceptions earlier to prevent nonadherence.

References

[1]Suh YS, Cheon YH, Kim HO, Kim RB, Park KS, Kim SH, Lee SG, Park EK, Hur J, Lee SI. Medication nonadherence in Korean patients with rheumatoid arthritis: the importance of belief about medication and illness perception. Korean J Intern Med. 2018 Jan;33(1):203-210.

Disclosure of Interests

None declared

AB1077 INFECTIOUS SPONDYLODISCITIS IN ELDERLY: IS IT MORE SEVERE DISEASE?

Background

Spondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms. In older patients, there are often difficulties in diagnosis and management.

Objectives

This retrospective study aimed to assess the characteristics of infectious spondylodiscitis in patients over 65 years of age.

Methods

This retrospective, monocentric study included patients aged over 65 years olds hospitalized in our department of rheumatology for spondylodiscitis.

Results

A total of 20 consecutive patients (10 males, 10 females) aged over 65 years were analyzed. The mean age of patients was 74 years (65-85). The most common comorbidities included diabetes (20%), chronic renal failure (5%). A history of nodal tuberculosis (10%), a tuberculosis contagion (30%), and raw milk ingestion (15%) were reported. The average delay for diagnosis was 10 months. The most common symptom was axial back pain (100% patients), then worsening health status (34%), and one patient had a significant neurological deficit. C-reactive protein was elevated in 95%. The most common involvement was in the lumbar vertebrae (13 patients, 65%), followed by thoracic and cervical level disease respectively in 3 patients (15%) and 2 patients (10%). Two patients (10%) had a multifocal spondylodiscitis. All patients underwent an MRI exam that confirmed the diagnosis. A percutaneous spine biopsy was performed in 80%. Pyogenic spondylodiscitis was the most common etiology (50%), followed by tuberculosis (35%) and brucellosis (15%). Antibiotic therapy was indicated to all patients with spinal immobilization in 65% of cases. Two patients underwent percutaneous drainage of paravertebral abscesses. The outcome was favorable in almost all cases until 12 months of following-up after completion of treatment. One patient died of septic shock and multi-visceral failure.

Conclusion

Elderly patients with infectious spondylodiscitis have fewer clinical symptoms leading to a delayed presentation. Increasing morbidity and mortality make rigorous monitoring necessary.

Disclosure of Interests

None declared

AB1070 INFECTIOUS SACROILIITIS: A RARE ENTITY IN RHEUMATOLOGY!

Background

Infectious sacroiliitis (ISI) is a rare disease, with misleading clinical symptoms that often delay the diagnosis.

Objectives

The aim of this study was to describe the clinical, microbiological, therapeutic and radiological characteristics of ISI.

Methods

This descriptive, retrospective study included all ISI patients that were hospitalized in our rheumatology department over an 11-year period [2010 - 2021].

Results

Overall, 25 cases of ISI were identified, comprising 15 men (60%) and 10 women (40%), with a mean age of 48.7±10.5 years [21-67]. ISI was caused by pyogenic microorganisms in 12 cases (70.5%), mycobacterium tuberculosis in 7 cases (41.2%), and brucella spp in 6 cases (35.3%). The mean symptoms duration in pyogenic, brucellar and tuberculous ISI was 42 days, 67 days, and 255 days, respectively. The onset was brutal in 88% of pyogenic ISI, while it was progressive in 68% of brucellar ISI and in all cases of tuberculous ISI. Lumbogluteal pain was the most common symptom (80%). The involvement of the sacroiliac joint was always unilateral, and inflammatory in 92% of cases. The other most common symptoms included: fever (80%), impotence (68%), and lumbago (52%). An infectious source was found in 17 patients: 41.2% pulmonary (tuberculosis, n=7), 29.4% urinary, 17.6% gynecological (postpartum, n=3), and 11.7% septicemic (n=2). Fifteen patients (60%) had a biological inflammatory syndrome. Leukocytosis was found in 11 cases (64.7%). Pelvic x-ray showed a narrowing of the sacroiliac joints in 52% of cases. CT of the sacroiliac joints showed erosions in 60% of cases. Sacroiliac MRI showed erosions (45%), joint effusion (32%), and psoas abscess (14%). A second infectious site was found in 20% of cases: psoas abscess (n=2), and a collection of the soft tissues facing the joint (n=1). A pathogenic agent was isolated by means of blood culture (48%; staphylococcus aureus 56%, streptococcus 28%, and staphylococcus with negative coagulase 16%), articular biopsy (40%), cytobacteriological examination of urine (20%), Wright serology (20%), and Tuberculin skin test (6.2%). All patients received germ-adapted antibiotics. No patients have had surgical treatment. Evolution was favorable in most cases (n=11). Four patients complained of residual pain in the sacroiliac region. None of the patients relapsed.

Conclusion

Although IS is rare, it remains an emergency diagnosis. A rigorous physical examination is essential in order to detect this infection early. Antibiotics often lead to clinical improvement, making thus the need for surgery exceptional.

Disclosure of Interests

None declared

AB1482 PROGNOSTIC FACTORS FOR TUBERCULOUS SPONDYLODISCITIS

Background

Tuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). It accounts for 46% to 64% of infectious spondylodiscitis and is the most common form of vertebral tuberculosis. Pott’s disease still poses a public health problem in Tunisia due to the endemicity of tuberculosis and the increase in extra-pulmonary forms.

Objectives

Our aim was to study factors impacting SPDT outcome.

Methods

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. The diagnosis was based either on a range of highly evocative clinical, biological and radiological arguments or on the disco-vertebral biopsy puncture. The study included correlations of the promoting factors of SPDT (tuberculosis infection, history of tuberculosis, diabetes, corticosteroids and trauma), epidemiological, clinical, biological, radiological and therapeutic data with good clinical outcome in the fourth week of the anti-tuberculosis drugs treatment.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were aged under 65 years versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The diagnosis of SPDT was based either on a range of highly evocative clinical, biological and radiological arguments (71.2%) or on the disco-vertebral biopsy puncture (28.8%). Among the clinical arguments suggestive of tuberculous SPD were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contibutive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. The treatment was based on anti-tuberculosis drugs for at least nine months. Only four factors had an unfavourable predictive value (p ≤ 0.05): Normochromic normocytic anemia observed in 53.8% of our patients (p = 0.018; Odds Ratio = 6.66), initial lymphocytosis (p = 0.048), fever in 36.5% of our patients (p = 0.01; Odds Ratio = 9.6) and standard X-ray vertebral compression in 67.3% of our cases (p = 0.001; Odds Ratio = 13).

Conclusion

Tuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Poor prognosis factors have been identified to provide insight into disease progression.

Disclosure of Interests

None declared

AB1459 IMPACT OF SOCIOECONOMIC FACTORS ON THE DISEASE ACTIVITY: DATA FROM THE TUNISIAN BINAR REGISTRY

Background

Despite the considerable therapeutic progress of inflammatory rheumatic diseases, access to treatment still challenging in developing countries because of scarce health resources and low socioeconomic status.

Objectives

To determine the influence of socioeconomic factors on disease activity in a national registry cohort, the Biological National Registry (BINAR) in Tunisia.

Methods

We enrolled patients with inflammatory rheumatic diseases under the first received biological drug and included in the BINAR registry from 2016 to 2020. Data on the inflammatory rheumatic disease (rheumatoid arthritis (RA) and spondyloarthritis (SA)), disease activity of RA and SA (DAS28-CRP and ASDAS-CRP respectively) at baseline, gender, active smoking, marital and work status and educational attainment were collected. Two groups were identified: Groupe 1 (G1) for patients with remission or low disease activity and groupe 2 (G2) for moderate or high disease activity according to DAS28-CRP and ASDAS-CRP.

Results

The study included 298 patients with a mean age of 49.2 years [18-79]. The mean disease duration was 6.7 ± 3.5 years [1-14] in patients with RA and 6.5 ±3.6 years [1-12] in patients with SA. G1 was made of 13 patients and G2 of 285 patients. The were no significant difference between G1 and G2 for (49.5 ± 11.9 versus 49.5±14.2, p=0.93) gender (% of females, 46.2% versus 37.1%, p=0.51) and marital status (% of single patients, 30.8 % versus 33.7%,p=0.82). Patients of G1 had better employability than G2 (61.5% % versus 45.6%) but this difference was not significant (p=0.26). Smoker patients had better disease outcomes comparing to nonsmokers but this difference was not significant (23.1 % versus 13.7%, p=0.34). Illiterate patients had more active diseases, comparing to literate, but this difference was not significant (30.8% versus 40.4%, p=0.49).

Conclusion

Our results did not confirm any difference in disease activity according to the collected socioeconomic factors. Data on the personal income, health insurance type and geographic distribution of our population should be further studied.

Disclosure of Interests

None declared

AB0193 BIOLOGIC DRUGS RETENTION IN ELDERLY RHEUMATOID ARTHRITIS: WHAT FEATURES?

Background

The elderly RA population is expanding. The management of RA in elderly patients can be challenging because of comorbidities, the frequency of adverse events. The efficacy and safety of RA therapies; particularly biologics drugs (bDMARDs); are poorly studied in this age group.

Objectives

To investigate the therapeutic response to bDMARDs in elderly rheumatoid arthritis.

Methods

We conducted a cross-sectional and observational study. Files of patients with RA on biologics drugs (archived from the files of patients on the National Health Insurance Fund of Tunis) were studied. The characteristics of RA, and the current treatments were studied. We have divided our population into two age groups. G1 aging under 65 years and G2 aged 65 or over. The therapeutic maintenance rate as well as the biologics survival was analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.

Results

Three hundred and seventy-four files were selected. Their average age was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41]. Subjects over the age of 65 represented 22.2% of the workforce, i.e. 83 patients. The first biotherapy prescribed was etanercept in 54% of cases, adalimumab in 14% of cases, certolizumab pegol 13%, infliximab 6%, tocilizumab 6% and rituximab in 7% of cases. The 4-year survival was 54.41% and 60.94% for subjects under 65 and 65 or older, respectively. Treatment maintenance for RA in the elderly (≥ 65 years old) was 42.21 months, [53.51–46.92]. In our study, age did not influence the survival of biologics with a Hazard Ratio (HR) = 0.997 (p=0.667).

Conclusion

RA therapy is generally effective and safe in elderly patients. We did not find any influence of age on survival and therapeutic maintenance of biological treatments. Further studies with a broader spectrum are needed to better understand this notion

Disclosure of Interests

None declared