Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure

BACKGROUND

Giant Cell Arteritis (GCA) is the commonest form of systemic vasculitis in people over the age of 50. Published research highlighted the lack of a disease-specific patient reported outcomes (PROMs) for GCA.

OBJECTIVES

To assess the validity, reliability and responsiveness to change of a devised disease specific patient self-reported outcome measures questionnaire for Giant Cell Arteritis (GCA).

METHODS

The GCA-PROMs was conceptualized based on frameworks outlined in the OMERACT developed core set of Outcome Measures for Large-Vessel Vasculitis and the guiding principles of the FDA guidance. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented.

RESULTS

A total of 54 GCA patients completed the questionnaire. The GCA-PROMs questionnaire was reliable as demonstrated by a high standardized alpha (0.878-0.983). Content construct assessment of the GCA-PROMs functional disability and QoL revealed significant correlation (p< 0.01) with both HAQ and EQ-5D. Changes in functional disability, QoL showed significant (p< 0.01) variation with diseases activity status in response to therapy.

CONCLUSIONS

The developed GCA-PROMs questionnaire is a reliable and valid instrument for assessment of GCA patients. A stratified treatment regimen depending on the individual patient's risk factors as well as preferences and associated comorbidities is the best approach to tailored patient management.

42 Egyptian evidence-based consensus recommendations for diagnosis and targeted management of juvenile dermatomyositis. An initiative by the Egyptian College of Pediatric Rheumatology

Background

Objective

Methods

Results

Conclusion

The implication to policy, practice, research and advocacy

001 Egyptian consensus-based recommendations for the diagnosis and targeted management of Kawasaki disease. An initiative by the Egyptian College of Pediatric Rheumatology

Background

Objectives

Methods

Results

Conclusion

The implication to policy, practice, research and advocacy

POS1288 TREAT TO TARGET MANAGEMENT OF FIBROMYALGIA: EVIDENCE-BASED CONSENSUS ON CLINICAL PRACTICE GUIDELINES

Background

Because of the subjective character of symptoms, absence of a diagnostic test, modest response to treatments, and at times, patient reports of important functional disability, fibromyalgia remains a challenge for the treating health care professionals in the standard clinical practice.

Objectives

To develop an up to date consensus, evidence-based clinical practice guidelines for treat to target management of fibromyalgia.

Methods

15 key clinical questions were identified by a scientific committee according to the Patient/ Population, Intervention, Comparison, and Outcomes (PICO) approach. A literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for fibromyalgia. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 16 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.

Results

An online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifteen recommendation items, categorized into 10 sections to address the main fibromyalgia categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 85-100%. Consensus was reached (i.e.≥80%of respondents strongly agreed or agreed) on the wording of all the 15 clinical standards identified by the scientific committee. Algorithm for the management of fibromyalgia have been suggested.

Conclusion

These recommendations provide an updated consensus on both the non-pharmacological as well as the pharmacological treatment of fibromyalgia. The provide strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Disclosure of Interests

None declared

AB0908 Treating to target of psoriasis: An evidence-based consensus on clinical practice recommendations

Background

The Tight Control of psoriatic arthritis (TICOPA) trial revealed a treat to target (T2T) strategy has led to improved clinical outcomes in psoriatic arthritis (PsA). The heterogeneity of the disease, the feasibility of therapy and the associated comorbidities made the implementation of such strategy in routine care a real challenge. There is a high need for establish real world recommendations for the T2T approach in PsA tailored to the disease activity status, the Psoriasis manifestations as well as the individual patient’s requirements.

Objectives

to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and its associated clinical manifestations.

Methods

14 key clinical questions were identified by scientific committee according to the Patient/ Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.

Results

An online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifty-one recommendation items, categorized into 6 sections to address the main 6 PsA categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 89.5-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of PsA have been suggested.

Conclusion

These recommendations provide an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal treat to target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Disclosure of Interests

None declared

AB1159 HYDROXYCHLOROQUINE SHORTAGE AND ITS RELATION TO ANXIETY LEVEL AND DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS DURING COVID-19 PANDEMIC

Background

Concerns of hydroxychloroquine (HCQ) shortage for patients with rheumatic diseases are growing during the era of COVID-19 pandemic as it was assigned in some treatment protocols. Its nonavailability may impact the disease management especially in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).

Objectives

To evaluate the shortage of HCQ in patients with RA and SLE and its impact on patients anxiety and disease activity.

Methods

219 RA patients (according to 2010 ACR/EULAR criteria) and 200 SLE patients (according to 2012 SLICC criteria) were recruited in the study. Demographic and clinical features of the patients together with the current disease activity parameters (CDAI and SELENA/SLEADI) were prospectively collected. previous disease activity measures were collected from the patients records before hydroxychloroquine shortage. Patient’s anxiety was measured using Hamilton anxiety rating scale.

Results

A total of 419 patients divided into two groups, Group (1); 219 RA patients with mean age 45.6±9.6 years, disease duration 45.5±32.8 months with female predominance (63 %). Group (2): 200 SLE patients with mean age 33.8±7.9 years, disease duration 61.2±39.2 months with female predominance (84%). 168 (76.7%) of the RA patients and 128 (64%) of SLE patients reduced or stopped the dose of HCQ due to unavailability. Despite HCQ shortage, there was no significant change in disease activity in RA or SLE patients (P=0.063 and 0.064 respectively). All participants suffered from different levels of anxiety which was positively correlated with HCQ shortage (p= 0.001 and 0.005 for RA and SLE respectively).

Conclusion

COVID 19 pandemic caused hydroxychloroquine shortage in the majority of patients with RA and SLE with no significant impact on their disease activity. Anxiety was found correlating to HCQ shortage in both diseases more significantly in SLE patients.

Disclosure of Interests

Mohammed Hassan Abu-Zaid: None declared, Hany Eitta: None declared, Abdelhfeez Moshrif Speakers bureau: Amgen, Jansen and Novartis, Doaa Abdeldaim: None declared, nehal EL Ghobashy: None declared

POS1168 TREAT TO TARGET OF GOUT: AN EVIDENCE-BASED CONSENSUS ON CLINICAL PRACTICE GUIDELINES

Background

New therapies, management approaches and evidence regarding the management of gout have become available over the past years. This triggered the need for updated recommendations for the management of gout.

Objectives

to develop an up-to-date consensus evidence-based clinical practice guideline for the management of gout including recommendations for management of acute gout flares, optimum usage of urate lowering therapy for chronic gout as well as patient education and lifestyle guidance.

Methods

An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated, based on 16-key questions identified according to population, intervention, comparator, and outcomes (PICO) approach. For each item, the level of evidence was determined using the Oxford Centre for Evidence-based Medicine (CEBM) system. These were evaluated by a panel of 17-experts via online surveys over a 2-round Delphi process.

Results

At the end of round 2, a total of 30-recommendation items, categorized into 10 domains to were obtained. Agreement with the recommendations (rank 7-9) ranged from 90-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording, the grade of recommendation and level of evidence of all the 30 clinical standards identified by the scientific committee. The guideline emphasized that all gouty patients should be screened for comorbidities. Based on this, an algorithm for treat to target management approach tailored to the individual patient’s needs and associated comorbidities has been outlined.

Conclusion

This work provides updated evidence-based recommendations for the prevention and treatment of acute as well as chronic gouty arthritis. It provides an approach for physicians and patients making decisions on the management of gout. It will also facilitate improvement and uniformity of care.

Disclosure of Interests

None declared

Updated clinical practice treat-to-target guidelines for JIA management: the Egyptian College of Pediatric Rheumatology initiative

Background

These updated guidelines aimed to provide appropriate and convenient guidelines for the treatment of various types of juvenile idiopathic arthritis (JIA).

Using the Delphi technique, this study was conducted to reach expert consensus on a treat-to-target management strategy for JIA. According to the PICO (patient/population, intervention, comparison, and outcomes) approach, the preliminary scientific committee identified a total of 17 key clinical questions. To assemble evidence on the advantages and dangers associated with JIA treatments, an evidence-based, systematic literature review was conducted. Researchers and clinicians with experience in JIA management were identified by the core leadership team. To establish a consensus on the management suggestions for JIA patients, a Delphi approach (2 rounds) was used.

Results

An online survey was applied to the expert panel (n = 27), and 26 of them completed both rounds. At the conclusion of round 2, a total of eighteen (18) recommendation items were gathered, which were divided into four sections to address the four key JIA categories. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 83.2 to 100% (average 86.8%). The phrasing of all 18 clinical standards identified by the scientific committee was agreed upon (i.e. 75% of respondents strongly agreed or agreed). Algorithms have been proposed for the management of JIA polyarthritis, oligoarthritis, and systemic JIA.

Conclusion

A wide and representative panel of experts initiated a consensus about the management of JIA. The created guidelines give a complete approach to the management of JIA for all healthcare professionals involved in its management, as well as a means of monitoring and evaluating these guidelines on a regular basis.

P063 Consensus-based recommendations for treat to target management of immunoglobulin A vasculitis

Background

IgAvasculitis (IgAV) is the commonest cause of vasculitis in childhood.

It is characterized by small vessel vasculitis of the skin, gastrointestinal tract, kidneys, joints, and, rarely, the lungs and the central nervous system. There is paucity of international guidelines for management of IgA V. the Objective is to develop guidelines specific for Egyptian children with IgA vasculitis.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for IgA vasculitis using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. Delphi process was implemented (2-rounds) to reach a consensus.

Results

An online questionnaire were sent to expert panel (n = 26) who participated in the two rounds. At the end of round 2, a total of 20 recommendation items, categorized into 2 sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the management have been suggested.

Conclusion

This was an expert, consensus recommendations for the diagnosis and treatment of IgA V and IgA V nephritis, based on best available evidence and expert opinion.

POS1104 THE DEVELOPMENT AND VALIDATION OF A RISK STRATIFICATION QUESTIONNAIRE TO SCREEN FOR MEDICATION RELATED OSTEONECROSIS OF THE JAW RISK IN OSTEOPOROTIC PATIENTS

Background:

Given the gaps in knowledge that exist in relation to risk stratification for osteonecrosis of the jaw (ONJ) amongst patients treated with anti-resorptive agents, there is a high need for an evidence-based measure which would facilitate the identification of those patients at higher risk of ONJ development; particularly, most of the available advice is empirically based.

Objectives:

to develop a valid self-administered questionnaire to facilitate risk stratification and risk minimisation of medication related ONJ in osteoporotic patients treated with anti-resorptive agents.

Methods:

Development of ONJ risk assessment questionnaire (ONRAQ) followed 5 stages: 1. Review of the literature to Identify the risk factors associated with medication related ONJ. 2. Item pool development: a list of the main risk factors was compiled. Rare or uncommon factors were excluded. 3. A questionnaire was developed. This was based on the idea that the questions should be straight forward and as clear as possible. 4. Pre-testing of the questionnaire. 5. Validation of the questionnaire by comparing the patients answers with their medical records. Patients at risk were advised to seek dental assessment and the dental report was evaluated. The last prescription was reviewed to verify the current medications. 157 patients were invited to participate and were prospectively monitored for 5-years to assess for the incidence of medication related ONJ. Advice was given regarding how to maintain good dental hygiene to prevent dental disease and to ensure that any dental interventions that are considered necessary are carried out as conservative and preservative as possible. Comprehensibility of the model sections was also assessed.

Results:

Stages 1 and 2 identified the risk factors chosen for the questionnaire. These risk factors were stratified into 4 sections: Personal, Dental and oral health, current medications and associated comorbidities. Stage 3 led to the development of the 27 items questionnaire. Personal: 3 risk factors (age, elevated BMI and smoking), Dental and oral health (11 risk factors), current medications (3 risk factors) and associated comorbidities (10 risk factors). Analysis of the answers provided by 126 patients, who completed the study, age range 58-82 years revealed that the mean time to answer the questionnaire was 1.9 + 0.153 minutes. The ONRAQ has shown a strong validity when compared to the patients’ data record (range 0.89-0.97). All patients rated the questionnaire as easily comprehensible. Comprehensibility of the various questionnaire sections ranged between 96.1% and 98.2% denoting that all the questions were well understood by the great majority of patients. 11/126 (8.7%) had a dental procedure in the past 6-months, 13/126 (10.3%) were advised to stop smoking. Whereas 20/126 (20.6%) had associated comorbidities. Risk stratification led to the advice to start oral bisphosphonates/ denosumab rather than IV zoledronate for patients at moderate risk (comorbidities, personal, medication). Treatment was postponed till complete healing for those with recent history of invasive dental procedure (high risk). No ONJ was identified after 5-years of follow up.

Conclusion:

Results of this questionnaire revealed that the ONRAQ is valid screening questionnaire. It can be implemented, as a risk minimisation measure, in standard practice. The questionnaire was able to identify patients at risk of developing medication related osteonecrosis of the jaw and facilitate the prospective risk management of ONJ.

Disclosure of Interests:

None declared.

THU0471 VITAMIN D SUPPLEMENTATION; IS IT EFFECTIVE IN FIBROMYALGIA PATIENTS?

Background:

Fibromyalgia syndrome (FMS) is a chronic pain syndrome which presented by easy fatigability, widespread body pain, anxiety and tenderness points on specific anatomic regions. Fibromyalgia may be risk factor for vitamin D deficiency because of pain, poor mobility, or depression, potentially leading to less time of sun exposure or high rates of adiposity leading to decreased synthesis of vitamin D & there are conflicting results on the role of vitamin D in improving chronic nonspecific musculoskeletal pains1, 2.

Objectives:

Assessment of the effectiveness of vitamin D supplements as adjuvant therapy in functional status, quality of life and psychological status in fibromyalgia patients with vitamin D insufficiency.

Methods:

One hundred adult patients of primary FMS (according to the 2010 ACR criteria for FMS) associated with vitamin D insufficiency (21-29 ng/mL) were selected to participate in this study. Patients with secondary FMS were excluded; also we excluded patients with any psychiatric disorders and patients who had other chronic diseases interfering with calcium, phosphorus, and vitamin D metabolism. After written consent; the patients were randomly divided into 2 equal groups; group I received duloxetine (60 mg once daily for 6 months) plus 50,000 unit oral cholecalciferol weekly for 8 weeks then monthly for 16 weeks. Group II received duloxetine (60 mg once daily for 6 months) plus placebo. The patients were assessed at baseline and after 6 months of treatment by measuring serum levels of 25(OH)D, Fibromyalgia Impact Questionnaire (FIQ), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) & Hospital Anxiety and Depression Scale (HADS).

Results:

Eighty six patients completed this study. There was no significant difference between all groups in demographic data, educational status and all baseline variants except serum levels of 25(OH) D. After 6 months; there was significant improvement (P<0.05) in group I in serum levels of 25(OH) D. There was significant improvement (P<0.05) after 6 months in FIQ, SF-36 and HADS in both groups. There was significant better improvement (P<0.05) in group I than in group II in FIQ, SF-36 and HADS. The results of the study are summarized in table 1.

Table 1.

Pre- and post-treatment assessment measures of the patient groups

assessment measuresBaselineBaselineAfter 6 monthsAfter 6 monthsGroup IGroup IIGroup IGroup II25(OH)D25.3 ± 4.9 ng/ml26.8+5.3 ng/ml36.8+3.9 ng/ml25.6 ± 3.4 ng/mlFIQ47.5±5.446.7±6.727.5±6.138.5±7.3SF-36 (Total score)47.6±10.447.0±9.961.0±5.854.8±5.3HAD anxiety8.2±0.68.4±0.37.1±0.77.5±1.4HADS depression8.6±0.38.6±0.97.3±0.87.7±1.4

Conclusion:

Vitamin D supplement is effective as an adjuvant therapy in improving functional status, quality of life and psychological status in fibromyalgia patients with vitamin D insufficiency.

References:

[1]Abd Elghany S E et al, Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. Journal of Back and Musculoskeletal Rehabilitation -1 (2018) 1–8

[2]Maria Helde-Frankling, Linda Björkhem-Bergman. Vitamin D in Pain Management. Int. J. Mol. Sci. 2017, 18, 2170

Disclosure of Interests: :

None declared

THU0322 EFFECTIVENESS OF COMBINED LOCAL COLCHICINE AND STEROIDS IN ORAL ULCERS OF BEHÇET’S DISEASE

Background:

Behçet’s disease (BD) is a chronic, multi-system vasculitic disease. It is characterized with relapsing episodes of oro-genital ulcers accompanied by cutaneous lesions, ocular symptoms, arthropathy, vascular thrombosis, central nervous system, gastrointestinal & cardiopulmonary involvements. Oral ulcers are frequently the first disease manifestationOral and genital ulcers cause pain and interfere with the quality of life. They may lead to difficulty in swallowing and walking. Most of them can be managed with topical glucocorticoids. Up till now there is no study discussed the effect of combined local therapy on oral ulcers in BD.1,2

Objectives:

To evaluate the effectiveness of combined local therapy (colchicine, steroid, antibiotic and anesthetic) on oral ulcers in BD

Methods:

This study included 44 Patients who had Behçet’s disease (according to International Study Group criteria) with active oral ulcers (at least three times in the previous 12-month period) Patients were excluded if they had active major organ involvement in the last 6 months. Patients with depilating diseases also were excluded.

Patients were randomly divided into two equal groups; group I received combined local therapy (lidocaine HCL 2.0% gel mixed with grinded tablet of 5 mg prednisone and grinded tablet of 0.6 mg colchicine). Group II received combine local therapy (lidocaine HCL 2.0% gel mixed with grinded tablet of 5 mg prednisone). Local treatments were applied to the lesions 3 times per day until healing of the ulcer (advised not to eat or drink for 30 minutes after application). All other topical medications were stopped during this study.

All patients were assessed with Oral ulcer severity score (OUSS), Behçet’s Disease Quality of Life score (BD-QoL), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) at baseline and after 24 weeks.

Results:

Thirty eight patients had completed this study; (20 in Group I & 18 in Group II). There were no significant differences between the 2 groups in both demographic data &educational status. At baseline there was no significant difference between both groups regarding all assessment measures. There was significant improvement (P<0.05) in both groups regarding OUSS, BD-QoL, SF-36 after 24 weeks. There was significant better improvement (P<0.05) in group I than in group II in all assessment measures (except ulcer free periods and sites). The results of the study are summarized in table 1 & figure 1.

Table 1.

A comparison of the individual ulcer characteristics in both groups at baseline and after 24 weeks

UlcercharacteristicsGroup I baselineGroup II baselineGroup I after 24 weeksGroup II after 24 weeksNumber13.6 ±3.512.9 ±2.38.2 ±1.5*¶10.3 ±1.7*Size11.8 ±3.312.5 ±2.47.6 ±1.8*¶9.6 ±1.2*Duration6.7 ±1.16.6 ±1.74.5 ±1.9*¶5.5 ±1.3*Ulcer-free period4.7 ±0.95.1 ±1.55.7 ±1.1*5.9 ±0.7*Pain8.7 ±1.28.6 ±1.45.3 ±1.5*¶6.7 ±1.1*Site4.9 ±0.85.1 ±1.23.8 ±0.6*4.2 ±0.9*

*Significant improvement after 24 weeks of the study

¶Significant difference between the two studied groups

Conclusion:

Combined local therapy (colchicine, steroid, antibiotic and anesthetic) is an effective method in management of oral ulcers in BD.

References:

[1]Taylor J, Glenny AM, Walsh T, et al. Interventions for the management of oral ulcers in Behçet’s disease (Review). 2014;(9):CD011018.

[2]Hatemi G, Mahr A, Ishigatsubo Y et al. Trial of Apremilast for Oral Ulcers in Behçet’s Syndrome. N Engl J Med. 2019; 381(20):1918-1928.

Disclosure of Interests:

None declared

THU0485 THE EFFECT OF PERINEURAL INJECTION THERAPY IN PERIARTHRITIS SHOULDER

Background:

Primary adhesive capsulitis of the shoulder is a common pathology of the glenohumeral joint characterized by shoulder pain and progressive restriction of the range of motion,its treatment options either medication, local injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic and open capsular release1.

Subcutaneous prolotherapy injections can reduce vascular endothelial growth factor levels and restore effective repair processes so induce apoptosis of proliferating peptidergic noceffectors and neovessels and inhibit TRPV1 receptors resulting to reduction of pain2,3.

Objectives:

To assess the effectiveness of perineural injection therapy in management of pain and physical function in Primary adhesive capsulitis of the shoulder.

Methods:

One hundred patients with primary adhesive capsulitis in the freezing stage were selected in this study according to the classification of Hannafin and Chiaia and had restriction of passive motion of greater than 30°in 2 or more planes of movement. Patients with previous corticosteroid injection or previous surgery in the affected shoulder, secondary adhesive capsulitis including inflammatory or infectious arthritis,previous fracture, rotator cuff lesions were excluded from this study.

Ptients were randomly devided into two equal groups; Group I received 6 weekly subcutaneous injections of 0.5-1 ml of buffered dextrose 5% in each chronic constriction injury points and tender points at shoulder and along course of suprascapular, supraclavicular, axillary, musculocutanous and radial nerves. Group II received oral NSAIDs and muscle relaxants for 6 weeks. All patients in both groups received the same stretching and exercise therapy during the period of treatment. All procedures were done after informed consent. Assessments were performed at baseline, at the end of the treatment and after three and six months using visual analog scale (VAS) for pain, range of mvement measurements by goniometer, Shoulder Pain and Disability Index (SPADI) & the Western Ontario Rotator Cuff (WORC) Index.

Results:

Patients in Group I had more rapid relief of pain and better functional improvement compared with group II (p<0.05). There was significant improvement in both groups (p<0.05) after 3 and 6 months with significant difference between the 2 groups indicated that better results in perineural group. Results were summarized in table 1.

Baseline GIBaseline GIIAfter end of treatment GIAfter end of treatment GIIAfter 3ms GIAfter 3ms GIIAfter 6ms GIAfter 6ms GIIVAS8.7±0.98.4±1.05.0±1.5*¶5.7±1.1*4.4±1.5*¶5.1±1.6*3.8±1.2*¶4.9±1.3*SPADI80.4±9.878.9±10.741.5±10.2*¶50.4±8.8*35.8±7.5*¶46.6±7.9*32.6±10.2*¶44.5±8.7*WORC28.5±10.626.5±11.560.4±9.8*¶55.9±10.5*67.9±9.7*¶57.3±10.3*71.5±12.3*¶60.1±9.6*

*significant improvement after treatment

¶significant difference between the two studied groups

Conclusion:

Perineural injection therapy is an effective modality in management of pain and physical function of Primary adhesive capsulitis of the shoulder.

References:

[1]Franz A, Klose M, Beitzel K. Conservative treatment of frozen shoulder. Unfallchirurg. 2019;122(12):934-940.

[2]Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain. Australasian Musculoskeletal Medicine. 2007; 12(2):110-112

[3]Abu-Zaid MH, Tabra SA, Elmorsy S. FRI0687 Effect of perineural injection therapy in moderate and severe knee osteoarthritis; a comparative study. Annals of the Rheumatic Diseases 2018;77:862-863.

Disclosure of Interests: :

None declared

THU0466 EARLY DIAGNOSIS IS ASSOCIATED WITH LESS DISEASE SEVERITY AND BETTER OUTCOME IN FIBROMYALGIA SYNDROME: A TRICENTRIC PROSPECTIVE ANALYSIS OF A COHORT OF 370 PATIENTS

Background:

Delayed diagnosis of fibromyalgia (FM) has been reported to be associated with more economic burden, healthcare utilization and worse response to treatment1,2. However, its impact on the patients’ symptomatology and disease severity is still underestimated.

Objectives:

to evaluate the effect of diagnostic delay (DD) on FM severity and disease assessment parameters.

Methods:

in this cross sectional study, 370 FM patients were prospectively interviewed. Information about DD, widespread pain index (WPI), symptom severity scale (SSS), total severity scale (SSS+WPI) and number of tender points were collected. We proposed to classify our patients into 3 categories; early diagnosis (ED ≤ 2 years; 83 patients), late diagnosis (LD: >2-7 years; 198) and very late diagnosis (VLD >7 years; 89 patients).

Results:

the mean age of patients was 33.9 (±9.8) and 79.4 % were female. The mean for DD was 5.6 (±3.6) while the means for SSS, total scale and tender points were 7.8 (±1.6), 16.46 (±4.1), 14.31 (±2.3) respectively. A significant correlation has been found for DD with SSS (r = 0.14), total scale (r = 0.37) and tender points (r = 0.16) but not with WPI (r = 0.059).

Comparing the three categories, the mean for SSS was 7.54 (±1.6), 7.73 (±1.4) and 8.25 (±1.7) in the groups of ED, LD and VLD respectively (P =0.008) while the mean for the total scale was 15 (±3.8), 15.95 (±3.8) and 18.96 (±4.4) respectively (P = 0.000) and the mean for tender points was 13.7 (±2.3), 14.35 (±2.1) and 14.77 (±2.8) respectively (P = 0.011). The mean for WPI did not significantly differ as it was 7.45 (±2.8), 7.8 (±3.6) and 7.18 (±4.8) in the groups of ED, LD and VLD respectively (P = 0.415).

Conclusion:

early diagnosis of FM is associated with low SSS, total severity scale and tender points reflecting a better outcome and a less disease severity.

References:

[1]Hughes G, Martinez C, Myon E, Taïeb C, Wessely S: The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice.Arthritis Rheum 2006, 54(1):177-83.

[2]Choy et al., A patient survey of the impact of fibromyalgia and the journey to diagnosis BMC Health Services Research 2010, 10:102.

Disclosure of Interests: :

None declared

The role of microalbuminuria as a predictor of subclinical cardiovascular events in rheumatoid arthritis patients and its relation to disease activity

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects many body tissues and leads to major morbidity and mortality. Renal disease in RA is clinically important because it restricts the management of primary disease and increases mortality. The objectives of this study are to (1) investigate the difference between RA patients with and without microalbuminuria (MAU) and (2) find out the relation between MAU and disease activity as well as subclinical cardiovascular effects. Ninety RA patients were divided into two groups according to the presence of MAU, in addition to 30 healthy volunteers. ESR, hs-CRP, RF, lipid profile, urinary microalbumin, GFR, renal function tests, carotid intima media thickness (cIMT), flow-mediated dilatation of the brachial artery (FMD), ECG, and echocardiographic examination were performed for patients and controls. MAU positive RA patients revealed significantly higher lipid profile, ESR, hs-CRP, DAS 28, cIMT, and lower FMD as well as ECG and echocardiographic abnormalities compared to MAU negative RA patients. Moreover, there was significant positive correlation between MAU and DAS28, hs-CRP, LDL, cIMT as well as negative correlation with FMD%. In our study, all RA patients with MAU had a normal serum creatinine concentration and gave a negative result with Albustix. MAU is significantly correlated with ESR, hs-CRP, lipid profile, cIMT, and FMD% in RA patients; therefore, it can be used as an index to measure disease activity as well as subclinical cardiovascular affection in RA patients.