22 Monitoring of juvenile idiopathic arthritis: don’t miss the foot deformities!

Background

Foot deformities seem to be frequent in children with Juvenile Idiopathic Arthritis (JIA) [1,2]. These deformities can deeply affect the child’s activity and alter his quality of life.

Objectives

To study the association between disease activity and foot deformities in JIA patients.

Methods

We conducted a cross-sectional study including patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria for JIA. For each patient, we collected the following data: age, disease duration, tender joint count (TJC), swollen joint count (SJC), Patient Global Assessment (PGA), Visual Analogic Scale (VAS), and therapeutic management. Disease activity was assessed using the Juvenile Arthritis Disease Activity score (JADAS). Foot deformities were assessed using an optical podoscope. C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) levels were measured. Statistical analysis was performed using SPSS software.

Results

We included 35 patients. Forty-three percent of the patients were boys (n = 15). The mean age was 12.2 ± 3.61 years. The mean disease duration was 4.1 ± 3.29 years. The mean PGA and the mean VAS were 3.4 ± 3.02 and 3.37 ± 2.92, respectively. The mean TJC and the mean SJC were 1.48 ± 1.69 and 0.61 ± 0.77, respectively. The mean CRP and ESR were 7.51 ± 11.85 mg/l and 18.88 ± 15.53 mm, respectively. Twenty-four patients were under non-steroidal anti-inflammatory drugs (69%), 12 patients were under methotrexate (34%), and 5 patients were under TNFα inhibitor (14%).

The mean JADAS was 7.58 ± 6.3. Seventeen percent of the patients had the inactive disease (n = 6). Foot deformities were found in 80% of the patients (n = 28). They were flatfoot in 40% (n = 14) and pes cavus in 46% (n = 16). These deformities were bilateral in 18 cases (51%). Hallux valgus was present in 14% of the cases (n = 5). Foot deformities were associated to a higher PGA (4.04 ± 3.01 vs 0.86 ± 1.2, p< 10^–3), VAS (3.93 ± 2.94 vs 1.14 ± 1.46, p = 0.022), CRP level (8.84 ± 13.1 vs 2.79 ± 2.5 mg/l, p = 0.039), and higher JADAS (9.12 ± 6.25 vs 2.08 ± 1.93, p< 10^–3).

Conclusion

Our study showed that foot deformities are common in JIA. Interestingly, these deformities are associated with a higher CRP level and a higher disease activity. These results suggest that an early screening of foot deformities is advisable in patients with active disease.

References

1. Truckenbrodt H, Häfner R, von Altenbockum C. Functional joint analysis of the foot in juvenile chronic arthritis. Clin Exp Rheumatol. 1994; 12 Suppl 10: S91-96.

2. Gschwend N, Ivosevic-Radovanovic D. [The child’s foot in juvenile polyarthritis (cP)]. Orthopade. 1986; 15(3):212–9.

21 Disease activity and body mass index in juvenile idiopathic arthritis: is the truth revealed?

Background

Objective

Methods

Results

Conclusion

19 Maternal and early childhood exposures in relation to juvenile idiopathic arthritis

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. JIA likely has a complex aetiology, with multiple genetic and environmental factors contributing to its development. Existing data on associations between maternal and early childhood exposures and JIA is rare. Previous studies showed potential role for prematurity, number of siblings and infections.

Objectives

The aim of our study is to assess maternal and early childhood exposures in patients with JIA.

Methods

Mothers of children with JIA followed in rheumatology department were asked about maternity related data as well as the course of perinatal period of the child with JIA based on the International League of Associations for Rheumatology (ILAR) criteria. Exposure information from birth included: Maternal factors (age when they had the first child, age when they had the child with JIA, plurality (singleton, twin/multiple gestation), number of prior fetal losses, number of prior births; delivery method (vaginal, cesarean section)) and also information about birth weight (low (&lt;2500 grams), normal (2500– 4000 grams), excessive (4000+ grams)); size for- gestational-age and gestational age (preterm, normal term, post term) and postpartum complications.

Results

Thirty children (sixteen females and fourteen males) with JIA were included. The most common type of JIA was enthesitis-related in 13 cases, then oligoarthritis in 8 cases, polyarthritis without rheumatoid factor in 4 cases, polyarthritis with positive rheumatoid factor in 2 cases and psoriatic arthritis in 3 cases. The mean age of the mothers was 27.1 years [22–40] when they had their first child and 30.27 years [22–42] when they had their child with JIA. They were nulliparous in 40% of the cases. All of the children were from a singleton pregnancy. Thirty percent of the mothers had at least one prior fetal loss before they had their child with JIA. During their pregnancy with their child with JIA, five mothers had pre-eclampsia and two of them had gestational diabetes. None of them smoked during the pregnancy. Only 2 children had preterm birth. Birth weight was normal (2.500–4.000 grams) in 24 cases, low in 3 cases (&lt;2.500 grams) and above normal (&gt;4000 grams) in 3 cases. Size for gestational age was normal in all cases. Nineteen mothers had vaginal delivery and eleven had cesarean section. Neonatal complications were noted in 7 cases who needed to be admitted to neonatal intensive care unit (1 for hypoglycemia, 1 for jaundice, 2 for infection, 1 for respiratory distress and two because of preterm birth). Maternal complications were noted in four cases: 2 postpartum hemorrhage and 2 postpartum infections.

Conclusion

Our study assessed maternal and early childhood exposures in patients with JIA. Further studies are required to explore associations between these factors and the occurrence of the disease for a better knowledge of etiologies of JIA and for a possible prevention from this pathology.

AB0215 DOES THE PARITY IMPROVE THE RHEUMATOID ARTHRITIS ACTIVITY?

Background

The parity seems to decrease the risk of auto-immune diseases like Rheumatoid arthritis (RA). The risk reduction appeared when the parity number reached two [1]. The activity of RA improved during pregnancy and flares postpartum, but the relationship of parity to RA prognosis is unclear. The impact of childbirth on disease activity is less studied.

Objectives

We aimed to investigate the impact of parity on rheumatoid arthritis activity.

Methods

We conducted a retrospective study including patients fulfilling the American Congress Of Rheumatology / European League Against Rheumatism (ACR EULAR) 2010 criteria.

We collected epidemiological, clinical, biological (C-reactive protein: CRP, erythrocyte sedimentation rate (ESR), immunological status (rheumatoid factor RF and anti-citrullinated protein/peptide antibody ACPA), and disease activity index (The Disease Activity Score 28 DAS 28). We divided our patients into two groups: group (G1): the nulliparous women; group 2 (G2): women who gave birth.

Results

Ninety-two patients were enrolled. There were 14 men and 78 women. The mean age was 59.56 ± 11.7 years. The mean disease duration was 9.32 ± 8.22 years. Among 78 women, we found 50 patients with parity. The main swollen joint was 3.34 ± 3.6 in G2 versus 4.44 ± 4.04 in G1 (p=0.94). The mean painful joints were 6.74 ± 5.12 and 9 ± 9.19 (p=0.28), respectively. However, the inflammatory syndrome is higher among women in G2. The mean CRP level was 15.1 mg/l, and the mean ESR was 37.7 mm. In G1, the RF and ACPA were 131 UI/l and 281 UI/l, respectively compared with 568 UI/L and 315UI/l, respectively in G2.

A significant difference was noted in the DAS28-CRP between the two groups (G2: 4.18 ±1.23 versus G1: 4.49 ± 2.5, p=0.04).

However, no association was found between parity and disease activity using the DAS28-ESR.

Conclusion

Our study showed that parity could have a protective effect on disease activity. It seems to be associated with a lower joint count and a lower rate of RF and ACPA. However, more studies are necessary to conclude these issues.

References

[1]Chen WMY, Subesinghe S, Muller S, Hider SL, Mallen CD, Scott IC. The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. avr 2020;50(2):252‑60.

Disclosure of Interests

None declared

AB0819 Impact of childbirth on the sacroiliac joints in non-radiographic axial Spondyloarthritis

Background

The era of magnetic resonance imaging (MRI) has contributed to a better assessment of patients with early disease stages of axial spondyloarhtis (ax-SpA), to the extent that a new entity has emerged. Indeed, the spectrum of SpA has broaden to include non-radiographic axial spondyloarthritis (nr-axSpA). Childbirth has been found to be associated with bone marrow edema (BME) in the sacroiliac joints (SIJ) [1], yet the extent of these lesions is inadequately described, which complicates the distinction with nr-axSpA.

Objectives

This study aimed to explore the impact of childbirth on MRI findings and BME in nr-axSpA.

Methods

We conducted a cross-sectional study including women diagnosed with nr-axSpA according to the ASAS (Assessment of SpondyloArthritis international Society) criteria. Socio-demographic data as well as childbirth history were recorded. The sacroiliac joints manoeuvers’ examination were also transcribed. Ultrasound of the SIJ as well MRI-SIJ was performed in all the women. The sequence protocol included the following: T1-weighted, T2-weighted and axial STIR and were scored for BMO. We investigated an association between the number of children and MRI abnormalities mainly the presence of BME. The level of significance was fixed for p<0.05.

Results

The study included 30 women. The mean age at diagnosis was 40±9.8 years old [21-59] and the mean age at inclusion was 49±11 years old [26-74]. The median number of children was 2 [0-7]. Half of the patients were multiparous. Doppler ultrasound of the SIJ was found in 59.1% of cases. Overall, 36.7% of the women fulfilled the ASAS definition of a positive MRI. BME was displayed on STIR MRI sequence in 26.5% of cases and was equally present at the right SIJ compared with the left (26.7% vs 23.3%). Gadolinium enhancement was found in 16.7% of cases and subchondral erosions were found in 36.7% of cases. There was no association between the different sacroiliac maneuvers on physical examination and the number of children: distraction test (p=0. 145), compression test (p=0.088), Gaenslen test (p=0.475), and Mennel test (p=0.088). BME was more frequent among multiparous women (33% vs 29%) without reaching a statistically significant difference (p=0.635). There was no association between the number of children and Hyper T1 (p=0.608), T1 gadolinium (p=0.55) as well as sclerosis (p=0.55). Similarly, there was no association between the presence of Doppler signal on ultrasound and multiparity (p=0.5).

Conclusion

Our study showed that MRI-SIJ findings were similar in nr-axSpA women regardless of the number of children, mainly BME. More trials are needed to evaluate the discriminatory capacity of MRI abnormalities and to palliate to the lack of specificities of the ASAS MRI criteria.

References

[1]Germann C, Kroismayr D, Brunner F, Pfirrmann CWA, Sutter R, Zubler V. Influence of pregnancy/childbirth on long-term bone marrow edema and subchondral sclerosis of sacroiliac joints. Skeletal Radiol. 2021;50(8):1617-1628.

Disclosure of Interests

None declared

POS1313 HIP INVOLVEMENT IS A MORE FREQUENT COMPLICATION IN ENTHESITIS-RELATED ARTHRITIS COMPARING TO THE ADULT SPONDYLARTHRITIS

Background

The hip disease develops in 30% to 50% of children with juvenile idiopathic arthritis (JIA) and is associated with poor outcomes and functional impairment. The coxitis in enthesitis-related arthritis (ERA or juvenile-onset spondyloarthritis) patients was frequent but weakly studied.

Objectives

To assess the occurrence of coxitis in patients with ERA and compare it to that of older patients with spondyloarthritis (SpA).

Methods

We conducted a retrospective comparative study including patients with ERA and adult spondyloarthritis patients.

The first group included patients under 16 years old fulfilling the International League of Associations for Rheumatology (ILAR). The second group of patients fulfilled the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria.

We studied the socio-demographic characteristics of both groups, the hip involvement occurrence, and the treatment modalities.

Quality of life was appraised by the Study 36-item Short-Form Health Survey (SF-36) and the Ankylosing spondylitis quality of life test (ASQOL).

Results

Forty ERA (mean age= 25,3 ± 10,15) patients and 134 SpA (mean age=37,96±11,77) patients were enrolled. Seventeen ERA patients (42,5%) had coxitis at recruitment compared to 28 SpA patients (20,9%), p=0,06. More than half of the ERA patients were positive to HLAb27, compared to the SpA group (44,7%) without reaching a significant threshold, p=0,07. The mean delay of coxitis onset in ERA patients was 4,66 ± 8,46 years, and was 5,65 ± 6,85 years in SpA patients, with no significant difference between the two groups (p=0,527). There was no difference between the two groups for the coxitis being unilateral or bilateral (p=0,272 and 0,169 respectively). Regarding the treatment approach, local therapy was proposed to 11 patients in the ERA group and 13 patients in the SpA group (p=0,07), with synoviorthesis being the most common therapy. Total hip replacement was done in 8 ERA patients (of which seven were bilateral) and in 17 SpA patients (of which ten were bilateral), without reaching the significant threshold (p=0,858). There was no significant difference between the two groups on the period when the total hip replacement was done (p=0,925). Quality of life assessed by the ASQOL and the SF-36 was comparable between the two groups (p=0,666 and 0,326; respectively).

Conclusion

Our study shows the high prevalence of hip involvement in the juvenile group of SpA. This complication occurs within the five years of disease outcomes and constitutes a turning point in their lives.

Disclosure of Interests

None declared

AB1255 ASSESSMENT OF SLEEP DISTURBANCES IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Sleep problems are common among children with chronic illnesses such as Juvenile Idiopathic Arthritis (JIA), which is one of the most common rheumatic diseases in childhood. Sleep disturbances collectively refer to impairments in the ability to initiate or maintain sleep. They can be measured by parent or child self-report and by objective measures such as actigraphy and polysomnography.

Objectives

The aim of this study was to assess sleep disorders in children with JIA.

Methods

Parents of children suffering from JIA (according to the International League of Associations for Rheumatology (ILAR)), followed in rheumatology department were asked to complete a specific specialized scale for children (HIBOU) [1] to screen sleep disorders. This scale assesses five aspects of sleep: irregular schedule and daytime drowsiness, insomnia, moves in sleep, nose obstruction and ultra-vigilance. Parents were asked to answer 8 questions rated from 1 to 3 according to the frequency of the problem, 1: rarely, 2: 3 to 4 times a week and 3 if 5 to 7 times a week. If the sum is ≤ 9, only sleep hygiene is recommended. If the sum is between 10 and 15 the child requires regular supervision. If the sum is between 16 and 24, the child needs to be referred to a specialist. General demographic and clinical information (family history of chronic inflammatory disease, child’s current age, diagnosis and type of JIA, duration of disease progression and activity of the disease) were also collected.

Results

Twenty-four children with a mean age of 12 years [4-16] were included in the study. The gender ratio was 1. The mean duration of the disease was 4 years with extremes from three months to thirteen years. The frequency of each JIA subset was as follows: polyarticular with rheumatoid factor (n= 2), polyarticular without rheumatoid factor (n=5), psoriatic arthritis (n= 1), enthesitis-related arthritis (n=10) and oligoarthritis (n= 6). Irregular sleep schedule and daytime drowsiness were reported at least 3 times a week by 58.3% of the children. Insomnia and inability to initiate sleep were reported in 29.3% of the children at least 3 times a week. Parents reported exaggerated moves during sleep in 50% of the cases and airway obstruction or snoring in 58.3% more than 3 times a week. Difficulties to maintain a good night of sleep more than three times a week were reported in 25% of cases. To sum up, 29.2% of the children had a score above 15 and needed to be referred to a specialist and 58.3% of them need a regular supervision of their sleep and may need to be referred to a specialist. Only three children had a score under 9 and don’t have concerning sleep disorders according to this scale.

Conclusion

This study showed that sleep disorders are a common challenge in children and adolescents with JIA which could have a huge impact on their physical and psychosocial health-related quality of life. This study highlights the need for assessment of sleep disorders in JIA patients.

References

[1]Benhaberou-Brun D. HIBOU: pour évaluer les troubles du sommeil [HIBOU: evaluating sleep disorders in children]. Perspect Infirm. 2011;8(6):35-37.

Disclosure of Interests

None declared

AB0820 Remission criteria in non-radiographic axial spondyloarthritis: don’t miss subclinical inflammation

Background

With the advent of the treat-to-target strategy (T2T), clinical remission has become the main objective to achieve in patients with rheumatic diseases. Contrary to rheumatoid arthritis, the T2T strategy is less codified in axial spondyloarthritis, even more in non-radiographic SpA (nr-axSpA) [1]. More importantly, T2T based on imaging remission and guidance for tapering medication has not been extensively studied.

Objectives

The objective of this study was to investigate the prevalence of bone marrow edema in the sacroiliac joint of nr-axSpA patients in remission.

Methods

We undertook a cross-sectional study including nr-axSpA patients according to the ASAS criteria, treated with NSAIDs. Socio demographic data as well disease characteristics were recorded. Disease activity parameters were also collected including the duration of morning stiffness, the number night awakening, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). MRI-SIJ was performed for all the patients. All the images were screened for bone marrow edema with the corresponding sequence (short tau inversion). To define remission, we used in addition to BASDAI<4, more stringent criteria: BASDAI<4 and CRP<6 mg/l and ESR<20 mm/h and EGM<4 [2]. The level of significance was fixed for p<0.05.

Results

The study included 43 nr-axSpA patients. There was a female predominance with a sex ratio of 0.43. The mean age of the patients was 42±12 years [20-71] and the mean disease duration was 17±9.7 years [4-38]. The mean ESR and CRP were 2.2 mg/L [2-65] and 6.4mm/h [1-47], respectively. A higher level of acute phase reactants was found in 40.5% of cases (ESR: 35.7%, CRP: 11.9%). Forty percent of the patients had high CRP or ESR despite BASDAI<4. According to BADSAI<4, of the 15 patients in remission, BME was displayed in 43.5% of the cases. According to the used criteria, 25.6% of the patients were in remission, of which 45.4% exhibited BME in the sacroiliac joint. There was no statistically significant association between disease activity according to the used definition and the presence of BME (p=0.473). Nr-axSpa patients in remission without BME had more durable morning stiffness and articular involvement without reaching a statistically significant difference (p=0.361, p=0.08 respectively). Similarly, we did not find an association between this subgroup and sex, age, night awakenings, the presence of HLAB27 (p>0.05).

Conclusion

Our study showed that even when using stringent criteria, subclinical remission evidenced by BME was not achieved in nr-ax SpA. Nevertheless, imaging remains one important parameter to consider in therapeutic decision making. More studies are needed to identify the best criteria for an optimal remission in this population.

References

[1]Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis?. Rheum Dis Clin North Am. 2020;46(2):311-25.

[2]Navarro-Compán V, Plasencia-Rodríguez C, de Miguel E, et al. Anti-TNF discontinuation and tapering strategies in patients with axial spondyloarthritis: a systematic literature review. Rheumatology (Oxford). 2016;55(7):1188-94.

Disclosure of Interests

None declared

AB1262 PERFORMANCE OF JADAS-ESR AND JADAS-CRP IN THE ASSESSMENT OF DISEASE ACTIVITY IN TUNISIAN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

The Juvenile Arthritis Disease Activity Score (JADAS) is a feasible tool which consists of four items: tender (TJC) or swollen joint count (SJC), the physician and the patient’s/parent’s global assessment and the erythrocyte sedimentation rate (ESR). C-reactive protein (CRP) has also been suggested as an alternative inflammatory marker.

Objectives

To compare the performance of JADAS-ESR and JADAS-CRP in the evaluation of JIA activity.

Methods

Twenty nine patients who met the International League of Associations for Rheumatology (ILAR) criteria for JIA were enrolled in the study. Disease activity was assessed by the JADAS-ESR and JADAS-CRP scores at 54 consultations, 29 at baseline and 25 during the last follow-up consultation. Data of JIA subtypes, disease duration and treatment were retrospectively collected from medical records. All data were checked for normality by the Kolmogorov-Smirnov test. The Spearman correlation was used for data analysis and p values less than 0.05 were considered statistically significant.

Results

The mean age of our population was 13.1±4.2 years [4-21] and the sex ratio of males to females was 1.07. The mean disease duration was 4.69±3.26 years [0.3-13]. JIA subtypes were: enthesis-related arthritis (n=12), polyarthritis (n=7), oligoarthritis (n=6), undifferentiated (n=3) and psoriatic arthritis (n=1). At baseline most of our patients (51,73%) were not under treatment, 34.49% were under non-steroidal anti-inflammatory drugs (NSAIDs) and 13.8% under methotrexate (MTX). At the last follow-up consultation 41.38% of the patients were under MTX, 34.49% under NSAIDS and 10.35% under TNF inhibitor (Etanercept). At baseline JADAS-ESR1 was correlated to JADAS-CRP1 (p<0.001, r=0.808) in all AIJ subtypes. JADAS-ESR1 and JADAS-CRP1 were not correlated to ESR1 (p=0.416, p=0.661) nor to CRP1 (p=0.376, p=0.058). Both JADAS-ESR1 and JADAS-CRP1 were correlated to TJC1 (p<0.0001, r=0.643; p=0.015, r=0.502) and only JADAS-ESR1 was correlated to SJC1 (p=0.012, r=0.461). At the last follow-up consultation, correlations were observed between JADAS-ESR2 and JADAS-CRP2 (p<0.001, r=0.992) in all AIJ subtypes. JADAS-ESR2 and JADAS-CRP2 were both correlated to CRP2 (p=0.015, p=0.003) but not to SJC (p=0.175, p=.119), nor to ESR2 (p=0.535, p=0.426).

Conclusion

Our study suggests that both JADAS-ESR and JADAS-CRP correlate closely during the follow-up of JIA. JADAS-CRP could be recommended for assessing disease activity in JIA.

Disclosure of Interests

None declared

AB0768 Influence of continuous non-steroidal anti-inflammatory drugs intake on bone marrow edema in non-radiographic Spondyloarthritis

Background

The concept of non-radiographic axial spondyloarthritis (nr-axSpA) has revolutionized the classical understanding of axSpA. Indeed, it facilitated the classification of patients with axSpA who did not present substantial structural damage as it was only detectable on magnetic resonance imaging of the sacroiliac joints (MRI-SIJ) [1]. Continuous non-steroidal anti-inflammatory (NSAIDs) intake has been reported as a potential factor reducing the sensitivity of MRI-SIJ to detect bone marrow edema (BME).

Objectives

The aim of the study was to investigate the effect of continuous NSAIDs intake on BME in nr-axSpA.

Methods

We undertook a cross-sectional study including nr-SpA according to the ASAS criteria and treated with NSAIDs at baseline. Socio demographic data as well disease characteristics were recorded. Disease activity parameters were also collected including the duration of morning stiffness, night awakenings, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). MRI-SIJ was performed for all the patients. All the images were screened for bone marrow edema with the corresponding sequence (short tau inversion). Patients were grouped according to NSAIDs intake: G1: continuous versus G2 occasional. The level of significance was fixed for p<0.05.

Results

The study included 43 nr-axSpA patients. There was a female predominance with a sex ratio of 0.43. The mean age of the patients was 42±12 years [20-71] and the mean disease duration was 17±9.7 years [4-38]. The mean morning stiffness duration was 47.3±45.6 [15-240] minutes. The mean spinal VAS was 5.9±2.6 [0-10]. Nearly 41% of the patients had an active disease with a mean BASDAI of 4.7± 2.1 [0-8.6]. The prescribed NSAIDs were as follows: Diclofenac (44 %), Indomethacin (8%), Ketoprofen (18%), Meloxicam (3%), Celecoxib (3%), Piroxicam (3%) and Naproxen (21%). Nearly half of the patients were continuously taking NSAIDs (52.6%) versus occasional intake (47.4%). Four patients failed two NSAIDs and were treated with a third one. Both groups were comparable for age (p=0.193), sex (p=0.386), and disease duration (p=0.4). Similarly, there were no statistically significant differences regarding disease activity parameters between both groups: numerical rating scale of pain (p=0.713), ESR (p=0.314), CRP (p=0.644), morning stiffness (p=0.428), night awakening (p=1), as well as BASDAI (p=0.514). Regarding MRI-SIJ findings, hyper signal in STIR sequence was comparable between both groups (G1: 35% vs G2:33%, p=0.914). Moreover, the increased signal with Gadolinium injection on T1-weighted images was similar between both groups (p=0.113).

Conclusion

Our study showed that continuous NSAIDs intake was not associated with significant changes in MRI-SIJ features. This study suggests that a NSAID-free period is not necessary before assessing bone marrow edema on MRI-SIJ.

References

[1]Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis?. Rheum Dis Clin North Am. 2020;46(2):311-25.

Disclosure of Interests

None declared

AB0870 ASSESSMENT OF FRACTURE RISK IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background

Spondyloarthritis (SpA) is a chronic inflammatory disease that predominantly affects the sacroiliac joints and the spine. Patients with SpA have an increased risk of osteoporosis and fracture resulting from a combination of inflammation and immobility. The non-radiographic form for SpA (nr-axSpA) has the same predictors factors of bone fragility however the real fracture risk is unknown in this phenotype.

Objectives

This study aims to investigate BMD and the Fracture Risk Assessment Tool (FRAX) in patients with nr-axSpA.

Methods

We conducted a retrospective study including 40 patients with nr-axSpA, according to the ASAS criteria. For the enrolled patient, we collected the clinical and biological data. We calculated the disease activity using the Bath Ankylosing Spondylitis disease activity (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Functional impairment was assessed by the Ankylosing Spondylitis Functional Index (BASFI). We measured the bone mineral density using the dual-energy X-ray absorptiometry (DXA) in the anteroposterior lumbar, lateral spine, and hip neck. The ten-year probability of major osteoporotic fracture was calculated using the Tunisian version of Fracture Risk Assessment Tool (FRAX).

Results

Twenty-seven women (67.5%) and thirteen men (32.5%) were enrolled. The mean age was 41.5 years (±11.2), and the mean disease duration was 3,1 years (±2.7). The mean BASDAI and ASDAS CRP was 4.7 ± 2.2 and 3.27 ± 1.29, respectively. The mean BASFI was 3.6 ± 2.5. According to World Health Organization (WHO) criteria, 45% of patients displayed osteopenia and 30% osteoporosis. The mean major osteoporotic fracture (MOF) score was 0,09 ± 0,25 [0-1,3]. The MOF was significantly associated with BMD (p=0.000). The variables associated with MOF were a high physician’s global assessment score, a high BASFI, and female gender, but without significant relation. However, no correlation was found between the MOF and the disease duration, the presence of peripheral arthritis or enthesitis, and the ASDAS.

Conclusion

In nr-axSpA, patients with low BMD had a higher calculated 10-year fracture risk. FRAX score is related to functional impairment and gender. Disease activity does not affect the probability of fracture.

Disclosure of Interests

None declared

AB1111 NO INCREASED RISK OF ADVERSE EVENTS OF THE WHO-VALIDATED COVID-19 VACCINES IN PATIENTS WITH RHEUMATIC DISEASES TREATED WITH BIOLOGICS

Background

The COVID-19 pandemic is a major concern for the management of patients with rheumatic diseases (RD). Indeed, an increasing risk of coronavirus infection has been demonstrated in these patients, explained on the one hand by the chronic inflammation and on the other hand by the immuno-modulating treatments used [1]. In this context, vaccination represent an efficient mean to prevent infections and should be included in the management of these patients.

Objectives

The objective of our study was to determine the peculiarity of vaccination against SARS-COV2 in patients with RD treated with biologic therapies.

Methods

We conducted a cross-sectional study during August 2021, including patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA). Sociodemographic data as well as disease characteristics were recorded. Patients were asked to answer a self-questionnaire about SARS-COV2 vaccination: modalities, time between doses, type of vaccine, adverse events, and time to biologic injection. We compared these results between the two groups: group 1 patients on biologics and patients on conventional disease-modifying antirheumatic drugs (DMARDs). A significance level was set for p<0.05.

Results

The study included 102 patients with RD: RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 years [19-77]. There was a female predominance (71 women and 31 men) with a gender ratio of 0.4. The mean duration of disease progression was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7 mg [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. SARS-COV2 infection was found in 27.3% of cases, of which 19% had a severe form. Sixty percent of patients received the SARS-COV2 vaccine, and 25% of them received only the first dose. The mean time between the two injections was 27 ± 7.6 days [23-67 days]. The most common type of vaccine was Pfizer (54.4%), Moderna (5.5%), followed by AstraZeneca (20%), Sinovac (16.4%), Johnson (1.8%) and Sputnik (1.8%). Three patients deferred their biotherapy injection by one week. Only one patient discontinued methotrexate therapy for one month. Sixteen patients reported adverse events such as injection site pain (62.5%), disease flare (12.5%) and fatigue and fever (25%). Patients receiving biologics were not at greater risk of SARS-COV2 infection (p=0.076) or hospitalization (p=0.131) compared to patients receiving conventional therapy. Similarly, patients on conventional therapy did not report more adverse events (p=0.678). The vaccination rate was significantly higher in patients on biologics compared to patients on CsDMARD: 72% versus 43%, p=0.004.

Conclusion

Our work demonstrated that patients treated with biologics adhered to vaccination and did not have more SARS-COV2 infections or adverse events compared to patients on conventional treatment.

References

[1]Akiyama S, Hamdeh S, Micic D, Sakuraba A. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. 2020;80:384-391.

Disclosure of Interests

None declared

AB1259 THE NEUTROPHIL-TO-LYMPHOCYTE AND THE PLATELET-TO-LYMPHOCYTE RATIOS AS INFLAMMATORY MARKERS IN JUVENILE IDIOPATHIC ARTHRITIS

Background

The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have recently emerged as potential indicators of systemic inflammation in chronic rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, and spondyloarthritis.

Objectives

To investigate the value of NLR and PLR as inflammatory markers in juvenile idiopathic arthritis (JIA) and to explore possible associations with disease activity parameters.

Methods

We enrolled 29 patients with JIA according to International League of Associations for Rheumatology (ILAR) criteria. Tender joint count (TJC), swollen joint count (SJC) and laboratory tests were retrospectively collected from medical records. Disease activity was also assessed by the Juvenile Arthritis Disease Activity Score (JADAS). All data were checked for normality by the Kolmogorov-Smirnov test. The Spearman correlation was used for data analysis and p values less than 0.05 were considered statistically significant.

Results

A total of 54 consultations (29 at baseline and 25 at the last follow-up consultations) of 29 patients were included in our study. The mean age was 13.1±4.2 years [4-21] and the sex ratio of males to females was 1.07. JIA subtypes were: enthesis-related arthritis (n=12), polyarthritis (n=7), oligoarthritis (n=6), undifferentiated (n=3) and psoriatic arthritis (n=1). At baseline 51,73% of the patients were not under treatment, 34.49% were under non-steroidal anti-inflammatory drugs (NSAIDs) and 13.8% under methotrexate (MTX). At the last follow-up consultation 41.38% of the patients were under MTX, 34.49% under NSAIDS and 10.35% under Etanercept. At baseline, NLR1 was positively correlated with TJC1 (p=0.022, r=0.424) and SJC1 (p=0.014, r=0.453) but not with C-reactive protein CRP1 (p=0.512) neither erythrocyte sedimentation rate ESR1 (0.096) nor disease activity scores JADAS-CRP1 (p=0.063) and JADAS-ESR1 (p=0.091). PLR1 was positively correlated with SJC1 (p=0.004, r=0.521) and both disease activity scores JADAS-CRP1 (p=0.026, r=0.462) and JADAS-ESR1 (p=0.052, r=0.364). At the follow-up consultations only PLR2 was positively correlated to CRP2 (p=0.045, r=0.404). No correlation was noted between NLR2 and PLR2 and JADAS-CRP2 (p=0.281, p=0.063) and JADAS-ESR2 (p=0.324, p=0.082).

Conclusion

Our study suggests that NLR and PLR may be used as assessment tools of disease activity in patients with JIA. Further studies with larger sample sizes are needed to confirm these results and to explore the value of these ratios in the follow-up and the prognosis of JIA.

Disclosure of Interests

None declared

AB0285 MTX REDUCED THE CARDIOVASCULAR RISK IN RHEUMATIC DISEASES

Background

The relationship between cardiovascular risk (CVR) and inflammatory rheumatic diseases (IRD) remains certain [1].

The aggressive suppression of systemic inflammation by the CsDMARDs or biologics may lower this risk.

Objectives

The purpose of this study was to assess the protective role of the different treatments in rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Methods

We carried out 107 patients followed up for IRD between March and December 2020. We collected the socio-demographic data of patients, the clinical and biological characteristics of the disease. Prescribed treatments were specified.

CVR was assessed by measuring, in centimeters, the Intima-media Thickness (IMT) at the level of the left (LCC) and right (RCC) common carotid arteries and by calculating the Framingham risk score (FRS) for each patient. Individuals with IMT≥0.9 mm or an FRS≥20% were considered as those with high CVR (HCVR).

Results

Of the 107 surveyed patients, 56% had RA (n=47) and 44% had SpA (n=60). Among them, 55% were male. The mean age was 43.9±14.2 years. The mean disease duration was 117.3±89 months. The mean BASDAI was 4.98 ±2.7. The mean DAS28 was 4.13±1.5. Seventy percent of patients had active disease. Conventional DMARDs were prescribed in 54.7% of cases: Methotrexate (95% in RA versus 5% in SpA) and Sulfasalazine (13% in RA versus 30% in SpA), NSAIDs in 57.3% of patients (4.5% in RA versus 96.6% in SpA), corticosteroids (CT) in 25% (47.5% in RA versus 8.5% in SpA), and biotherapy in 9% of cases (12.8% in RA versus 6.7% in SpA).

The mean FRS was 5.98 ± 6.6. The mean IMT was 0.58±0.15. About 60% of patients were considered with HCVR.

NSAIDs were associated with an increase in IMT in the LCC (p<0.001) and in the RCC (p<0.001). MTX had a significant protective effect on IMT in LCC (p=0.001).

However, there was no association between CT use and IMT. Regarding FCS, no significant association was found based on MTX (p=0.09), NSAIDs (p=0.11), CT (p=0.45) nor biologic use (p= 0.74).

Conclusion

In our study, patients taking MTX had a lower IMT than those not taking this molecule. NSAIDs were associated with an increase in IMT. However, we didn’t observe any effect of CT and biologic treatment on CVR in our population.

References

[1]Cho SK, Kim D, Won S, Lee J, Park B, Jang EJ, Bae SC, Sung YK. Impact of anti-rheumatic treatment on cardiovascular risk in Asian patients with rheumatoid arthritis. Semin Arthritis Rheum. 2018;47(4):501-506.

Disclosure of Interests

None declared

AB1254 CHALLENGES FACED BY FAMILIES OF CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatism of childhood. Diagnostic and therapeutic approaches are difficult for families to sustain with significant psychological and social effect.

Objectives

The aim of this study is to understand the different challenges faced by families with children suffering from JIA.

Methods

Parents of children with JIA (according to the International League of Associations for Rheumatology (ILAR)) followed in rheumatology department were asked to complete a survey in order to screen the impact of their children’s disease on their family life. Open-ended questions and directed questions were included. General demographic and clinical information (family history of chronic inflammatory disease, child’s current age, diagnosis and type of JIA and, duration of disease progression) were also collected.

Results

The study included 24 children with a gender-ratio of 1. The mean age was 12.4 years old [4-16]. The mean duration disease was 4 years with extremes varying from 3 months to 13 years. The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 2), polyarticular without rheumatoid factor (n=5), psoriatic arthritis (n= 1), enthesitis-related arthritis (n=10) and oligoarthritis (n= 6). Twenty-four parents completed the survey. The mother was the one who answered the questions in 83% of the cases. Other family members with a chronic rheumatic disease were reported in 40% of the families.

Parents noted negative impact on their work in 50% of cases (40% missing time from work, 10% changing work schedule) and, significant parental stress, anxiety, and fatigue in 75% of the cases. In 33% of the cases, parents had difficulty getting the required medical care and attention for their child’s illness because of financial issues and 37.5% of them were feeling anxiety regarding diagnosis uncertainty. Parents reported worry about their child’s daily functioning and future in 75% of the cases. They noted psychological impact on the child itself in 58% of the cases and child missing school in 41% of the cases. The most common resources parents used for information were health care professionals in 54.2 % of the cases and 45.8% of them got additional information from online research.

Conclusion

Parents of children with JIA share common challenges due to their child’s illness including a substantial impact on their work and personal wellness in addition to the psychosocial impact of the disease on the child. Support groups or educational sessions may be needed to provide guidance for these families to cope with disease.

Disclosure of Interests

None declared

AB1248 CONTRIBUTION OF IMAGING IN THE DIAGNOSIS OF ATRAUMATIC HIP

Background

Joint pain of the hip in children and adolescents is one of the most frequent symptoms seen by pediatricians, orthopedists, and pediatric rheumatologists, with an annual incidence of 148.1/100 000 [1]. The identification of an etiology for atraumatic hip pain is challenging. Even though imaging findings are often various and nonspecific, they are necessary for an accurate diagnosis.

Objectives

The main goal of this study is to investigate the contribution of the different imaging techniques in the diagnosis of the hip main in children.

Methods

We conducted a retrospective study including children and adolescents with atraumatic hip pain recruited from the Kassab institute of orthopedics. Transcribed data included age, sex, and the etiology of the hip disease. We also recorded different imaging techniques performed for the diagnosis: plain radiography, ultrasound (US), Computed tomography (CT) as well as magnetic resonance imaging (MRI).

Results

The study included 81 patients. There was a male predominance (59.3% boys versus 40.7% girls) with a sex ratio of 1.45. The mean age at diagnosis was 9.9 years [1-16]. The mean disease duration was eight months [0.1-156]. Hip disorders were distributed as follows: Legg-Calvé-Perthes disease (n=3), epiphysiolysis of the femoral head (n=30), transient synovitis of the hip (n=7), septic hip (n=10), tumor (n=4), hip dislocation (n=8), hip dysplasia (n=4), juvenile idiopathic arthritis with coxitis (n=15). The hip X-ray was abnormal in 75.6% of cases. The hip US was performed in 34.2% of the patients and showed abnormalities in most of the cases (88.5%). US findings were as follows: joint effusion (n=26), synovial thickening (n=18), synovitis (n=12), and a positive power Doppler signal (n=7). Seven patients underwent pelvic CT scans. The main findings were joint effusion (n=2), synovial thickening (n=1), and hip dysplasia (n=4). MRI of the hip was carried out in 23 children and was contributive in 91.3% of the cases. The main findings were as follows: joint effusion (n=12), synovitis (n=10), bone marrow edema (n=8), synovial thickening (n=7), nidus (n=3) and tumoral process (n=1).

Conclusion

Our study showed that hip X-ray and US are the first-line imaging modalities in an atraumatic hip diagnosis. However, in other cases, further investigations may be needed to make an early diagnosis and avoid adverse sequelae.

References

[1]Yagdiran A, Zarghooni K, Semler JO, Eysel P. Hip Pain in Children. Dtsch Arztebl Int. 2020;117(5):72-82.

Disclosure of Interests

None declared

AB1405 THE USEFULNESS OF TELEMEDICINE IN RHEUMATOLOGY: POINTS OF VIEW OF PRACTITIONERS AND PATIENTS

Background

The advent of COVID-19 has allowed a rapid expansion of telemedicine (TM) and its implementation in various specialties. Despite this extensive use of TM, its role in rheumatology is conflicting and much remains unknown about TM’s acceptability and efficiency in rheumatology [1].

Objectives

Our study aimed to evaluate rheumatologists’ and patients’ willingness for TM and factors helping to adopt this alternative.

Methods

We conducted a cross-sectional study including patients attending our rheumatology department as well as rheumatologists. Patients were contacted by phone and rheumatologists were invited to answer a questionnaire via Google Form. We evaluated their points of view and suitability for TM by inquiring about their experience with tele-rheumatology, information technology supports, personal barriers to telemedicine, and reasons for adopting this alternative. Moreover, additional questions probed the clinician’s perception of the appropriate clinical context for TM application as well as the corresponding legislation.

Results

Overall, 135 responses were collected including 60 rheumatologists and 75 patients. The distribution of diagnosis was as follows: rheumatoid arthritis (RA) (n=15), spondyloarthritis (SpA) (n=20), juvenile idiopathic arthritis (n=23), and osteoarthritis (n=17). Of the rheumatologists, 76.2 % were aged between 30 and 50 years old, 79.3% reported working at an academic center, and the majority were physician-level practitioners (71.2%), working for more than 5 years (61%). Afforded electronic devices were as follows: laptop (87.9%), smartphone (70.7%), afforded headset microphone (24.1%), camera (29.3%) for doctors. Forty-six percent of the rheumatologists estimate that they have a good internet connexion, 62.7% had an appropriate place for teleconsultation. Nearly, 40.7% of the rheumatologists were familiar with the concept of TM but only 39% reported experience with TM. Willingness to accept this model of care for rheumatologists and patients was found in 78% and 37.3% respectively. According to the doctors, the benefits of TM encompassed tele-training (61.7%), remote medical monitoring (61.7%) especially during the COVID-19 (70.2%), benefits for patients (74.5%), reduced inequalities in access to healthcare (46.8%), and improved quality of care (29.8%). The main barriers to TM were the lack of clear legislation (47.8%) and financial compensation (17.4%). Clinicians and patients identified common barriers to effective tele-rheumatology as the inability to perform a physical exam (91.3% vs 33.3%), the fear of trivializing the disease (34.8% vs 36%), and the lack of resources and infrastructures (43.5% vs 29.3%). The majority of the doctors (86.2%) expressed their willingness to attend training workshops. Reported areas to apply TM according to the doctors were mainly osteoarthritis (76.3%) and rheumatic diseases (64.4%), but also pediatric rheumatology (28.8%) and undiagnosed new patients (3.4%). Regarding legislation, most of practitioners estimated that it should be selective with specific authorizations (42.4%) or relaxed with the possibility of derogation (32.2%). Twenty-two percent of them reported that legislation should be strict with the possibility of sanctions, whereas a minority (3.4%) opted for a free practice without regulation at all. Factors associated with adherence to TM were age<40 years (p=0.036) for doctors and familiarity with the concept (p=0.006) and electronic devices afforded (p=0.000) for the patients.

Conclusion

Findings from this study showed the reluctance of the patients to adhere to TM compared to doctors. Concerns and risks may lessen for both sides, once remote consultations are applied. Nevertheless, patient education is required for the success of TM application.

References

[1]Sloan M, Lever E, Harwood R, et al. Telemedicine in rheumatology: A mixed methods study exploring acceptability, preferences and experiences among patients and clinicians [published online ahead of print, 2021 Oct 26]. Rheumatology (Oxford). 2021;keab796.

Disclosure of Interests

None declared

AB1249 IMPACT OF OVERWEIGHT AND OBESITY ON HIP INVOLVEMENT IN JUVENILE IDIOPATHIC ARTHRITIS

Background

The prevalence of obesity among children is on the rise, becoming a worldwide epidemic. The overweight is also associated with mechanical stress in the weight-bearing joint especially in the hip joint. Previous studies showed that increased Body mass index was a predicting factor of a poor outcomes [1].

Objectives

In this regard, we proposed to evaluate the effect of obesity on hip involvement in JIA patients.

Methods

We conducted a cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR)). Transcribed data included age, sex and the characteristics of the disease (subtype of JIA, disease duration). Data on hip involvement was also collected. Weight and height of each patient was recorded. The body mass index (BMI) was calculated (Kg/m2). We compared these parameters between two groups: G1: presence of coxitis and G2: absence of coxitis.

Results

The study included 62 patients with a male perdominance: sex ratio was 2.3. The mean age of onset of the disease was 11.4 years [3-16].The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n=2), polyarticular without rheumatoid factor (n=4), systemic (n= 1), enthesitis-related arthritis (n=44), oligoarthritis (n=8), psoriatic arthritis (n=3). Hip involvement was reported in 71 % of cases and was bilateral in 81% of patients. The mean weight (Kg) and height (meter) was similar between the two groups (57.4 in G1 vs 53.6 in G2, p=0.486) and (1.61 in G1 vs 1.58 in G2, p=0.483) respectively. The prevalence of overweight patients was higher in G1 than G2 without reaching a statistically significant correlation (23% vs 12.5%, p=0.518). Similarly, there was no statistically significant correlation between the body mass index (Kg/m2) and coxitis (22.2 vs 21, p=0.45). Moreover, a higher BMI was not associated with a limited range of motion as well as hip replacement (p=0.7, p=0.1 respectively).

Conclusion

Our study showed that BMI did not impact hip involvement in juvenile idiopathic arthritis patients. As obesity confers an additional health risk, addressing this co-morbidity should be a health priority in these patients.

References

[1]Makay B, Gücenmez ÖA, Ünsal E. Inactive Disease in Enthesitis-related Arthritis: Association of Increased Body Mass Index. J Rheumatol. 2016;43(5):937-43.

Disclosure of Interests

None declared

AB1128 MAINTENANCE THERAPY FOR PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19

Background

The Covid-19 pandemic has been raging for more than a year in a pandemic mode. Since then, many questions have been raised regarding the management of patients with rheumatic diseases (RD). In this context, the maintenance therapy of conventional, biologic and targeted synthetic disease-modifying antirheumatic drugs (Cs DMARDs, bDMARDs and tsDMARDs respectively) during the Covid-19 infection remains a subject of debate given their immunosuppressive effects as well as their potential generation of lung fibrosis. While the EULAR 2020 guidelines emphasize that discontinuation or maintenance should be discussed on a case-by-case basis, the ACR guidelines advocate discontinuation of all therapies except for the anti-interleukin-6 [1,2].

Objectives

The objective of our work was to report our real-life experience of therapeutic maintenance during the covid-19 pandemic.

Methods

We conducted a cross-sectional study of patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA) recruited from the rheumatology department of the Kassab Institute of Orthopedics. All the patients were asked to complete a questionnaire about their disease management in the era of the Covid-19. The questionnaire included sociodemographic data, treatment modalities, as well as data related to the infection with the Covid-19 (severe forms defined by the need for oxygen therapy or hospitalization), and changes in treatment during the infection.

Results

The study included 102 patients with RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 [19-77] years. There was a female predominance with a sex ratio of 0.4. The mean duration of the disease was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7±4.5 mg/L [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. A Covid-19 infection was occurred at least once in 25.5% of cases, of which 19.2% had a severe form (hospitalization (15.4%), oxygen therapy (19.2%)). No deaths were observed. The treatments received during the covid-19 infection were: corticosteroids (n=5), heparin therapy (n=6) and antibiotic therapy (n=10). No patient tapered treatment dosage of DMARDs but discontinuation was reported by 4 patients with a mean time between discontinuation and resumption of 2.1 ± 2 months [0.5-5 months]. The cessation of the treatment was dictated by the treating physician in 2 cases and involved csDMARD in 3 cases (Methotrexate (n=2), Leflunomide (n=1)) and biologics in only one patient. There were no cases of clinical pulmonary worsening upon resumption of the treatments. We found no statistically significant association between severe forms of the infection and the type of RD (p=0.925), as well as the presence of comorbidities (p=0.825). Similarly, the presence of severe forms was not associated with the use of long-term NSAIDs (p=0.29), corticosteroids (p=0.85), or biological treatment (p=0.7). However, maintenance therapy was significantly associated with a lower risk of severe forms (p=0.013).

Conclusion

Our work showed that the maintenance of conventional treatment during Covid-19 infection was associated with a lower risk of severe forms. Our results, along with those of other studies in the literature, support the maintenance of antirheumatic treatments.

References

[1]Landewé RB, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;79(7):851-8.

[2]Roongta R, Ghosh A. Managing rheumatoid arthritis during COVID-19. Clin Rheumatol. 2020 Nov;39(11):3237-44.

Disclosure of Interests

None declared

Perception de la télémédecine par les consultants en rhumatologie à l’ère de la COVID-19

Introduction

Avec l’avènement de la pandémie de COVID-19, le système de santé a été confronté à des difficultés pour fournir des soins appropriés aux patients suivis au long cours pour des pathologies autres que le COVID-19. Ces derniers, du fait de la chronicité de leurs maladies, nécessitent un suivi régulier et rapproché [1]. Quoique la télémédecine n’est pas encore officiellement mise en œuvre en Tunisie, cette alternative peut avoir le potentiel d’améliorer l’accès aux soins en plus de réduire les dépenses de santé. L’objectif de notre étude était d’évaluer la perception de la télémédecine par les patients suivis en rhumatologie et d’étudier les facteurs favorisant l’adoption de cette alternative à l’ère du COVID-19.

Patients et méthodes

Nous avons mené une enquête transversale structurée par téléphone auprès des patients suivis au service de rhumatologie de l’institut Kassab d’orthopédie, pour un rhumatisme inflammatoire chronique ou pour une pathologie dégénérative. Les données sociodémographiques et les caractéristiques de leur maladie ont été recueillies. Nous avons évalué leur point de vue et leur aptitude à la télémédecine.

Résultats

L’étude a inclus 75 patients. Il y avait une prédominance féminine avec un sex-ratio de 0,4. La répartition des pathologies rhumatismales était comme suit: polyarthrite rhumatoïde (PR) (20 %), spondyloarthrite (SpA) (26,6 %), arthrite juvénile idiopathique (30,7 %), et pathologie dégénérative (22,7 %). La durée d’évolution de la maladie était en moyenne de 9,8 ± 7,5 [1–29] ans. Près de la moitié des patients (46,7 %) avaient un revenu mensuel inférieur à 500 dinars et 44 % d’entre eux avaient un revenu mensuel entre 500 et 1000 dinars (151 et 303 euros). La durée moyenne du trajet pour se rendre à l’hôpital était de moins de 2 heures dans 61,3 % des cas, entre 2 et 5 heures dans 28 % des cas et plus de 5 heures dans 10,7 % des cas. Les appareils électroniques disponibles étaient les suivants: smartphone (18,7 %), internet (16 %), téléphone portable simple (24 %), et l’association des trois (41,3 %). Seuls 14 patients connaissaient le concept de télémédecine et 37,3 % d’entre eux accepteraient ce modèle de soins. Le moyen de télécommunication le plus apte à être adopté selon les patients était les appels vidéo (64 %) comparé aux appels téléphoniques (36 %). Les principales raisons de préférer la télémédecine étaient comme suit: éviter les hôpitaux pendant la pandémie (28 %), faire des économies (25,3 %), gagner du temps (26,7 %) et éviter l’absentéisme (14,7 %). Les principales raisons de préférer la consultation en direct étaient la crainte d’une éventuelle discordance entre l’évaluation physique et l’évaluation à distance (33,3 %), la crainte de la banalisation de la maladie (36 %), les inquiétudes quant à maîtrise de la technologie (21,3 %) et enfin, la crainte de perdre la connectivité (29,3 %). Il n’y avait pas d’association entre la préférence pour la télémédecine et le motif de consultation (p = 0,87), un revenu plus élevé (p = 0,84), la durée du trajet vers l’hôpital (p = 0,07), la profession (p = 0,54), ainsi que des antécédents familiaux de COVID-19 (p = 0,54). Les patients au courant du concept de télémédecine et disposant de ressources électronique adhéraient plus à la télémédecine (p = 0,006, p = 0,000 respectivement).

Conclusion

Contrairement aux données de la littérature, notre étude a montré la faible prévalence des patients prêts à accepter la télémédecine comme modèle de soins. En effet, en Tunisie, le concept de télétravail en général n’était pas d’usage courant avant la pandémie, d’où la nécessité de sensibiliser les patients d’avantage afin de promouvoir cette alternative.

P027 Assessment of physical activity in Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood, grouping together different diseases characterized by arthritis of unknown origin with onset before age of 16 years. JIA may cause functional impairment and a limited exercise capacity thus a reduced time engaged in physical activity. The aim of the study was to describe participation in physical activity among children with JIA.

Methods

We conducted a descriptive retrospective study including 23 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology ILAR. Demographic data were collected. All patients answered a questionnaire referring to physical activity.

Results

The mean age of our patients was 16 years old with a sex ratio of 3. The education level was distributed as follows: 8,7% were in elementary school and 21,7% were in high school. Only 4,3% of the children were participating in high loading sports. Twenty-one per cent of the children reported spending &gt;3 h per week in physical activity during leisure time. Participation in compulsory school-educational physical activity was reported in 43,5% of the children and 26,1% reported full participation. Full exemption from school sports was reported in 46.5% of cases and it was mostly associated with functional limitations.

Exercise therapy was prescribed in 26.1% of patients and it was mainly swimming. The impact of physical activity on symptoms was divided into 43,5% of the children who reported an aggravation, 8,7% who reported an improvement and 34,8% who didn't report any change.

Conclusion

Physical activity in childhood is important to acquire knowledge and behavioral skills in order to maintain an active lifestyle. A special attention to children with JIA is required in order to promote their full potential of social interaction and improve long-term outcome.

[Musculoskeletal hand disorders in musicians]

Music is often associated with joy, pleasure and leisure. However, like any other profession, it has its constraints and risks.The purpose of this update is to present a non-exhaustive inventory of musculoskeletal hand disorders most frequently associated with music practice.All music instruments are concerned. The difference lies in damage location as well as in the frequency of specific pathologies according to the used instrument. The most feared disorder by musicians is focal dystonia, which is characterized by a painless and repetitive coordination disorder. It only appears in the realization of specific professional movements. The overuse syndrome and the nerve entrapment syndrome constitute other dreaded disorders. Specific and multidisciplinary care is often necessary.

Complications of Paget Bone Disease: A Study of 69 Patients

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

AB0693 NON-STEROIDAL ANTI-INFLAMMATORY DRUGS DURING CORONAVIRUS 19 PANDEMIC: WHAT DO TUNISIAN RHEUMATOLOGISTS THINK?

Background:

Concerns over the safety of non-steroidal anti-inflammatory drugs (NSAIDs) use during severe acute respiratory syndrome associated with coronavirus 19 disease (covid-19) have raised. NSAIDs are one of the most commonly prescribed and used pain medications for acute and chronic rheumatic diseases such as spondyloarthritis (SpA) and osteoarthritis.

Objectives:

This study aimed to assess the impact of covid-19 pandemic on NSAIDs prescription.

Methods:

A cross-sectional web survey was disseminated to all Tunisian rheumatologists through a mailing system and social media. The French version was accessible on Google form. It included close-ended questions about the prescription of NSAIDs during covid-19 pandemic. Participation was anonymous. Data collection and analysis was performed between January the first and January 30, 2021.

Results:

Among one hundred and thirty Tunisian rheumatologists, thirty responded to the online questionnaire. Ninety percent of participants were women. The mean age of rheumatologists was 34 years [25-57]. The duration of practice was inferior to 5 years in 59.3%, between 5 and 10 years in 18.5%, and superior to 10 years in 22.2% of cases. Sixty-three percent of rheumatologists reported that their activity decreased during covid-19 pandemic. NSAIDs prescription was avoided as much as possible in 40.7% of cases.

The participants indicated NSAIDs less frequently in 33.3% of cases, and as much as before the pandemic in one-quarter of cases.

Rheumatologists believed that NSAIDs worsen the respiratory symptoms (67%), delay recovery (55%), and increase mortality (48%), hospitalization in intensive care (44%), and infectious complications (33%).

The participants suggested that the most incriminated NSAIDs were: Ibuprofen (7.4%), indomethacin (7.4%), celecoxib (7.4%), and diclofenac (3.4%). The majority of rheumatologists (74%) believed that all NSAIDs had a similar risk.

For patients with osteoarthritis, rheumatologists replaced NSAIDs with paracetamol and corticoids in 78% and 11% of cases, respectively. If mandatory, reducing NSAIDs doses or duration was an option in 22% and 74% of cases.

For patients with SpA, half of rheumatologists did not change the treatment. However, the participants limited the use of NSAIDs or discontinued the treatment in patients with comorbidities. More than 60% of rheumatologists didn’t know the effect of NSAIDs in the post-covid-19 syndrome.

Conclusion:

Covid-19 pandemic has affected rheumatologists’ practice. Rheumatic disease management during this pandemic may be challenging. More evidence is mandatory to standardize treatment prescription, especially with NSAIDs.

Disclosure of Interests:

None declared

AB0171 ACHILLES ENTHESITIS AND PLANTAR FASCIITIS IN RHEUMATOID ARTHRITIS PATIENTS: IMPACT OF BODY MASS INDEX

Background:

Enthesitis is known as a hallmark of spondyloarthitis. However, the growing use of ultrasonography (US) increased our opportunity to encounter enthesitis in rheumatoid arthritis (RA). The involvement of Achilles tendon and the plantar fascia is not rare in RA patients.

Objectives:

The aims of this study were to determine the prevalence of Achilles enthesitis and plantar fasciitis in RA patients, and to identify association with clinical data.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic and clinical data were collected. Three groups were defined according to the BMI: normal (BMI<25kg/m2), overweight (BMI≥25kg/m2) and obese (BMI≥30kg/m2). US examination of Achilles tendon and plantar aponeurosis was performed by a blinded radiologist experienced in musculoskeletal US using a Philips HD11 device with a high-frequency linear transducer. Enthesitis was defined as hypoechoic and/or thickened insertion of the tendon close to the bone (within 2 mm from the bony cortex) which exhibits Doppler signal if active and that may show erosions, enthesophytes or calcifications as sign of structural damage. A p-value <0.05 was considered significant.

Results:

Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].

The mean BMI was 27.7±5.4 kg/m2 [18.3-45.8]. Obesity was noted in 22.7 % of patients and overweight in 45.5% of patients. Clinical examination revealed pes planus valgus (PPV) in 55.6% of cases and pes cavus varus (PCV) in 18.5% of cases.

Heel US revealed Achilles enthesitis in 79.6% of cases. The following elementary lesions were noted in the enthesis: thickness (24.1%), hypoechogenicity (37%), erosions (9.3%), enthésophytes (75.9%), and Doppler signal (3.7%). Plantar fasciitis was noted in 81.5% of cases. The following elementary lesions were found in the insertion of plantar aponeurosis: thickness (75.9%), hypoechogenicity (77.8%), erosions (16.7%), enthesophytes (13%), calcifications (1.9%), and Doppler signal (1.9%).

An association was noted between BMI and Achilles enthesitis (p=0.002). This association was not found with plantar fasciitis (p=0.224).

Achilles enthesitis was also associated with PCV (p=0.007) while plantar fasciitis was associated with PPV (p=0.039).

Conclusion:

Achilles enthesitis and plantar fasciitis are common in RA patients. These lesions seem to be associated with BMI and foot deformities rather than the inflammatory process.

Disclosure of Interests:

None declared

AB0186 AT WHAT LEVEL SHOULD WE MEASURE INTIMA-MEDIA THICKNESS IN RHEUMATOID ARTHRITIS?

Background:

Rheumatoid arthritis (RA) is chronic inflammatory rheumatism characterized by an independent cardiovascular (CV) risk. The screening of carotid intima-media thickness (IMT) in the common carotid artery appears to be a marker of atherosclerosis and is used as a specific tool for CV risk assessment.

Objectives:

The main of this study was to determine the most associated US sites with CV risk in RA.

Methods:

The present study is a prospective study conducted on Tunisian RA patients in rheumatology department of Mohamed Kassab University Hospital (March and December 2020). The characteristics of the patients and those of the disease were collected. The measurement of cIMTwas done using high-resolution B-mode carotid US with a Philips machine with the patient in supine position, according to AmericanSociety of Echocardiography guidelines.The carotid bulb below itsbifurcation and the internal and external carotid arteries were evaluated bilaterally with gray scale, spectral and color Doppler ultra-sonography using proprietary software for carotid arterymeasurements.IMT was measured using the two inner layers of the commoncarotid artery and an increased IMT was defined as ≥0.9 mm. The CV risk at 10 years was calculated by the SCORE index.

Results:

Forty-seven patients were collected, of which 78.7% were women. The mean age was 52.5 ±11.06 years. The rheumatoid factor (RF) was positive in 57.8% of cases, and anti-citrullinated peptide antibodies (ACPA) were positive in 62.2% of cases. RA was erosive in 81.6% of cases. Hypertension (hypertension) was present in 14.9% of patients and diabetes in 12.8% of patients. Nine patients were active smokers. The mean IMT in the left common carotid (LCC) was 0.069 ±0.015, in the left internal carotid (LIC) was 0.069 ±0.015, in the left external carotid (LEC) was 0.060 ±0.023. The mean IMT was 0.068 ±0.01 in the right common carotid (RCC), 0.062 ±0.02 in the right internal carotid (RIC), and 0.060 ±0.016 in the right external carotid (REC). The mean SCORE index of CV risk was 2±2.81 [0-11.6]. CV risk was significantly associated with the IMTs for LIC (p=0.029; r=0.374), LEC (p=0.04; r=0.480), and REC (p=0.016; r=0.408). No association was found between the IMT in the LCC (p=0,361; r=0,162), neither in the RCC (p=0,438; r=0,140) nor the RIC (p=0,670; r=0,077).

Conclusion:

In our study, IMT is strongly associated with score index, especially in carotid bifurcation. However, IMT measured in common carotid does not reflect a cardiovascular risk at 10-years.

References:

[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and Experimental Rheumatology 2018; 36: Clinical E.xperimental.

[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2017.

[3]Martin I. Wah-Suarez and al, Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis. 2018;1–7.

Disclosure of Interests:

None declared

AB0124 STRUCTURAL DAMAGE IN THE FOOT IN RHEUMATOID ARTHRITIS: DON’T MISS THE OTHER METATARSOPHALANGEAL JOINTS

Background:

The foot involvement in rheumatoid arthritis (RA) affects the functionality and the quality of life in patients. Despite this, the clinicians do not give enough care to the foot in RA patients, especially if asymptomatic, resulting in joint damage, deformity, and disability. The distribution of erosions of the other MTP joints (excluding the 5th) has not previously been studied.

Objectives:

This study aimed to investigate the distribution of erosions in MTP joints and their clinical implications.

Methods:

We conducted a retrospective study including patients with RA according to the American college of rheumatology/ the European league against rheumatism classification criteria. Sociodemographic data, as well as disease activity related characteristics, were recorded.

Posterior–anterior radiographs of the hands and feet of each patient were assessed for erosions.

All patients were assessed by Ultrasonography (US) of the hands. US erosions were scored 0-3 according to Szkudlarek [1]. We divided patients into two groups (G1 without MTPs erosions and G2 with MTPs erosions).

Results:

We enrolled forty-two females and eleven males in our studies. The mean age was 58.6 years ±12.7 [23-77], and the mean disease duration was 8.4 years [1-47]. Rheumatoid factor or cyclic citrullinated peptide antibodies (Anti-CCP) were positive in 62.3% of cases. The mean DAS28ESR score was 5.1±1.16 [2.5-7.7]. Half of the patients had the active disease (52.8%). Hand erosions evaluated with plain radiographs and the US were found in 43.1% and 50.9% of cases, respectively. The distribution of foot erosions (15.1%) was at follows: 5th right MTP (7.5%), the 5th right IPP (2%), the 1st left MTP (2%), 3th left MTP (3.8%), 4th left MTP (5.7%) and the 5th left MTP (9.4%). Erosions on MTPs with the exclusion of the 5th MTP were present in 9.4% of cases. The presence of MTPs erosion was more frequent in males (p=0.01) but was not associated with age (p=0.6) or disease duration (p=0.2). Seropositivity was similar between the two groups (p=0.06). Similarly, the inflammatory markers (ESR and CRP), as well as DAS28 ESR, did not differ between the two groups (p>0.05). MTPs erosion was not associated with the presence of hand erosions on a plain radiograph (p=0.445). However, MTPs erosion was significantly more frequent in patients with less erosive hands-on US (p=0.034).

Conclusion:

Our study showed that screening of other MTPs (excluding the 5th) is mandatory in RA diagnosis. Interestingly, in our result, MTPs erosion is more frequent in males with less erosive hands.

Disclosure of Interests:

None declared

POS1018 IMPORTANCE OF LATERAL SPINE VIEW IN DXA BONE DENSITOMETRY IN PATIENTS WITH SPONDYLOARTHRITIS

Background:

Osteoporosis is an increasingly important health problem among patients with spondyloarthritis (SPA). The Measure of Bone Mineral Density BMD is routinely carried out in an anteroposterior (AP) view of the spine. However, the syndesmophytes, ligaments calcifications, and the posterior part of vertebrae affect AP scanning. A lateral spine view is a more sensitive tool in assessing bone loss in trabecular bone.

Objectives:

We aimed to evaluate the association between lateral lumbar DXA and syndesmophyte grading in patients with SPA.

Methods:

We conducted a retrospective study including 75 patients with SPA. Bone density of the hip and lumbar spine was measured with a GE Lunar Prodigy Advance Bone Densitometer equipment. All patients had lumbar lateral, AP, and proximal femur DXA scans. The T-score, which measures the difference between a patient’s BMD and young-normal subjects, was computed and age-matched.

Results:

The mean age of the patients was 36±11 years. Male predominance was noted with a sex ratio of 4.76. The mean BMI was 25±5 kg/m2. Eight percent were obese. Fifty-two percent had Vitamin D deficiency.

Forty-eight percent of the patients had axial SPA, while 52% had axial and peripheral symptoms.

The mean age of onset was 27±7 years. Fifty-two percent of the patients had high inflammatory biomarkers. The BASDAI, ASDAS-VS, and ASDAS-CRP mean levels were respectively: 3.5±2.4, 3.1±0.9, and 3±0.8. The mean BASRI and mass were respectively 8 + 4.8 and 16.4 + 19.4. Analyses of T-score values obtained over the femoral neck revealed osteoporosis in 18.7% of the cases and osteopenia in 32% of the cases. On the other hand, analyses of AP, spine views revealed osteoporosis in 25.3% and osteopenia in 45.3% of patients (p=0.028, r=0.254). We detected the highest percentage of osteoporosis in lateral lumbar view and T-scores matched more closely with femoral neck values; osteoporosis in 29.3%, and osteopenia in 22.7% of the patients (p<10-3, r=0.562). BMD measured in AP, and lateral views were in good agreement (p<10-3, p=0.592). Age was inversely but not significantly associated with BMD in lateral (p=0.442, r=-0.09), AP (p=0.319, r=-0.117) and femoral neck projections (p=0.179, r=-0.157). Femoral neck BMD was associated with the activity of SPA (ASDAS vs (p=0.027, r= -0.295), and the mobility limitation BASMI (p=0.032, r= -0.247). Coxitis, BASRI, or mSASS were independent of BMD.

Conclusion:

We conclude that spine lateral view in DXA accurately measures BMD exceeding the AP spine views and femoral neck values. Therefore, structural changes do not affect this measurement

Disclosure of Interests:

None declared.

AB0742 PREVALENCE AND RISK FACTORS OF OSTEOPOROSIS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background:

Childhood rheumatic diseases are associated with reduced Bone mass and increased risk of fractures (1). Several factors may interact to determine osteoporosis other than direct bone detrimental effects of the disease or its treatment.

Objectives:

In this work, we aimed to investigate the prevalence of bone loss in patients with JIA and to determine the relative factors associated with osteoporosis during this chronic disease.

Methods:

A retrospective monocentric study was carried out on JIA patients (ILAR criteria).Dual-energy x-ray absorptiometry (DEXA) was used to determine bone status. Disease activity was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis related enthesitis form. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were noted. The data were analyzed using the SPSS statistical package. A p value < 0.05 was considered significant.

Results:

The sample included 40 JIA (25 male and 15 female) with a mean age at disease onset of 11.3 ± 3.6 years. The median disease duration was 90 months [7-408].The median JIA diagnosis delay was 8 months [1-108]. The JIA subgroups were in decreasing order of frequency: Enthesitis-related Arthritis (n=27), Polyarticular RF- (n=4), Polyarticular RF+ (n=1), Oligoarticular (n=4), Systemic (n=2), Psoriatic Arthritis (n=1) and Undifferentiated (n=1). Median ESR and CRP were 29 mm/hour [2-98] and 14.5 mg/l [0-70] respectively. Median BASDAI score was 4.3 [1-9.7]. Median JADAS10 score was 1[1-21].

Overall, 45% of patients had osteoporosis, 27.5% had osteopenia, and 27.5 % had normal bone densitometry. None of the patients had a history of vertebral or peripheral fractures.

Thirty per cent of patients (n=12) were on long term corticosteroid therapy with a mean dose of 6.6 ± 2.8 mg/day. Only 12.5% (n=5) of them had a regular physical activity.

Osteoporosis was associated with age at JIA onset (p=0.005), disease duration (p=0.001), ESR (p=0.08), CRP (p=0.04), BASDAI score (p=0.017) and sedentarily (p=0.026). Osteopenia was only associated with corticosteroid therapy (p=0.01). Neither osteoporosis (p=0.37) nor Osteopenia (p=0.25) was associated with disease activity score.

Conclusion:

In our study, osteoporosis was a common feature during JIA. A long term corticosteroid therapy and sedentarily seem to be correlated with more impaired bone abnormalities. Hence, targeted interventions are urgently required to preserve bone health during JIA.

References:

[1]McDonagh JE. Osteoporosis in juvenile idiopathic arthritis. Curr Opin Rheumatol. 2001;13(5):399-404.

Disclosure of Interests:

None declared

AB0191 ON WHICH FACTOR TO ACT TO REDUCE CARDIOVASCULAR RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Background:

Patients with rheumatoid arthritis (RA) are at higher cardiovascular risk (CVR) than the general population due to chronic inflammation. Several factors, both modifiable and non-modifiable, can increase this risk. Intima-media thickness (IMT) was considered as a marker for atherosclerosis.

Objectives:

This study aimed to identify predictor factors of increasing IMT.

Methods:

The prospective study was carried out on patients with RA who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. These patients were followed in the rheumatology department of the Kassab Institute. The socio-demographic data, biological and immunological parameters were collected.

Framingham’s score quantified the cardiovascular risk at 10-years. Carotid Ultrasonography (US) using a high resolution B mode carotid measured intima-media thickness (IMT) as a subclinical marker of atherosclerosis. Carotid US was performed in the supine position, according to American Society of Echocardiography guidelines. IMT was measured in the left (LCC) and right (RCC) common carotid arteries, the left (LIC) and right (RIC) internal carotid arteries, and the left (LEC) and right (RIC) internal carotid arteries. An increased IMT was defined as ≥0.9 mm.

We analyzed data by the SPSS statistical package. A p-value <0.05 was considered significant.

Results:

Of the 47 patients surveyed, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The duration disease was 86.25 ±63 months [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. Eight patients had a previous CV history (hypertension, diabetes or dyslipidemia) and 16.4% were active smokers. Among women, 43.6% were postmenopausal. ITM was significantly higher in men at LIC (0.037) and LEC (0.025). Older age was associated with increased ITM in LIC (p=0.046; r=0.295), LEC (p=0.05; r=0.412), RCC (p=0.034; r=0.317), and REC (p=0.009; r=0.382). The ITM for LCC, LIC, LEC, RCC, RIC, and REC was higher in postmenopausal women, with no significant difference (p=0.782, p=0.208, p=0.877, r=0.734, p=0.808, p=0.437, respectively).

Among the modifiable factors, active smoking was associated with a higher ITM at the REC level (p=0.047). However, weight was not associated with an increased ITM (LCC: p=0.092; LIC: p=0.985; LEC: p=0.952; RCC: p=0.744; RIC: p=0.210; REC: p=0.510). In our study, there was no significant association between DAS28 disease activity or inflammatory marks and ITM (LCC: p=0.784; LIC: p=0.316; LEC: p=0.420; RCC: p=0.784; RIC: p=0.484; REC: p=0.754).

Conclusion:

In our study, the non-modifiable factors associated with increased ITM were advanced age and male gender. The modifiable factor impacting ITM was primarily active smoking. Surprisingly, disease activity and biological inflammation did not influence ITM.

References:

[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and experimental rheumatology 2018; 36: clinical e.xperimental.

[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid Arthritis. Scandinavian cardiovascular journal, 2017.

[3]Martin i. Wah-suarez and al, carotid ultrasound findings in rheumatoid arthritis and control subjects: a case-control study. Int j rheum dis. 2018;1–7.

Disclosure of Interests:

None declared

POS0586 RHEUMATOID ARTHRITIS IS AN INFLAMMATORY DISEASE WITH A HIGH CARDIOVASCULAR RISK

Background:

Hypertension, diabetes, and dyslipidemia are traditional risk factors of cardiac events. Carotid ultrasonography is an available way to detect subclinical atherosclerosis.

Objectives:

This study aimed to compare the intima-media thickness in RA patients based on their personal cardiovascular (CV) history of hypertension (hypertension), diabetes, and dyslipidemia.

Methods:

The present study is a prospective study conducted on Tunisian RA patients in the rheumatology department of Mohamed Kassab University Hospital (March and December 2020). The characteristics of the patients and those of the disease were collected.

The high-resolution B-mode carotid US measured the IMT, according to American Society of Echocardiography guidelines. The carotid bulb below its bifurcation and the internal and external carotid arteries were evaluated bilaterally with grayscale, spectral, and color Doppler ultrasonography using proprietary software for carotid artery measurements. IMT was measured using the two inner layers of the common carotid artery, and an increased IMT was defined as ≥0.9 mm. A Framingham score was calculated to predict the cardiovascular risk at 10-year.

Results:

Forty-seven patients were collected, 78.7% of whom were women. The mean age was 52.5 ±11.06 [32-76]. The rheumatoid factor (RF) was positive in 57.8% of cases, and anti-citrullinated peptide antibodies (ACPA) were positive in 62.2% of cases. RA was erosive in 81.6% of cases. Hypertension (hypertension) was present in 14.9% of patients, diabetes in 12.8% of patients, and dyslipidemia in 12.8% of patients. Nine patients were active smokers. The mean IMT in the left common carotid (LCC) was 0.069 ±0.015, in the left internal carotid (LIC) was 0.069 ±0.015, in the left external carotid (LEC) was 0.060 ±0.023. The mean IMT was 0.068 ±0.01 in the right common carotid (RCC), 0.062 ±0.02 in the right internal carotid (RIC), and 0.060 ±0.016 in the right external carotid (REC). The IMT was significantly higher in the left common carotid (LCC) in patients with hypertension (p=0.025). There was no significant difference in the other ultrasound sites (LIC, LEC, RCC, RIC, and REC) according to the presence or absence of hypertension. The IMT was also significantly increased in patients with diabetes at LCC (p=0.017) and RIC (p=0.025). There was no significant difference in the IMT at different ultrasound sites between patients with and without dyslipidemia.

Conclusion:

Hypertension was significantly associated with the increase in IMT at the LCC level in RA patients. Diabetes had an impact on IMT in LCC and RIC. However, dyslipidemia did not affect the IMT at the different ultrasound sites.

References:

[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and Experimental Rheumatology 2018; 36: Clinical E.xperimental.

[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2017.

[3]Martin I. Wah-Suarez and al, Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis. 2018;1–7.

[4]Gobbic C and al. Marcadores subclínicos de aterosclerosis y factores de riesgo cardiovascular en artritis temprana. Subclinical markers of atherosclerosis and cardiovascular risk factors in early arthritis marcadores subclínicos de aterosclerose e fatores de risco cardiovascular na artrite precoce.

Disclosure of Interests:

None declared

POS0538 RELATIONSHIP BETWEEN HINDFOOT DEFORMITIES AND ULTRASOUND TENOSYNOVITIS IN RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is an inflammatory disease that frequently affects the joints and soft tissues of the feet. Tibialis posterior tenosynovitis has a reported prevalence between 13 and 64% in RA. The condition is associated with a progressive flat foot deformity and significant gait disability. However, few studies have investigated the relationship between foot deformities and the involvement of tendons. Recently, ultrasonography (US) has been reported as the gold standard for the investigation of tendons.

Objectives:

This study aimed to assess the relationship between hindfoot deformities and US tenosynovitis in RA.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. For each patient, a podoscope examination of both feet was performed by a rheumatologist. A radiologist experienced in musculoskeletal imaging performed a US examination using a Philips HD11 device with a high-frequency linear transducer. The assessed lesions were synovitis of the tibiotalar, talonavicular, and subtalar joints, and tenosynovitis of tibialis anterior (TA), extensor hallucis longus (EHL), extensor digitorum longus (EDL), tibialis posterior (TP), flexor digitorum longus (FDL), flexor hallucis longus (FHL), fibularis brevis (FB) and fibularis longus (FL) tendons. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler/grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.

Results:

Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in respectively 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].

Podoscope examination revealed pes planus valgus (PPV) in 55.6% of cases and pes cavus varus (PCV) in 18.5% of cases. US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. In the anterior compartment, tenosynovitis of TA was noted in 5.6% of cases, of EHL in 1.9% of cases, and EDL in 9.3% of cases. In the medial compartment, tenosynovitis of TP was found in 22.2% of cases, of FDL in 5.6% of cases, and FHL in 0% of cases. In the lateral compartment, tenosynovitis of FB and FL was found in 25% and 11.1% of cases respectively.

An association between PPV and synovitis of the tibiotalar joint (p<0.001) and the subtalar joint (p=0.007) was found. An association was also noted with FL tenosynovitis (p=0.045) but not with the other assessed tendons.

No association was noted between PCV and synovitis or tenosynovitis of the assessed structures.

Conclusion:

PPV was frequent among RA patients. This condition was associated with tibiotalar and subtalar synovitis and FL tenosynovitis. It is important to detect and correct foot deformities in order to ensure optimal control of the disease.

Disclosure of Interests:

None declared

POS1274 THERAPEUTIC MANAGEMENT OF RHEUMATOLOGISTS VERSUS OTORHINOLARYNGOLOGISTS OF CERVICOGENIC DIZZINESS

Background:

The treatment of patients presenting with cervicogenic dizziness (CGD) may be challenging. Indeed, there is no consensual treatment approach for CGD, nor is there no gold-standard assessment for diagnosis.

Objectives:

Our study aimed to assess the management of CGD by rheumatologists versus otorhinolaryngologists.

Methods:

We conducted a cross-sectional study including Tunisian doctors dealing with CGD. Rheumatologists (RTO) and otorhinolaryngologists (ORL) were invited to answer a questionnaire via google form about CGD daily management. Outcomes of interest were treatment modalities.

Results:

The study included 30 RTO and 32 ORL. Most of the doctors (RTO, vs ORL) were females (88.3%, vs 56.3%), aged between 35 and 45 (43.3%, vs 62.5%), and worked at a private practice (33.3%, vs 59.4%). The number of patients diagnosed with CGD by RTO was as follows: 1-2 per year (33.3%), 1-2 per month (18.8%), 1-2 per week (20%), less than one patient a year (10%) and none in 3.3% of cases. The number of patients diagnosed with CGD by ORL was as follows: 1-2 per year (50%), 1-2 per month (33.3%), 1-2 per week (6.2%), less than one patient a year (15.7%) and none (9.4%). Most patients presenting with CGD were females in both groups (93.1%, vs 82.8% respectively) with a mean age between 36 and 65 (79.3%, vs 82.1%). Most of the respondents declared treating patients with CGD (93.1%, vs 79.1%). Regarding treatment modalities, physical therapy was the most prescribed in both specialties (81.5% and 48.3%, respectively). Only RTO (18.5%) prescribed manual therapy. Concerning medical treatment, anti-inflammatory were the most prescribed drugs in both groups (92.6, and 34.5%, respectively). Sixty-seven percent of RTO prescribed anti-vertigo medication. Interestingly, it was the least prescribed drug by ORL (6.9%). Only RTO (59.3%) prescribed Muscle relaxants.

Conclusion:

Despite the disparities in the management of CGD, physical therapy remains the first prescribed treatment by Tunisian doctors. Further studies are needed to establish a consensus to treat CGD.

Disclosure of Interests:

None declared

POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

Background:

Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.

Objectives:

The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.

Results:

Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].

Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.

US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.

An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.

No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).

Conclusion:

Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.

Disclosure of Interests:

None declared

POS0549 FUNCTIONAL IMPACT OF FOREFOOT INVOLVEMENT IN RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disease that mainly affects small joints of the hands and feet. Foot deformities may affect the patient’s gait, thus compromising their daily activities and autonomy.

Objectives:

The aim of this study was to analyze its functional impact.

Methods:

We conducted a cross-sectional study including patients diagnosed with RA according to the ACR/EULAR 2010 criteria. Demographic variables, Foot Function Index (FFI), and Health Assessment Questionnaire (HAQ) scores were analyzed. We collected data on the following clinical variables: The pain Visual Analog Scale (VAS), forefoot deformities, erythrocyte sedimentation rate (ESR), and Disease Activity Score 28 (DAS28). All patients had feet X-rays and the Larsen score was calculated. A blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer performed ultrasonography (US) of MTP joints. Synovitis was defined as an abnormal hypoechoic synovial tissue within the capsule that is not displaceable and poorly compressible and that may exhibit Doppler signals. The composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.

Results:

We included 31 patients (25 men and six women) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. The mean ESR and DAS28 ESR were 33±26 mm [5-102] and 3.8±1.5 [0.6-7], respectively. Twenty-nine percent of patients had a high disease activity.

Metatarsalgia was reported by 54.8% of patients with a mean VAS of 4.5±3.7 [0-9]. Forefoot deformities were noted in 42% of patients: round forefoot in 13% of cases, triangular forefoot in 29% of cases, hallux valgus in 29% of cases, Quintus varus in 29% of cases, and claw toes in 13% of cases. Corns and calluses were noted in 42% and 29% of cases respectively.

X-rays showed abnormalities in 75% of patients. The mean Larsen score was 9.8±6.2 [0-28].

US showed synovitis in 46.3% of MTP1, in 53.7% of MTP2, in 48.3% of MTP3, in 42.6% of MTP4, and in 37% of MTP5 joints. Doppler signal was detected in 5.6% of MTP1 and MTP2, and in 3.7% of MTP3, MTP4, and MTP5 joints. The mean US score was 5.3±4.3 [0-15].

The mean FFI was 66.5%. Mean rates of pain, difficulty, and disability were 89.5%, 40%, and 70% respectively. The mean HAQ score was 0.5±0.5 [0-2]. Severe disability was noted in 20% of patients.

A significant positive correlation was noted between FFI and, Larsen score (r=0.214, p=0.014) and US score (r=0.420, p=0.021). A significant positive correlation was also noted between HAQ score and, foot pain VAS (r=0.555, p=0.009).

Conclusion:

Foot involvement is frequently seen in RA. This condition may affect patients’ autonomy. Early diagnosis and appropriate treatment are necessary in order to preserve the quality of life.

Disclosure of Interests:

None declared

POS1013 LET’S TAKE A LOOK AT THE SYMPHYSIS PUBIC AREA IN SPONDYLARTHRITIS

Background:

Symphysis pubic (SP) is the frequent site of enthesitis in spondylarthritis (SpA). Radiological changes in SP appear later in the course of the disease. Underdiagnosed, its prevalence varies from 4% to 47% (1), depending on imaging modalities.

Objectives:

This study aimed to evaluate the prevalence of SP involvement in patients with spondyloarthritis (SpA). We also focused on the relation between radiographical changes and clinical findings.

Methods:

It was a cross-sectional study, including patients with SpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. We collected the following data: age, gender, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), and Bath Ankylosing Spondylitis Functional Index (BASFI).

Pelvic radiographs were examined by 2 experimented rheumatologists. Grading symphysial involvement was made as follow: scores ranged from 0-4 per reading: grade 0 = normal; grade 1 = subtle irregularity and/or subchondral sclerosis, grade 2 = clear erosions, 3 = marked sclerosis, grade 4 = ankylosis.

We divided our patients into two groups: G0 patients without SP changes and G1 patients with SP changes.

Results:

One hundred and thirty-one patients were included, 84 were male, and 48 were female. The sex ratio M/F was 1.72. The mean age was 41.32±12.42 years. The mean disease duration was 12.65 ± 9.49 years. The clinical presentation of SpA was peripheral in 61 cases and axial in 118 cases. The mean disease scores activity was: BASDAI: 3.94±2.046 and ASDASCRP: 2.75±1.05. The mean BASFI was 4.17±2.7

SP changes were observed in 31 patients: score 1 (n=14), score 2 (n=8), score 3 (n=8) and score 4 (n=4). Sex ratios M/F were 2.1 and 1.65 in G1 and G0, respectively (p=0.23). No statistically significant differences were reported between the two groups G0 and G1: mean age (40.48 vs. 43.45, p=0.324), mean disease duration (11.19 vs. 14.45, p=0.218), mean BASDAI (3.8 versus 3.9, p=0.850), mean ASDAS-ESR (3.09 vs. 2.55, p=0.113) and mean BASFI (3.76 versus 4.96, p=0.06) respectively. In G1, nine patients had hip involvement (p=0.203). Enthesitis was more common in patients with SP changes (p=0.02).

Conclusion:

In our study, the presence of enthesitis was associated with SP changes. Surprisingly, age and disease duration did not influence SP changes (1).

References:

[1]Kang Y, Ahn JM, Lee E, Lee JW, Kang HS. Active inflammatory changes around the pubic symphysis in patients with axial spondyloarthritis: Magnetic resonance imaging characteristics and association with clinical factors. Eur J Radiol. mars 2020;124:108802.

Disclosure of Interests:

None declared.

AB0740 IMPACT OF DIAGNOSIS DELAY ON DISEASE PARAMETERS DURING JUVENILE IDIOPATHIC ARTHRITIS

Background:

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in childhood (1). Prompt diagnosis is mandatory to avoid joint destruction and growth abnormalities. However, it’s often misdiagnosed by pediatricians and general practitioners leading to longer diagnosis delay (2).

Objectives:

The aim of this study was to evaluate the lag time between JIA symptoms onset and diagnosis and its impact on disease activity and bone loss.

Methods:

A retrospective monocentric study was carried out on JIA patients (ILAR criteria). Diagnosis delay was collected from the patient’s medical files. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis related enthesitis form. The data were analyzed using the SPSS statistical package. A p value < 0.05 was considered significant.

Results:

We enrolled 48 JIA (31 male and 17 female) with a mean age at disease onset of 11.2 ± 3.8 years. The median disease duration was 84 months [2-408]. The median JIA diagnosis delay was 8 months [1-108]. The JIA subgroups were in decreasing order of frequency: Enthesitis-related Arthritis (n=32), Polyarticular RF- (n=4), Polyarticular RF+ (n=2), Oligoarticular (n=6), Systemic (n=2), Psoriatic Arthritis (n=1) and Undifferentiated (n=1).

At diagnosis, median ESR and CRP were 44 mm/hour [2-100] and 24 mg/l [2-86] respectively. Median JADAS10 score was 4 [0-21]. Median BASDAI score was 6.2 [2-9.4].

At follow-up, five patients (10.4%) had atlantoaxial subluxation and 17 had coxitis (43.8%).

At bone densitometry, 45% of patients had osteroposis and 27.5% had osteopenia.

An agreement was assessed between a long diagnosis delay and the following parameters: male gender (p=0.04) and osteoporosis (p=0.018). A Significant positive correlation was found between delay in JIA diagnosis and BASDAI score (p=0.047, r=0.63). No association was found between JIA diagnosis delay and JADAS score (p=0.56). Neither ESR (p=0.19) nor CRP (p=0.42) was associated with JIA diagnosis delay.

Finally, no link was observed with the occurrence of hip arthritis (p=0.281) or atlantoaxial subluxation (p=0.137).

Conclusion:

In this study, delay in diagnosis was associated with higher disease activity scores and bone loss. Our results suggest that early identification and treatment of JIA leads to improved outcomes as well as bone mass.

References:

[1]Petty R.E., Southwood T.R., Manners P. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390.

[2]Foster HE, Scott C, Tiderius CJ,et al. Improving musculoskeletal health for children and young people - A ‘call to action’. Best Pract Res Clin Rheumatol. 2020 Oct;34(5):101566.

Disclosure of Interests:

None declared

AB0133 LATE-ONSET AND BONE LOSS IN RHEUMATOID ARTHRITIS: WHAT FACTORS SHOULD WE CONSIDER?

Background:

Rheumatoid arthritis (RA) is an inflammatory rheumatism that causes alterations in bone components through the increased production of pro-inflammatory cytokines. Besides traditional risk factors of osteoporosis (OP), elderly RA patients are at higher risk of progressive decline in bone mineral density resulting from the disease.

Objectives:

This study aimed to determine factors associated with bone loss in late-onset RA patients.

Methods:

A cross-sectional study including patients with RA (according to ACR/EULAR classification criteria) in whom disease onset was after age 65 years. Sociodemographic data, daily calcium intake, and menopausal state were recorded. The characteristics of the disease were transcribed, including inflammatory markers (erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP)), the disease activity assessed by Disease Activity Score 28 (DAS28), seropositivity for anti-cyclic citrullinated peptide antibody (ACPA) and rheumatoid factor (RF), and treatment modalities (cumulative dose of corticosteroids and Methotrexate). Bone mineral density (BMD) was assessed by Dual-energy X-ray absorptiometry. The risk of hip fracture (HF) and major osteoporotic fracture (MOF) after ten years were assessed using the fracture risk assessment tool (FRAX). Patients were divided into two groups (G1 with bone mineral loss (BML) and G2 without BML). Statistical analysis was performed using Kruskal-Wallis Test and chi-square. The level of significance was fixed for p< 0.05.

Results:

The study included 58 late-onset RA patients with a female predominance (sex ratio M/F=0.3). The mean age was 71.6 ± 5.9 years [65-85], and the mean disease duration was 3.1 ±2.9 years [0-15]. The mean calcium intake was 416.4± 168.6 mg per day [168-1043]. The mean BMD was 1.5 g/cm2[0.1-28.3] at the vertebral site and 0.7±0.2 g/cm [-0.1,1.2] at the femoral site. Bone loss was found in 55.2% of cases and was significantly associated with age (p=0.022) and longer disease duration (p=0.015). Similarly, there was a positive correlation between CRP and BML (p=0.023). However, bone loss was not correlated to sex (p=0.865), RF and ACPA positivity (p=0.9, p=0.1 respectively), or to coxitis (p=1). Similarly, disease activity, body mass index, and calcium intake were comparable between the two groups (p=0.311, p=0.179, p=0.099, respectively). G1 had a higher incidence of fractures without reaching a statistically significant correlation (63.2% in G1 and 51.3% in G2, p=0.393). Also, G1 had a higher risk of MOF (p=0.003) but not with a higher risk of HP (p=0.127). Regarding treatment modalities, the BML was significantly correlated to non-steroidal anti-inflammatory drug (NSAIDs) intake (85.7% in G1 and 37.8% in G2, p=0.001), but was not correlated to the cumulative dose of corticosteroids (p=0.384) and Methotrexate (p=0.054).

Conclusion:

Our study showed that age, disease duration, NSAIDs, and inflammation were risk factors for a bone mineral loss in late-onset RA. Screening for these factors would be useful as part of an ideal form of fracture risk management.

Disclosure of Interests:

None declared

AB0501 CORRELATION BETWEEN AXIAL AND PERIPHERAL ENTHESIS IN SPONDYLARTHRITIS

Background:

Enthesitis is the clinical hallmark of spondylarthritis. It refers to the inflammation of joint attach in the bone. Several sites enthesitis may be affected, and a wide variety of scoring systems were available.

Objectives:

We aimed to determine the prevalence of axial enthesitis in the anterior chest wall (ACW), and its correlation with peripheral sites especially, the Achilles tendon (AT).

Methods:

We conducted a prospective study including patients with SpA according to the ASAS criteria. Sociodemographic data, as well as disease characteristics, were recorded. The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used to assess clinical entheses (first and seventh costochondral joints, posterior superior iliac spine, anterior superior iliac spine, iliac crest, and Achilles tendon insertion). The presence of enthesitis on the US was then assessed in the right and left sternoclavicular (SCJ), manubriosternal (MSJ) joints, as well as in the AT, using Esaote My Lab 50.

Results:

The study included 47 patients with SpA: axial (n=26), axial and peripheral (n=21). There was a female predominance (sex ratio: 0.2). The mean age was 42.2 years ± 12.6 [11-70]. The age of onset of the disease was <40 years in 59.6% of cases. Tenderness in entheseal sites was found in 63.8% of patients, especially in the plantar fascia and AT (32.7%, 6%, respectively). The mean MASES score was 2.9 [0-13]. Clinical ACW involvement (29.1%) was at follows: 1st right chondro-sternal joint (CSJ) (19.1%), 1st left CSJ (25.5%), 7th right CSJ (27.7%) and 7th left CSJ (31.9%).US involvement of the ACW was 14.3%. Enthesitis of the AT was found in 70% of cases on US examination. ACW US involvement was correlated neither to the BMI nor to MASES score (p=0.16, p=0.6 respectively). Similarly, there was no correlation between the presence of US ACW enthesitis and clinical nor the US AT enthesitis (p=0.09, p=0.209, respectively).

Conclusion:

Our study showed that ACW enthesitis is frequent in SpA, especially by US screening. This axial enthesitis, don’t necessarily reflect a simultaneous clinical or US involvement of the peripheral entheses. Further studies are needed to characterize this subtype of SpA.

References:

[1]Verhoeven F, Guillot X, Godfrin-Valnet M, Prati C, Wendling D. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study. J Rheumatol. 2015;42(1):87-92

Disclosure of Interests:

None declared.

AB0187 PREVALENCE, RISK FACTORS, AND TREATMENT MODALITIES OF ATLANTOAXIAL DISLOCATION IN RHEUMATOID ARTHRITIS

Background:

Cervical spine involvement is common in patients with rheumatoid arthritis (RA). The most common abnormality is atlantoaxial dislocation (AAD). It may lead to severe neurological symptoms and even death. Currently, there is a lack of consensus on the best approach to treatment.

Objectives:

We investigated the prevalence of and risk factors for AAD in patients with RA, as well as its relationship to treatment modalities.

Methods:

We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck, anteroposterior and odontoid projection view. Patients were divided into two groups: (G1) a group with AAD and (G2) without ADD. We compared clinical, radiological, and laboratory findings between the two groups, as well as the treatments used: Steroid therapy, classic and biologic disease-modifying anti-rheumatic drugs (DMARDs). Structural joint damage was assessed with the Sharp/van der Heijde radiographic method. Functional impairment was assessed using the Health Assessment Questionnaire (HAQ). We used Statistical Package for Social Sciences (SPSS) 22.0 to analyze the results. The level of statistical significance was set at 0.05.

Results:

ADD was present in 16% of the cases (n=36). Female predominance was noted, with a sex ratio of 0.25 (p=0.530). The mean age was 58±12 years, with no significant difference between groups (p=0.146). The mean disease duration was significantly higher in G1 (11.5 ± 10.5 years versus 5.9 ± 6.3, p=0.004). A noticeable relationship between AAD and immunopositivity was found: rheumatoid factor (RF) was present in 86.1% of the cases in G1 versus 67.5% in G2 (p=0.025). Anti-citrullinated protein antibodies (ACPA) were present in 86.1% of the cases in G1 versus 64.8% in G2 (p=0.012). We found a significant difference between AAD and disease activity assessed by DAS28-VS (5.8±1.3 in G1 versus 5.3±1.6 in G2,p=0.027). AAD was significantly associated with more structural joint damage: erosions (121.1±60.9 in G1 versus 61.8±56.5 in G2,p<10-3), joints space narrowing (77.4±47.4 in G1 versus 38.7±40 in G2, p<10-3), Sharp/van der Heijde radiographic score (190.2±103.1 in G1 versus 100.1±90.6 in G2, p<10-3). Hip involvement was more frequent in G1 (22.2% versus 9.4% in G2, p=0.038).

HAQ score was higher in G1 (1.8±0.7 versus 1.2±1, p=0.002).

Seventy-five percent of patients in G1 had received methotrexate versus 82.3% in G2 (p=0.301). The mean duration of methotrexate therapy was longer in G1 (24.6±23.5 versus

18±24 months, p=0.015). G1 patients received a higher mean dose and cumulative dose of methotrexate: 13.2±3.5 g/week versus 11.8±4.4 g/week (p=0.048), and 6.5±6.8 versus 4.8±8.5 (p=0.025), respectively.

Thirty-five percent of patients in G1 had received corticosteroids versus 25% in G2 (p=0.217). Patients in G1 had a significantly longer duration of steroid therapy: 17.8 + 20.2 versus 13.3 + 24.3 months (p=0.22). The mean dose of corticosteroids was similar between the two groups: 6.9±4.3 mg/day versus 5.7±4.6 mg/day (p=0.132). The total cumulative dose was significantly higher in G1: 6.5±6.8 mg/day versus 4.8±8.5 mg/day (p=0.025).There was no significant difference in using other DMARDs: Sulfasalazine (p=0.182) and leflunomide (p=0.276).

No significant difference was observed with patients under biologic DMARDs: 24.1% in G1 versus 17% in G2 (p=0.725).

Conclusion:

Cervical spine involvement is common in RA and may be asymptomatic. Immunopositive patients seem to have more frequently ADD, as well as those with high disease activity and severe structural joint damage. The treatment modalities do not appear to be affected by AAD; however, patients with ADD seem to have higher cumulative doses of corticosteroids and methotrexate. Given the cross-sectional nature of our study, it is difficult to confirm the connection between the two. Further studies are needed.

Disclosure of Interests:

None declared

AB0741 PREVALENCE AND ASSOCIATED FACTORS OF ATLANTO-AXIAL INSTABILITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background:

Atlanto-axial instability (AAI) is a serious complication during Juvenile Idiopathic Arthritis (JIA). It can lead to severe neurological morbidity or mortality if left untreated (1).

Objectives:

To determine the prevalence of AAI in patients with JIA and to identify factors associated with an increased risk of its occurrence.

Methods:

A retrospective monocentric study was carried out on JIA patients (ILAR criteria). Data, including age at disease onset, JIA type, disease activity at AAI diagnosis and treatment were collected. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis related enthesitis form. Standard radiographs of the cervical spine were analyzed. The data were analyzed using the SPSS statistical package. A p value < 0.05 was considered significant.

Results:

We enrolled 48 JIA (31 male and 17 female) with a mean age at disease onset of 11.2 ± 3.8 years. The median disease duration was 84 months [2-408]. The median JIA diagnosis delay was 8 months [1-108]. The JIA subgroups were in decreasing order of frequency: Enthesitis-related Arthritis (n=32), Polyarticular RF- (n=4), Polyarticular RF+ (n=2), Oligoarticular (n=6), Systemic (n=2), Psoriatic Arthritis (n=1) and Undifferentiated (n=1).

At diagnosis, median ESR and CRP were 44 mm/hour [2-100] and 24 mg/l [2-86] respectively. Median JADAS10 score was 4 [0-21]. Median BASDAI score was 6.2 [2-9.4].

At follow-up, five patients (10.4%) had atlantoaxial subluxation and 17 had coxitis (43.8%).

At bone densitometry, 45% of patients had osteroposis and 27.5% had osteopenia.

An agreement was assessed between a long diagnosis delay and the following parameters: male gender (p=0.04) and osteoporosis (p=0.018). A Significant positive correlation was found between delay in JIA diagnosis and BASDAI score (p=0.047, r=0.63). No association was found between JIA diagnosis delay and JADAS score (p=0.56). Neither ESR (p=0.19) nor CRP (p=0.42) was associated with JIA diagnosis delay.

Finally, no link was observed with the occurrence of hip arthritis (p=0.281) or atlantoaxial subluxation (p=0.137).

Conclusion:

In our study, the prevalence of AAI was 10.4%. Prolonged corticosteroid use and elevated inflammatory markers were the major factors associated with an increased risk of upper cervical spine involvement. Hence, targeted treatments are required to prevent cervical spine instability.

References:

[1]Hospach T, Maier J, Müller-Abt P, Patel A, Horneff G, von Kalle T. Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study. Pediatr Rheumatol Online J. 2014;12:9.

Disclosure of Interests:

None declared

AB0520 PUBIC SYMPHYSIS INVOLVEMENT IN NON-RADIOGRAPHIC SPONDYLARTHRITIS

Background:

Structural change within pubic symphysis (PS) occurs in 20–25% of patients with spondylarthritis (SpA). It occurs in all developmental stages, even in the early stages of the disease. Changes in the symphysis can sometimes precede spine and sacroiliac involvement. Radiological findings in PS were poorly described in the SpA, especially on its non-radiographic form (nr-axSpA).

Objectives:

We aimed in this study to evaluate pubic symphyseal features in patients with a confirmed diagnosis of nr-axSpA and to assess the correlation of these changes with clinical and imaging features of nr-axSpA in these patients. We also focused on the relationship between parity and radiographic changes in pubic symphysis (PS).

Methods:

We retrospectively reviewed the data of 40 patients diagnosed with nr-axSpA according to the ASAS criteria. Radiological-morphological changes of PS were assessed in pelvic radiography by two distinct rheumatologists. Grading symphysial involvement was made as follow: scores ranged from 0-4 per reading: grade 0 = normal; grade 1 = subtle irregularity and/or subchondral sclerosis, grade 2 = clear erosions, 3 = marked sclerosis, grade 4 = ankylosis.

For all patients, we calculated the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the BASRI (Bath Ankylosing Spondylitis Radiology Index).

For all patients, we recorded the sacroiliac changes showed by the previous pelvic radiography and/or the pelvic scanner and/or by magnetic resonance imaging (MRI).

Results:

We enrolled forty patients with a sex-ratio H/F=1/3. Mean age of patients at diagnosis was 39,9 +/- 10,8 [17-59]. Forty percent of patients had peripheral enthesitis, and 45% had peripheral arthritis. BASDAI mean score was 4,63 +/- 0,9 [0-8,6]. HLA B-27 was present in 32,3% of cases. We noted radiographic changes in PS in 37,5% (15 patients): grade 1 (n=1), grade 2 (n=10), grade 3 (n=3) and grade 4 (n=1). There was not a significant difference between the sex group (p=0,85). A comparison of 2 groups (women with 3 children or more and women with less than 3 children) concluded that childbirth did not modify PS changes (p=0,9). Also, PS changes did not differ with age (p=0,5). There was no correlation between the BASRI value with the presence of PS changes nor with its grades (p=0,5 and p=0,89, respectively). Also, disease activity did not influence the PS involvement (p=0,4). Radiological findings in PS was not correlated with the sacroiliac features found on MRI or pelvic CT scan (p=0,59 and p=0,1).

Conclusion:

In SpA criteria, PS changes were not considered. It can be an additional help in making the diagnosis. Interestingly, pubic symphysis may exist without sacroiliitis.

Disclosure of Interests:

None declared.

AB0189 LIPOPROTEIN ABNORMALITIES IN RHEUMATOID ARTHRITIS PATIENTS

Background:

The lipid paradox is termed the decreased cholesterol level in rheumatoid arthritis (RA). Nevertheless, the apolipoprotein levels are usually higher than a healthy person and are predictors of cardiovascular events.

Objectives:

We aimed to describe lipid abnormalities in RA patients and to look for predictor factors of these changes.

Methods:

The prospective study was carried out on patients with RA who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. These patients were followed in the rheumatology department of the Kassab Institute.

We collected the socio-demographic data, biological and immunological parameters.

The lipid assessment included: a measurement of total cholesterol (TC), HDL, LDL, and triglycerides (TG). Lipoproteins APOA1 and APOB were measured. All data were collected after patient consent.

Results:

Of the 47 patients recruited, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The average RA progressed from 86.25 ±63 months [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. Eight patients had a previous CV history.

Mean TC was 4.42 ±1.3 [1.2-7.58], mean HDL was 1.38 ±0.73 [0.18-4.10], mean LDL was 2.55 ±1.16 [0.24-5.54]. The mean TG value was 1.28 ±0.6 [0.24-5.54]. TC elevation was found in 9.1% of cases, HDL in 21.3% of cases, LDL in 5.5% of cases, and TG in 16.4% of cases. Mean APOB/APOA1 ratio was 0.67 ±0.18 [0,46-1,11]. LDL elevation was associated to a high DAS28 (p=0.06, r=0.512). APOA1 was associated to a low DAS28 (p=0.04, r=-0.642).

The mean value of APO A1 was 1.36 ±0.21 [0.84-1.81], that of APOB was 0.90 ±0.22 [0.58-1.40]. APOA1 values were lower in patients with high-level LDL (p=0.767). The APOB value was associated with lipid disturbance without significant correlation (p=0.291).

Conclusion:

Lipid test abnormalities can be found in RA patients outside of any known CV risk factors. APOA1 seems to have a protective effect. Screening and treatment of these abnormalities can prevent CV risk.

References:

[1]Miguel Bernardes and al. Coronary artery calcium score in female rheumatoid arthritis patients: Associations with apolipoproteins and disease biomarkers. Int J Rheum Dis. 2019;00:1–16.

[2]Anna So dergren and al. Biomarkers associated with cardiovascular disease in patients with early rheumatoid arthritis. PLOS ONE. August 5, 2019.

Disclosure of Interests:

None declared

AB0744 HOW JUVENILE IDIOPATHIC ARTHRITIS PATIENTS PERCEIVE THEIR ILLNESS?

Background:

Juvenile idiopathic arthritis (JIA) represents the most common inflammatory rheumatism of childhood. Because of a prolonged course of active disease, many patients experience physical and psychosocial limitations. Illness perceptions involve the personal beliefs that patients have about their illness and may influence health behaviors considerably.

Objectives:

The present study aimed to investigate the illness perception of patients with JIA.

Methods:

We conducted a cross-sectional study including children with JIA (according to the International League of Associations for Rheumatology (ILAR)). We recorded sociodemographic data and the subtype of the JIA. To assess a child’s perception of how arthritis affects their life, the Brief Illness Perception Questionnaire (IPQ) was completed by the parent (child age ≤10 years) or by the child (age ≥11 years). The Brief IPQ is a nine-item questionnaire rated using a 0-to10 response scale that assesses cognitive illness representations: consequences (Item 1), timeline (Item 2), personal control (Item 3), treatment control (Item 4), and identity (Item 5). Two of the items assess emotional representations: concern (Item 6) and emotions (Item 8). One item assesses illness comprehensibility (Item 7).

Results:

The study included 22 patients. The mean age was 15 ± 7 years [4-35], and the mean age at diagnosis was 9 ±3 years [3-14]. There was a female predominance (sex ratio= 2.1). The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 1), polyarticular without rheumatoid factor (n=3), systemic (n= 2), enthesitis-related arthritis (n=9), oligoarthritis (n= 7), undifferentiated (n=1). Non-steroidal anti-inflammatory drugs were prescribed in 72% of cases, and Cs-DMARDs in 59% of patients. The most-reported causal factor in their illness was a history of traumatism (22%). Perceiving symptoms (identity) were significantly related to being affected by the disease (emotional response) (p= 0.01). Conversely, patients who had personal and treatment control expressed less emotional response (r = −0.7, r=-0.2 respectively). Moreover, those who were concerned about the disease perceived more the consequences of their illness (p=0.09) and understood it more (p=0.029). We also noted significant correlations between personal control and treatment control (p = 0.033). A positive correlation was found between identity as well as consequences and timeline (p=0.011, p=0.024), showing that the perception of chronicity was associated with pain and the burden of the disease.

Conclusion:

Our study highlighted the importance of assessing illness perception in JIA patients. Patient education programs should be implemented since diagnosis for better disease management.

Disclosure of Interests:

None declared

AB0148 CHARACTERISTICS OF RHEUMATOID ARTHRITIS PATIENTS WITH HIP INVOLVEMENT

Background:

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects both small and large joints. Hip involvement is an evolutionary turning point in RA and significantly alters the patient’s quality of life.

Objectives:

This study aimed to assess characteristics of RA patients with hip involvement.

Methods:

It was a cross-sectional study, including patients with RA (according to 2010 ACR/European League Against Rheumatism (EULAR) criteria).We divided patients into two groups: G0 patients without hip involvement, G1 patients with hip involvement. Hip involvement was defined with a limited movement during examination with abnormalities on standard radiographs. We collected the following data: age, the disease activity score (DAS28), the inflammatory biomarkers C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR), Rheumatoid Factor (RF), and Anti Citrullinated Peptides Antibodies (ACPA), and SHARP score (A scoring system used to assess the radiological changes in patients with RA. It describes erosions and narrowing of the joint space of 27 small joints of the hands, including the carpal bones and feet).

Results:

Among the 224 patients included, 25had hip involvement (11%). The male / female sex-ratio was higher in G1 (0.66 vs 0.22, p=0.017).Patients in G1 were younger at disease onset (44,16±16,11 years vs 51.9±13.9 years, p= 0.022) and had a longer disease duration (12,28 ± 11,49 years vs 6,2010 ± 6,45 years, p=0.02). They had also higher HAQ(1,7692 vs 1,3054, p=0.05).SHARP score was higher in G1 (176.32 vs. 106.88, p=0.011). Atlantoaxial subluxation was more common in G1 (32% vs 14%,p=0.035).When comparing the groups we did not find any significant difference regarding age (56.12 ± 11.88 years vs 58,24±12,26 years, p=0.341), disease activity (DAS28-ESR:5.41 vs. 5.65, p=0.380; DAS28-CRP: 5.19 vs. 5.51, p=0.290), ESR (53.88 vs. 46.95, p=0.237), CRP:23,8894 vs 22,89, p=0.975), and in the serological profile (RF; G1:68% vs G0: 70.8%, p=0.817, ACPA; G1: 60% vs G0:69%, p=0.366).

Conclusion:

Patients with hip involvement were commonly male, were younger at disease onset and had more functional impairment based on the HAQ score. C1-C2 dislocation wasalso more common in this group.The SHARP score was also significantly higher in G1, which shows a severe and destructive disease.

Disclosure of Interests:

None declared

POS0587 EFFECT OF RHEUMATOID ARTHRITIS TREATMENTS ON THE INTIMA-MEDIA THICKNESS OF SUPRA-AORTIC TRUNKS AND ON CARDIOVASCULAR RISK

Background:

Patients with rheumatoid arthritis (RA) are exposed to a multifactorial cardiovascular risk: chronic inflammation, endogenous and exogenous factors, and treatment.

Objectives:

The aim of this study was to investigate the impact of RA treatments on cardiovascular risk and the influence of supra aortic trunks.

Methods:

This is a prospective study conducted on RA patients followed-up between March and December 2020 at the rheumatology department of the Mohamed Kassab Institute of Orthopedics and Traumatology. Socio-demographic data of patients and characteristics of the disease were collected. The disease activity was evaluated by the Disease Activity Score 28. Prescribed treatments were specified. Ultrasonography of the supra aortic trunks was performed by measuring, in centimeters, the Intima-media Thickness (IMT) at the level of the left (LCC) and right (RCC) common carotid arteries, the left (LIC) and right (RIC) internal carotid arteries and the left (LEC) and right (REC) internal carotid arteries.

Results:

Of the 47 patients surveyed, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The average RA progressed from 86.25 ±63 [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. The treatments taken were: Methotrexate (MTX) (54.5%), Sulfasalazine (SLZ) (1.8%), Leflunomide (LFN) (3.6%), a combination of cs-DMARDs (5.5%), and biotherapy (10.9%). The prescribed biotherapies were: Etanercept (3.6%), Adalimumab (1.8%), Certolizumab (1.8%), Infliximab (3.6%). Corticosteroids (CT) were prescribed in 38.2% of patients, non-steroidal anti-inflammatory drugs (NSAIDs) (3.6%), and analgesics (41.8%).

CT had a protective effect on IMT in LIC (p=0.031) and RIC (p=0.016). MTX had a significant protective effect on IMT in RIC (p=0.002) and LEC (p=0.033).

SLZ was associated with an increase in IMT at the RIC level (p=0.05). There was no association between NSAID use and IMT. MTX and CT were significantly associated with a decrease in SCORE (p=0.02; p=0.05, respectively). There was a non-significant association between SLZ or LFN and decreased SCORE (p=0.140, p=0,970).

Conclusion:

In our series, patients taking MTX and CT had a lower IMT than those not taking these drugs. SLZ was associated with an increase in IMT. NSAIDs did not affect IMT in our study.

References:

[1]Pasquale Ambrosino and al, Subclinical atherosclerosis in patients with rheumatoid arthritis A meta-analysis of literature studies. Thrombosis and Haemostasis 113.5/2015

[2]Hyun-Je Kim and al, Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis. The Korean Academy of Medical Sciences 2015.

Disclosure of Interests:

None declared

AB0512 CLINICAL AND RADIOLOGICAL FEATURES OF SHOULDER INVOLVEMENT IN SPONDYLARTHRITIS

Background:

Peripheral joint involvement is frequent among patients with peripheral spondylarthritis (SA). However, the root joint involvement, such as hip involvement, has been described as being associated with axial spondylarthritis, while data for shoulder involvement are scarce. Cuff tendonitis and enthesitis are common features in the shoulder in patients with SA.

Objectives:

This study aimed to identify the prevalence of shoulder involvement in SA patients and describe its clinical and radiological features.

Methods:

We conducted a retrospective study including SA patients, all fulfilling the assessment of Spondyloarthritis International Society (ASAS) criteria.

For all patients, we collected the following data: Age, the clinical presentation of SA, the inflammatory biomarkers C-reactive protein (CRP), and the disease activity assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).

Regarding shoulder involvement, we assessed the following items: tenderness, mobility, rotator cuff tests, as well as the results of X-ray and Ultrasound examination (US).

Results:

We included one hundred and thirty-one SA patients (mean age 39,77 years). Among them, sixty-two percent were male. Ten percent of patients were smokers, 46,6% had the peripheral beginning of the disease. Fourteen patients complained of shoulder pain. The majority of them were male.

X-rays showed no abnormalities (n=2), while a destructive form was noted in (n=7).

Rotator cuff rupture or enthesopathy was also revealed by the reduction of subacromial space (n=5), condensation of the greater tuberosity (n=3), crooked aspect of the acromion (n=2), and Moloney’s line disruption(n=1).

US showed no abnormalities (n=1), supraspinatus tendinopathy (n=5), supraspinatus transfixing tear (n=1), infraspinatus tendinopathy (n=2), supraspinatus enthesopathy (n=2), infraspinatus enthesopathy (n=1), moderate synovitis (n=1), subacromiodeltoid bursitis (n=1).

Shoulder involvement was correlated significantly with the peripheral beginning of SA (P < 0.05). There were no significant differences in gender, tobacco use, CRP value, and the disease activity between the two groups (P > 0.05).

Conclusion:

The shoulder involvement was rare in our study. It is characterized by cuff tendonitis and enthesitis, especially in supraspinatus insertion. However, the glenohumeral synovitis was uncommon in our series, even in the peripheral form of the disease.

References:

[1]Hip and Shoulder Involvement and Their Management in Axial Spondyloarthritis: a Current Review Clementina López-Medina1,2,3,4 & M. Carmen Castro-Villegas1,2,3 & Eduardo Collantes-Estévez1,2,3, 23 July 2020.

Acknowledgements:

I would like to thank all the authors listed above, for they helped me make writing my first abstract less harder.

Disclosure of Interests:

None declared.

AB0150 ACPA-STATUS AND RHEUMATOID ARTHRITIS: MUCH MORE TO BE REVEALED!

Background:

Anti-citrullinated protein antibodies (ACPA) are commonly associated with Rheumatoid arthritis (RA). RA is, therefore, classified as immunopositive or immunonegative, with disparate mechanisms in predisposition.

Objectives:

Our study aimed to determine the baseline characteristics and differences of ACPA-positive and ACPA-negative RA.

Methods:

We conducted a cross-sectional study including 224 patients with RA. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. The patients were divided according to their ACPA status into two groups: ACPA-positive group (G1) and ACPA-negative group (G2). We compared clinical, radiological, and laboratory findings between the two groups, as well as extra-articular manifestations, comorbidities including fractures and osteoporosis. The Fracture Risk Assessment Tool (FRAX) was used to estimate the 10-year probability of major osteoporotic fracture (MOF) and also hip fracture (FH).

Results:

Of the 224 patients, 31.6% were negative for ACPA (n=71). Female predominance was found in both groups with a sex ratio of 0.25 (p=0.203). ACPA-negative subjects were younger (57±11 versus 59±12 years) (p= 0.305).

The initial presentation of RA was different between the two groups without reaching statistical significance. In the ACPA-negative group, alteration of general condition was more frequent (16.9% in G2 versus 13.7% in G1) (p=0.533), with a tendency to oligo-articular onset (18.5% in G2 versus 6.7% in G1) (p=0.737). ACPA-positivity was more associated with an acute start of symptoms (10.4% in G1 versus 8.4% in G2) (p=0.639)

There was no significant difference in the mean DAS28-VS (5.2±1.1 in G2 versus 5.5±1.3 in G1) and DAS28-CRP levels (5±1 in G2 versus 5.3±1.2 in G1) (p=0.069 and p=0.098 respectively).

ACPA-positive RA was, however, significantly associated with more structural joint damage: erosions (55.9±53 in G1 versus 78±36 in G2, p=0.01), joint space narrowing (50.4±45.5 in G1 versus 33.1±36.6 in G2, p=0.003), Sharp/van der Heijde radiographic score (126.6 ±103.2 in G1 versus 88.8±81.5 in G2, p=0.004). ACPA-positive RA patients had more atlantoaxial dislocation: 20.2% in G1 versus 7% in G2 (p=0.012). There was no significant difference in hip involvement (9.8% in G1 versus 14% G2) (p=0.344).

There were no significant differences in extra-articular manifestations between the two groups: Rheumatoid nodules (10.4% in G1 versus 18.3% in G2) (p=0.891), Sjögren’s syndrome (16.3% in G1 versus 16.9% in G2)(p=0.715), amyloidosis (0.6% in G1) (p=1), pulmonary fibrosis (5.8% in G1 versus 4.2% in G2) (p=0.757), neurological signs (4.5% in in G1 versus 5.6% in G2) (p=0.733), anaemia (5.8% in G1 versus 1.4% in G2) (p=0.175).

When analyzing comorbidities, no significant differences were found: diabetes (10.4% in G1 versus 18.3% in G2) (p=0.103), cardiovascular diseases (19.6% in G1) (p=1), neurological diseases (0.06% in G1 versus 1.4% in G2) (p=0.534), dysthyroidism (2.6% in G1 versus 5.6% in G2) (p=0.267), dyslipidemia (3.2% in G1 versus 4.2% in G2) (p=0.711), cancer (1.3% in G1) (p=1). There were neither significant differences in the prevalence of fracture (21.5% in G1 versus 18.3% in G2) (p=0.574), and osteoporosis (23.6% in G1 versus 29.5% in G2) (p=0.347), between the two groups. However, ACPA-positive patients presented with a significantly higher FRAX score of MOF (2±2.8 in G1 versus 1.2±1 in G2) (p=0.006), and FRAX score of FH (0,9±1.8 in G1 versus 0.3±0.5 in G2) (p=0.003).

Conclusion:

ACPA status appears to influence both the clinical presentation and radiological progression of RA patients. ACPA-positive patients present with an acute start of symptoms, with more structural damages and atlantoaxial dislocation. Comorbidities, including osteoporosis, does not seem affected by ACPA status. However, regardless of osteoporosis, ACPA-positivity is associated with a higher probability of major osteoporotic and hip fractures. Further research is needed to clarify this relationship.

Disclosure of Interests:

None declared

Atypical osteomalacia mimicking radiological features of spondyloarthritis: Never judge a book by its cover

Longstanding osteomalacia, by its proliferative enthesopathic changes, may mimic the advanced features of SpA. Despite the typical radiological findings, the lack of response to anti-TNF should encourage clinicians to reconsider the diagnosis.