Assessment Tools for Pulmonary Involvement in Patients with Ankylosing Spondylitis: Is Diaphragmatic Ultrasonography Correlated to Spirometry?

Objective

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease that can lead to spinal ankylosis and consequently, restrictive pulmonary dysfunction. Thus, the present study aimed to assess the accuracy of diaphragm ultrasound compared to spirometry in the screening of restrictive pulmonary disorders in radiographic SpA patients.

Methods

We conducted a cross-sectional study of 50 patients with radiographic SpA, over six months. Sociodemographic data, clinical characteristics of the disease, as well as biological, radiological, and therapeutic data, were collected. Spirometry and diaphragm ultrasound were performed.

Results

The mean age of the study participants (N= 50) was 42.7±11 years [range: 25-66] with male predominance (N= 41). Spirometry showed a restrictive disorder in 32% of cases. The mean chest expansion (CE) value was 3.9±1.81cm [range: 1-9] with a median of 4 cm. A pathological value (<5cm) was observed in 72% of cases. A significant positive correlation was found between the right inspiratory diaphragmatic thickness and forced vital capacity (FVC) (r= 0.36; p = 0.02) and the supine FVC (r=0.29; p = 0.04). The left inspiratory diaphragmatic thickness was correlated with the percentage of the FVC decrease (r= 0.35; p = 0.01) defined as the percentage of difference between FVC and supine FVC. The right expiratory diaphragmatic thickness was associated with the FVC (r=0.32; p = 0.02). A significant positive correlation was found between the CE and the presence of B lines (r=0.32; p = 0.02), but not between the CE and the FVC.

Conclusion

The present study showed that diaphragm ultrasonography is correlated with spirometric findings in radiographic SpA patients. Further studies are required to assess its reliability, specificity, and sensitivity in this pathology.

Factors associated with hip involvement in spondyloarthritis: a retrospective study

BACKGROUND

Hip involvement is a life-changing event during spondyloarthritis (SpA) since it's responsible for significant disability and functional impairment. This study aimed to determine the factors associated with hip involvement in patients with SpA.

METHODS

This was a retrospective study, including patients with axial and/or peripheral SpA divided into two groups: patients without and with hip involvement. Hip involvement was defined as pain or abnormality on clinical examination of the hip and/or on imaging. We collected clinical and laboratory data, activity and functional scores, and radiographic parameters. We conducted a multivariate analysis to identify the associated factors of hip involvement.

RESULTS

We included 165 patients with a mean age of 46.13 ± 13.07 years, 121 patients were male. The mean duration of disease was 10.91 ± 6.94 years. Hip involvement, defined as SpA-related hip pain, joint limitation, and dysfunction and/or imaging involvement (X-ray/MRI), was noted in 60 cases (36.4%). Multivariate analysis indicated that disease duration over 10 years (OR=3.847, 95% confidence interval (CI95%)[1.324-11.178], p=0.013), radiographic sacroiliitis (OR=8.949, CI95%[1.261-63.513], p=0.028), very high disease activity (Ankylosing Spondylitis Disease Activity Score: ASDASCRP≥3,5) (OR=9.364, CI95%[2.552-34.352], p=0.001), higher Bath Ankylosing Spondylitis Functional Index (BASFI) (OR=1.439, CI95%[1.120-1.850], p=0.004) and higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (OR=1.311, CI95%[1.065-1.615], p=0.011) were independently associated with hip involvement in these patients. Regarding extra-articular features, we found that pulmonary involvement and osteoporosis were significantly more frequent in patients with hip involvement, but neither retained significance in multivariate analysis.

CONCLUSION

Disease duration over 10 years, radiographic sacroiliitis, very high disease activity, functional impairment, and limited spine mobility were potential associated factors with hip involvement. Patients with these factors should be closely monitored to detect hip involvement at an early stage.

AB0195 PLATELET TO LYMPHOCYTE RATIO: A BIOMARKER OF STRUCTURAL DAMAGE IN RHEUMATOID ARTHRITIS

Background

A regular monitoring of structural damage in patients with rheumatoid arthritis (RA) is necessary to adjust the treatment. However, the rhythmicity of new radiographs to assess the structural damage is not codified. There is no biomarker able to reflect structural damage.

Objectives

Our study aimed to assess the relationship between the modified Sharp score and the platelet to lymphocyte ratio.

Methods

We performed a cross-sectional study including 53 patients with RA. A cell blood count was performed for each patient, and PLR was calculated. Modified Sharp score and its components (erosion score and joint space narrowing score) were evaluated using the radiograph of hands and feet.

Statistical analysis was performed using SPSS (Statistical Package for Social Sciences).

Results

Of the 53 patients, 39 were female (Sex Ratio: 2.8). The mean age was 53.9 ± 12.7 years. The mean age of the onset of the disease was 43.8±13.5 years. The mean disease duration was 10.1 ± 8.2 years. The mean DAS 28-ESR score was 4.64 ± 1.23.

The mean value of PLR was 161.62 ± 86.59. The mean modified Sharp score was 46.33 ± 37.74. Thirty-two percent of patients had a modified Sharp score greater than 50. The mean scores of joint erosion and joint space narrowing were 12.76 ± 15.05 and 33.57 ± 25.80.

Modified Sharp score was correlated to the PLR (r: 0.501; p <10-3).

Moreover, joint space narrowing score and joint erosion score were correlated to the PLR (r: 0.558; p <10-3 and r: 0.299; p: 0.033, respectively).

Patients with a modified Sharp score ≥ 50 had a higher PLR (203.12 ± 101.71 versus 142.33 ± 74.07).

As shown in Figure 1, the ability of PLR to distinguish patients with a modified Sharp score ≥ 50 was good with an AUC of 0.704 (p= 0.021) with a cut-off of 130.5 (sensitivity=75%, specificity=65.7%).

Figure 1.

ROC curve assessing the ability of PLR to distinguish patients with a modified Sharp score ≥ 50

Conclusion

Our study showed that the modified Sharp score correlated with PLR, which ​​can be useful to distinguish patients with severe structural damage with a cut-off of 130.5. This finding suggests that this ratio is a reliable marker to reflect radiographic joint damage.

Disclosure of Interests

None declared

AB0860 Repercussions of tobacco on spondyloarthritis: the Iceberg effect!

Background

The deleterious effect of smoking is frequently studied in inflammatory diseases such as spondyloarthritis (SA) [1].

Objectives

The objective of our study was to identify the consequences of smoking during AS.

Methods

We conducted a cross sectional study including patients followed for spondyloarthritis meeting the ASAS 2009 criteria. For each patient we collected the following parameters: age, age at onset of the disease, duration of progression, disease activity using BASDAI and ASDAS-CRP scores and structural damage using BASRI and mSASSS scores. We also measured sedimentation rate (ESR) and C-reactive protein (CRP).

Statistical analysis was performed using SPSS software.

Results

We included 140 patients. Seventy-three percent were male (n=102). The mean age was 43 ± 12.9 years. The age of onset of the disease was 34.28 ± 12 years. The mean disease duration was 110 ± 107.8 months.

Sixty patients were smokers (43%) at an average of 20.75 ± 16.09 pack-years.

Mean ESR and CRP were 36.49 ± 27.22 mm and 29 ± 44.27 mg/L, respectively.

The mean BASDAI and ASDAS-CRP were 3.68 ± 1.86 and 2.99 ± 0.98, respectively.

The mean BASRI and mSASSS were 4.12 ± 3 and 10.26 ± 15.41, respectively.

Smokers had significantly higher BASRI and mSASSS scores (BASRI: 5.02 ± 3.32 vs 3.47 ± 2.6; p=0.005 and mSASSS: 14.07 ± 17.56 vs 7.02 ± 12 .62; p=0.03).

In addition, the number of packets year was correlated to mSASSS (r=0.399; p=0.01).

On the other hand, we did not find any association between smoking and the following parameters: ESR, CRP, BASDAI or ASDAS-CRP.

Conclusion

As reported in other studies, ours’ showed that structural damage was correlated with the number of pack-years [2]. Smoking was associated with this structural damage in SA regardless the inflammatory biomarkers and the disease activity. This suggests that control of structural damage in SA requires smoking cessation.

References

[1]Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology. 1 juill 2020;59(7):1472‑81.

[2]Wendling D, Prati C. Spondyloarthritis and smoking: towards a new insight into the disease. Expert Rev Clin Immunol. juin 2013;9(6):511‑6.

Disclosure of Interests

None declared

AB1336 EFFECTS OF MUSLIM PRAYER ON LOWER LIMB ENTHESIS ULTRASOUND

Background

Muslim prayer, also known as salat, includes a series of postures and movements, concomitant with a spiritual meditation and Quran recitations, performed at least 5 times a day by Muslim worshipers [1]. Each prayer includes a specific number of rakaa which consists of a single iteration of movements [2].

Objectives

We aim to assess the effects of the Muslim prayer movements on the lower limb entheses, using ultrasonography (US).

Methods

We performed a cross-sectional study including asymptomatic healthy individuals. Each subject was asked if they performed prayer (G1) or not (G0). People who performed prayer were asked about the age and year when they started praying, number of rakaa performed daily and duration of each rakaa. US of lower limb entheses was performed. We explored the entheses of quadricipital tendon (QT), proximal patellar tendon (PPT), distal patellar tendon (DPT), calcaneal tendon (CT), and plantar aponeurosis (PA) looking for thickening, hypoechogenicity, loss of fibrillar pattern, presence of doppler signal and structure damage lesions (calcifications, cortical irregularity, erosions and enthesophytes). The highest value of enthesis thickness of both sides was considered.

Ultrasonographic enthesitis assessment tools were used: the Spanish Enthesitis Index (SEI) [3] and the Glasgow Ultrasound Enthesitis Scoring System (GUESS) [4]. Data analysis was performed using the IBM SPSS software version 26.

Results

A total number of 370 entheses was evaluated. There were 29 males (78%) and 8 females. The mean age was 44.73±12.7 years. Twenty-five subjects (68%) practice prayer. The mean prayer starting age of 28.58±13.345 years. The mean number of years since prayer was started of 20±16.32 years. The mean daily number of rakaa was 19.16±4.16. The mean total daily prayer duration was 35.28±65.58 minutes.

The mean enthesis thickness was 5.98±0.72 mm (QT), 3.69±0.48 (PPT), 4.1±0.64 (DPT), 4.83±0.62 (CT) and 4.89±0.75 (PA). Structural damage lesions were found in 43.2% of subjects (QT), 8.1% (PPT), 13.5% (DPT), 64.9% (CT) and 21.6% (PA).

Structure damage lesions of CT enthesis were significantly more frequently found in people who performed prayer (G0: 41.6%, G1: 76%, χ2=4.194, p=0.041). Furthermore, they are significantly more likely to have thickened PA enthesis (G0: 50%, G1: 84%, χ2=4.752, p=0.029).

The mean SEI was 17.83 in G0 and 19.56 in G1, p=0.647. The mean GUESS was 18.29 in G0 and 19.34 in G1, p=0.781. A positive correlation was found between total daily duration of prayer and PPT enthesis thickness (r=0.575, p<10-3), DPT enthesis thickness (r=0.362, p=0.028), SEI (r=0.360, p=0.026) and GUESS (r=0.388, p=0.018). Thickness of PPT enthesis was also positively correlated to the number of years since prayer was started (r=0.036, p=0.026).

Conclusion

Our study showed that lower limb enthesis US abnormalities are frequent in asymptomatic and healthy subjects who perform Muslim prayer. This finding suggests that lower limb enthesis US should be carefully interpreted in these subjects.

References

[1]AlAbdulwahab SS, Kachanathu SJ, Oluseye K. Physical Activity Associated with Prayer Regimes Improves Standing Dynamic Balance of Healthy People. J Phys Ther Sci. 2013 Dec;25(12):1565–8.

[2]Kamran G. Physical benefits of (Salah) prayer - Strengthen the faith & fitness. Journal of Novel Physiotherapy and Rehabilitation. 2018 May 29;2(2):043–53.

[3]Alcalde M, Acebes JC, Cruz M, González-Hombrado L, Herrero-Beaumont G, Sánchez-Pernaute O. A Sonographic Enthesitic Index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis. 2007 Aug;66(8):1015–9.

[4]Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002 Oct;61(10):905–10.

Disclosure of Interests

None declared

AB1004 CONTRIBUTION OF DRY REHABILITATION VERSUS BALNEOTHERAPY IN THE CONTROL OF PAIN TRIGGERS IN GONARTHROSIS

Background

Gonarthrosis is a very common condition and a real public health problem [1]. One of the pillars of its management is pain management. In addition to drug treatment, rehabilitation is part of the therapeutic arsenal.

Objectives

The main objective of our work was to compare the contribution of balneotherapy versus dry rehabilitation in the control of pain triggers.

Methods

We carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis (KOA) was made according to the criteria of the ACR [2].

The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a standard rehabilitation program. The second group, called G2, received water gymnastics. Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of KOA was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

Pain was triggered by standing in 92% of cases in G1 versus 98% in G2 with a mean delay of 17.2 min for G1 and 20.1 min for G2. There was no statistically significant difference between the two groups (p=0.452). After rehabilitation, 22% of the patients in G1 and 43% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).

Prolonged sitting in 62% of cases in G1 versus 38% in G2 with a mean delay of 6.2 min for G1 and 52.3 min for G2 awakened pain. There was a statistically significant difference between the two groups (p=0.02). After rehabilitation, 23% of the patients in G1 and 30% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).

Pain was awakened by squatting in 93% of cases in G1 versus 97% of G2. There was no statistically significant difference between the 2 groups (p=0.554). After rehabilitation, 13% of the patients in G1 and 30% in G2 had noted a complete disappearance of pain with a statistically significant difference between the 2 groups (p=0.001).

All patients in G1 and 92% of patients in G2 reported pain when climbing/descending stairs. There was no statistically significant difference between the 2 groups. An improvement in symptomatology was noted in both groups with disappearance of pain in 18% of G1 and 27% of G2.

An adjustment on the parameters by which the 2 groups differed was made without impact on the results obtained.

Conclusion

Rehabilitation has an important role in the control of pain triggers by ensuring, in addition to analgesic means, good muscle balance, joint gain and good proprioception. Balneotherapy has proven to be more effective.

References

[1]Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5-15.

[2]Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-49.

Disclosure of Interests

None declared

AB0842 Foot entheses ultrasound in spondyloarthritis: a case control study

Background

Foot entheses involvement is a common manifestation of spondyloarthritis (SpA). It can be responsible for functional impairment. The superiority of ultrasound (US) examination in foot entheses damages detection has been reported [1].

Objectives

We aimed to compare the US findings of foot entheses between SpA patients and asymptomatic healthy control subjects.

Methods

We conducted a cross-sectional study including 37 SpA patients (G1) fulfilling ASAS criteria for Axial SpA and 37 healthy subjects (G0) matched by age and gender. Demographic and clinical characteristics were collected. A blind US of foot entheses was performed by Mindray DC-70 equipment with a 6-16 MHz linear probe. Calcaneal enthesis (CT) and plantar fascia (PF) were examined bilaterally. A total of 296 entheses were assessed.

In G1, disease activity was evaluated using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS).

Statistical Package for Social Sciences (SPSS) was used for analysis.

Results

The study included 58 men and 16 women. The mean age was 44.6 ± 12.3 years. In G1, the mean disease duration was 108.2±94 months. The average BASDAI was 4.5±2.2. The average ASDASCRP was 3.2±1.3. In G1, clinical examination showed tenderness at the posterior insertion of the CT or inferior insertion of PF in 16.2% of patients.

However, US lesions of the CT were found in 97% of cases in G1 and 67.6% in G0, p:0.001. US lesions are presented in Table 1.

Table 1.

Elementary US lesions in SpA and healthy control groups

EnthesisG1 (n (%))G0 (n (%))pCalcaneal tendonThickness15 (40.5)6 (16.2)0.02Erosion9 (24.3)1 (2.7)0.007Enthesophyte29 (78.4)20 (54)0.03Calcification14 (37.8)10 (27)0.32Bursitis4 (10.8)3 (8.1)1PD signal10 (27)00.001Plantar fasciaThickness30 (81.1)27 (73)0.4Erosion11 (30)1 (3)0.002Enthesophyte12 (32.4)2 (5.4)0.003Calcification18 (48.6)6 (16.2)0.003PD signal11 (30)0<0.001

G0: control group, G1: Spondyloarthritis group, PD: power doppler

Calcaneal tendon thickness was noted in 40.5% in G1 and 16.2% in G2 (p=0.02). Hypo-echogenicity and loss of normal fibrillar structure were more frequent in G1 (86.5% versus 29.7%, p<0.001). Structural damage lesions were found in 89.6 % in G0 (n= 33) and 64.9% in G1 (n=24), p=0.01. In the PF, US structural damage lesions were significantly more frequent in the SpA patients (70% versus 21.6%, p<0.001).

Vascularity at power Doppler was significantly more frequent in G1 (p=0.001 in CT and p<0.001 in PF).

In G1, the disease activity was higher in patients with structural damage lesions of the CT (ASDAS CRP: 3.2 versus 1.9; p=0.01). However, there was no associations between vascularity at power Doppler and high disease activity (p=0.47).

Conclusion

Our study showed that the US lesions of the heel entheses were frequent in SpA patients compared to healthy control. Moreover, US can reveal enthesitis even in asymptomatic patients.

The disease activity was higher in patients with US structural damage lesions of the CT.

References

[1]De Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009; 68(2):169-74.

Disclosure of Interests

None declared

AB1499 PAIN MANAGEMENT IN KNEE OSTEOARTHRITIS: BALNEOTHERAPY VERSUS CLASSIC REHABILITATION

Background

Knee osteoarthritis presents a heavy financial burden due to disability and supported care. Gonalgia is the main symptom leading patients to consult. For some clinicians, this is a warning signal that correlates with the extent of joint degradation [1]. The management of pain in knee osteoarthritis is multidisciplinary comprising pharmacological and non-pharmacological means including classical rehabilitation and aquatic gymnastics.

The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis.

Objectives

The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis.

Methods

Prospective, evaluative and comparative study about 120 patients with knee osteoarthritis carried out over 15 months (September 2016- December 2017) in the Department of Physical Medicine and Functional Rehabilitation.

The patients were divided into two groups of 60. The first group (G1) benefited from a classic rehabilitation program, the second group (G2) benefited from aquatic gymnastics.

The 2 programs were carried out at the rate of three sessions per week for two months. The study was based on the assessment of pain by the following scales: VAS pain and the Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC) questionnaire for the lower limbs (pain section).

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

The pain was mechanical in 89 % of cases. Positional nocturnal pain was noted in 72% of cases. Hydarthrosis was associated in 46% of cases. A daily intake of palliative I analgesics was noted in 56 % of patients.

The mean pain VAS at rest of 33.4±18 in G1 vs 27.3±23.2 in G2 (p=0.13). On exertion, it was 72.3±19 in G1 vs 83.3±20 in G2 (p = 0.72).

After the rehabilitation treatment, an improvement in the two groups was objectified, which was significantly more marked in G2:

Resting VAS improved by 57 % for G1 and by 84% for G2 (p = 0.015). Exercise VAS improved 20% in G1 and 43% in G2 (p <0.001).

The mean WOMAC pain score was 14.3 in G1 and 10.3 in G2 (p = 0.006).

There was an improvement in the WOMAC pain score of 24% in G1 and 58% in G2 (p <0.001).

Conclusion

Functional rehabilitation in the water or in the dry has a marked effect on pain in gonarthrosis patients. The aquatic environment can also bring many benefits on pain by lightening the weight of the body and the analgesic effect of the heat.

References

[1]Trouvin A-P, Perrot S. Douleur dans l’arthrose : comprendre les mécanismes pour améliorer la prise en charge. Revue du Rhumatisme. 2018 Jun;85(4):324–30.

Disclosure of Interests

None declared

AB0790 Effects of physical activity on disease activity and clinical enthesitis scores in patients with spondyloarthritis

Background

Regular physical activity (PA) highly recommended for patients with inflammatory diseases [1]. It was shown to significantly improve disease activity [1]. However, data regarding the effects of physical activity on disease activity and clinical enthesitis scores in patients with SA are scarce.

Objectives

We aim to assess the effects of performing PA on disease activity and clinical enthesitis scores in patients with SA.

Methods

We performed a cross-sectional study including patients with axial spondyloarthritis. Each patient was asked if he performed regular physical activity. Clinical disease activity scores were calculated: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score using C-Reactive Protein (ASDAS-CRP). Clinical enthesitis scores were calculated: Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) [2], Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) [3] and Leeds Enthesitis Index (LEI) [4].

Results

Thirty-seven patients were included: 29 males and 8 females. The mean age was 44.51±12.08 years. The mean disease duration of 9±7.8 years. Regular PA was reported by 51% patients (19). Aerobic exercise was performed by 48.6% of patients (walking: 27%, jogging: 8.1%, football: 5.4%, biking: 2.7%, handball: 2.7% and fitness exercise: 2.7%). Anaerobic exercise was performed by only one patient (2.7%) and consists of weightlifting.

The mean weekly duration of PA was of 4.32±3.4 hours. Means BASDAI, ASDAS-CRP, and ASDAS-ESR were of 4.74±2.2, 3.02±1.2 and 3.26±1.3, respectively. Mean MASES was of 2.95±2.86, LEI of 1.51±1.72 and SPARCC of 2.97±3.42. Patients who performed regular PA had significantly lower disease activity evaluated with BASDAI (3.53 vs 5.45, p=0.007), ASDAS-CRP (2.64 vs 3.44, p=0.045) and ASDAS-ESR (2.84 vs 3.7, p=0.44).

Clinical enthesitis scores were also significantly lower in physically active patients (MASES: 1.74 vs 4.22, p=0.007, LEI: 0.95 vs 2.11, p=0.038, SPARCC: 1.79 vs 4.22, p=0.029).

However, no significative difference was found between the two groups regarding CRP (16.11 mg/L vs 39.67 mg/L, p=0.107).

No correlation was found between the weekly number of hours of PA and the evaluated scores.

Conclusion

Physical activity was associated with lower disease activity scores and lower clinical enthesitis score. This highlights the importance of physical activity as a non-pharmacologic treatment in SA for the management of disease activity and entheseal involvement.

References

[1]Osthoff A-KR, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases. 2018 Sep 1;77(9):1251–60.

[2]Heuft-Dorenbosch L, Spoorenberg A, Tubergen A van, Landewé R, Tempel H van der, Mielants H, et al. Assessment of enthesitis in ankylosing spondylitis. Annals of the Rheumatic Diseases. 2003 Feb 1;62(2):127–32.

[3]Maksymowych WP, Mallon C, Morrow S, Shojania K, Olszynski WP, Wong RL, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Annals of the Rheumatic Diseases. 2009 Jun 1;68(6):948–53.

[4]Gladman DD, Inman RD, Cook RJ, Maksymowych WP, Braun J, Davis JC, et al. International spondyloarthritis interobserver reliability exercise--the INSPIRE study: II. Assessment of peripheral joints, enthesitis, and dactylitis. The Journal of Rheumatology. 2007 Aug 1;34(8):1740–5.

Disclosure of Interests

None declared

AB0792 Hip involvement in spondyloarthritis: analysis of associated factors

Background

Hip involvement occurs in about one-third of patients with spondyloarthritis (SA) [1]. It can be responsible for significant disability and functional impairment.

Objectives

This study aimed to assess the associated factors with hip involvement in SA.

Methods

We conducted a cross-sectional study, including 165 patients with SA diagnosed according to Assessment of SpondyloArthritis international Society (ASAS) criteria over a period from 2017 to 2021. Demographic, clinical, biological and radiographic data were collected. We compared following parameters assessed at the time of diagnosis of coxitis: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Bath Ankylosing Spondylitis Radiology Index (BASRI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

We used logistic regression analysis to identify factors associated with hip involvement in SA.

Results

A total of 165 Patients were enrolled (121 men and 44 women), the mean age was 46.13 ± 13.07 years. The mean age of disease onset was 35.01 ± 12.55 years. The average diagnostic delay was 37.54 ± 50.51 months. The average disease duration was 10.91 ± 6.94 years.

Eighty seven percent of patients had axial spondyloarthritis, 72% had extra-articular manifestations.

Mean ESR and CRP values were 37.49 ± 28.1 mm and 30.14 ± 43.55 mg/L, respectively. Mean BASDAI and ASDAS-CRP values were 4 ± 1.8 and 3.09 ± 1.13, respectively.

Hip involvement was noted in 60 patients (36.4%). It was bilateral in 75% of cases (n=45). A total number of affected hips was 105.

Following parameters were significantly higher in patients with hip involvement: age over 40 years old (73.3 vs 56.3%, p=0.030), symptoms duration over 10 years (60% vs 40.2%, p=0.015), elevated CRP (87.9% vs 73.7%, p=0.036), radiographic sacroiliitis (95% vs 82.7%, p=0.023), frequency of pulmonary involvement (25.0% vs 11.4%, p:0.023), frequency of osteoporosis (20.0% vs 8.6%, p:0.034), BASMI (3.71 vs 1.65, p<0.001), BASRI spine (5.97 vs 2.91, p<0.001), and mSASSS (16.24 vs 5.80, p:0.001). However, no association was found between HLA-B27 and hip involvement (50% vs 28.6%, p=0.099).

A multivariable logistic regression model showed that age over 40 years (OR=2.688 [1.020 - 7.083], p=0.045), radiographic sacroiliitis (OR=5.656 [1.007 - 31.769], p=0.049), and very high disease activity (ASDAS-CRP≥3.5) (OR=5.328 [1.774 - 16.002], p=0.003) were independently associated with hip involvement in SA.

Conclusion

Our study showed that age, symptoms duration, radiographic sacroiliitis, extra-articular manifestations, axial structural damage, elevated CRP, and very high disease activity were associated with hip involvement. These finding suggest that the control of disease activity and inflammation may prevent the onset of hip involvement. There are controversial findings regarding the association between HLA B27 gene and hip involvement [2].

References

[1]Vander Cruyssen B, Vastesaeger N, Collantes-Estévez E. Hip disease in ankylosing spondylitis. Curr Opin Rheumatol. 2013 Jul;25(4):448-54.

[2]Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, Chou CT. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2011 Jun;40(6):552-8.

Disclosure of Interests

None declared

AB1500 ASSESSMENT OF CLINICAL PARAMETERS AFTER CLASSIC REHABILITATION VERSUS BALNEOTHERAPY IN GONARTHROSIS

Background

Knee osteoarthritis (KOA) is the most common pathology of the lower limb. It is multifactorial and constitutes a real public health problem. Nowadays, in addition to the rehabilitation that is part of the multidisciplinary management of this affection, water gymnastics is increasingly finding its place [1].

Objectives

The main objective of our work was to compare the contribution of aquatic gymnastics compared to classical rehabilitation in patients with knee osteoarthritis through a clinical evaluation.

Methods

This is a prospective, comparative and evaluative study carried out in a department of Physical Medicine and Functional Rehabilitation over a period of 15 months between September 2016 and December 2017, including 60 patients with KOA.

The patients were randomly divided into 2 groups of 60 patients each one. The first(G1) benefited from a classic rehabilitation program. The second(G2) benefited from water gymnastics. Two clinical evaluations were carried out: T1 before the start of rehabilitation and T2 at the end of the eight weeks of treatment.

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

55 patients presented with a misalignment of the lower limbs with a varus knee in 33% of cases (G1 25% and G2 42%). 5 patients in G1 and 7 patients in G2 had a valgus knee. In G1, one patient had recurvatum and two patient had knee flexum with no statistically significant difference between the two groups.

After classic rehabilitation, Zohlen’s sign had disappeared in 6 patients for the right knee and 3 patients for the left knee. However, after water gymnastics, this sign had disappeared in 12 patients for the right knee and in 16 patients for the left knee.

A functional mobility sector (>90◦) was found in all patients with an average of 120◦ in G1 and 126◦ in G2. After rehabilitation, an improvement of 2% in G1 and 5% in G2 was noted with a statistically significant difference between the two groups (p<0.001).

Thirty-sex percent of G1 patients had quadriceps amyotrophy versus 32 % of G2, which disappeared in 5 patients after classic rehabilitation and in 6 patients after hydrotherapy.

48 patients of G1 and 56 patients of G2 presented with quadriceps retraction which disappeared in 21 subjects of G1 after classic rehabilitation and in 45 subjects of G2 after hydrotherapy.

A retraction of the hamstrings was noted in 13 and 18 patients respectively in G1 and G2 with a total improvement in the 2 groups.

Conclusion

Dry rehabilitation has its place in the management of knee osteoarthritis, but rehabilitation in water has better results. The aquatic environment makes it possible, by reducing the weight of the body, to reduce the stresses exerted on the knee joints, allowing better joint mobility with the added effect of heat on the reduction of pain and muscle relaxation.

References

[1]Erika Ferreira Nascimento, Paulo Henrique Altran Veiga, Rogério Azevedo Antunes Pereira, Antônio Nery de Araújo Neto. Analysis of quality of life and function in the elderly with overweight gonarthrosis submitted to aquatic physical therapy. Geriatrics gerontology and aging. 2012;6(1).

Disclosure of Interests

None declared

AB1223 ACTIVE MILITARY ARE AT HIGHER RISK OF CHRONICITY IN LOW BACK PAIN: A CROSS SECTIONAL COMPARATIVE STUDY

Background

The incidence of low back pain (LBP) was 40.5 per 1,000 person-years in active military population and thus was comparable to the general population. Other than pain and disability, chronicity of LBP has a significant impact on work through the high rates of resulting sick leave. The Start Back Tool (SBT) questionnaire is a well-known tool used to detect patients with prognostic factors for persistent and disabling back pain. The risk of chronicity in individuals on active military duty suffering from acute back pain is yet to be explored.

Objectives

The aim of our study was to assess the risk of chronicity in active Tunisian military population compared to non-military controls using the SBT questionnaire.

Methods

Cross sectional study in which we enrolled adult patients suffering from acute back pain, who consulted the outpatient department of rheumatology in the military hospital of Tunis from January 2021 to Mars 2021. All patients had a standardized clinical examination. They completed the SBT questionnaire in the validated Arabic language version. Patients were stratified in two groups, active military group (AMG) and non-military group (NMG). Categorical variables were compared with the χ2 -test. Comparisons of the differences of continuous variables were performed by Student’s T-test.

Results

We included 54 patients in the active military group and 60 patients in the non-military group, epidemiologic characteristics were distributed respectively as followed: mean age was at 43+/-8 versus 53+/-13 years old (p<0.001), sex ratios (F/H) were 0.23 versus 3.62 (p<0.001), 54% versus 73% (p=0.033) of patients were overweight or obese, 4% versus 18% (p=0.014) of patients had type 2 diabetes, 4% versus 13% (p=0.099) of patients had dyslipidaemia while 9% versus 20% (p=0.108) of patients had hypertension.

Active military group patients had significantly higher proportions of high risk SBT scores than non-military patients 50% versus 22% (2.27 risk ratio 95% CI 1.47 to 3.08; p=0.002), with total mean of scores significantly higher in the active military group 5.81 (95% CI 5.33 to 6.29) versus 4.85 (95% CI 4.43 to 5.27), p=0.014.

Active military group patients scored significantly higher on the psychological SBT sub-score with a mean of 3.02 (95% CI 2.8 to 3.24) versus 2.38 (95% CI 2.07 to 2.7) p=0.032, they were more susceptible to express low mood 53% versus 35% (1.51 risk ratio 95%CI 1.13 to 1.89; p=0.044).

There was no significant difference in expressed anxiety 69% versus 55% (p=0.139), catastrophizing thoughts 57% versus 47% (p=0.252) and avoidance beliefs 72% versus 60% (p=0.170) though all of these parameters were more prevalent in the active military group.

Conclusion

Though NMG patients had more classic low back pain risk factors such as age and obesity, this did not prevent the AMG to show higher trends toward chronicity via SBT scores. This is to our knowledge the first study to assess the high risk of persistent disabling back pain using the SBT in a Tunisian military population. The implementation of risk stratification for patients with low back pain in routine military health may improve physical function and time off work, sickness certification rates and reductions in healthcare costs compared to usual non-stratified care.

Disclosure of Interests

None declared

AB1497 THE EFFECT OF AQUATIC REHABILITATION ON QUALITY OF LIFE IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background

In addition to its multiple functional, social and economic consequences, knee osteoarthritis is responsible for a significant deterioration in the quality of life (QOL)[1]. Studies examining the impact of osteoarthritis on quality of life have been made possible through the development of validated measurement questionnaires. The SF-12 score with its aspects (physical, mental and social) is a valid and reliable instrument for the assessment of QOL.

Objectives

The main aim of our study was to make a comparison between the contribution of aquatic rehabilitation and classic rehabilitation in patients with knee osteoarthritis using the SF-12 score.

Methods

We carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis was made according to the criteria of the ACR.

The patients were randomly divided into 2 groups of 60 patients each. The first group called G1 received a classic rehabilitation program. The second group called G2 benefited from aquatic gymnastics. The study was based on the SF-12 quality of life assessment. Two evaluations were made, the first (T1) before the start of rehabilitation and the second (T2) at the end of the eight weeks of care.

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

Initially, the mean of SF12-P in G1 patients was 31.2 ± 6.5 compared to 35.4±6.2 in G2 patients. In our patients, the SF12-P score was less than 50 in 100% of cases in G1 and in 98% of cases in G2. There was a statistically significant difference between the 2 groups (p = 0.04).

After classical rehabilitation, the SF12-P had increased on average by 2.3 against 6.1 after aquatic gymnastics with a statistically significant difference between the 2 groups (p = 0.012).

Initially, the mean of SF12-M in G1 patients was 32.5 ± 10.2 and 35.3 ± 8.9 in G2 patients. In our patients, the SF12-M score was less than 50 in 94% of cases in G1 and in 98% of cases in G2. There was no statistically significant difference between the 2 groups (p = 0.652).

After classical rehabilitation, the SF12-M increased on average by 6.9 and 12.1 after aquatic gymnastics with a statistically significant difference between the 2 groups (p = 0.005).

Conclusion

The effectiveness of functional rehabilitation, whether aquatic or dry, has been well demonstrated by the study of quality of life, with better results for balneotherapy. The physical properties of water and heat have a positive short-term impact on quality of life by acting on several parameters, including pain, contractures and anxiety. Further studies evaluating this long-term effectiveness will be required.

References

[1]Gabriel SE, Crowson CS, Campion ME, O’Fallon WM. Indirect and non-medical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol. 1997;24(1):43–8.

Disclosure of Interests

None declared

AB0861 Increased serum interleukin 8 levels in spondyloarthritis

Background

Physipathological mechanisms of spondyloarthritis (SA) are very complex. The role of the interleukin (IL)- 8, which is an angiogenic chemokine, has been suggested [1].

Objectives

We aimed to evaluate the discriminative value of interleukin 8 in SA.

Methods

We conducted a cross-sectional study during two years (2019-2020) including 144 subjects divided into two groups: a group G1 that included 72 patients followed for spondyloarthritis meeting the Assessement of SpondyloArthritis international Society (ASAS) criteria and a group (G2) including 72 healthy controls. The two groups were matched by age and sex.

IL-8 was measured for each participant using chemiluminescence.

We performed a ROC analysis and computed the air under the curve (AUC) at IL-8 to assess the ability of this chemokine to diagnose SA and to distinguish between SA patients from healthy controls. Statistical analysis was performed using SPSS.

Results

We included 57 men and 15 females in each group. The mean age was 44.84 ± 13.42 years. In G1, the mean disease duration was 10.25 ±7.7 years. Axial and peripheral involvements were found in 85% of cases (n=65) and 50% of cases, respectively.

The mean BASDAI and ASDAS-CRP were 3.21 ± 1.87 and 2.92 ±1.55, respectively.

IL-8 was able to distinguish SA patients from healthy controls with a cutoff of 4.5 pg/mL. The AUC was good at 0.855 (p<0.0001). The sensibility and the specificity were 92.8% and 81.6% (Figure 1).

Figure 1.

AUC at IL-8 between SA patients and healthy controls 0.855 (p<0.0001)

Conclusion

Several studies have found that IL-8 was significantly higher in SA patients comparing to controls [2,3]. Our study showed that IL-8 could distinguish SA patients from controls with a cutoff of 4.5 pg/mL. This suggests that IL-8 could play a role in the pathophysiology of SA.

References

[1]König A, Krenn V, Gillitzer R, Glöckner J, Janssen E, Gohlke F, et al. Inflammatory infiltrate and interleukin-8 expression in the synovium of psoriatic arthritis--an immunohistochemical and mRNA analysis. Rheumatol Int. 1997;17(4):159‑68.

[2]Limón-Camacho L, Vargas-Rojas MI, Vázquez-Mellado J, Casasola-Vargas J, Moctezuma JF, Burgos-Vargas R, et al. In vivo peripheral blood proinflammatory T cells in patients with ankylosing spondylitis. J Rheumatol. avr 2012;39(4):830‑5.

[3]Sonel B, Tutkak H, Düzgün N. Serum levels of IL-1beta, TNF-alpha, IL-8, and acute phase proteins in seronegative spondyloarthropathies. Joint Bone Spine. 1 oct 2002;69(5):463‑7.

Disclosure of Interests

None declared

AB1002 CLASSIC VERSUS AQUATIC REHABILITATION IN GONARTHROSIS: WOMAC SCORE

Background

Gonarthrosis is the most frequent and common condition of the lower limb, responsible for gonalgia, stiffness, leading sometimes to major functional impotence. The WOMAC with its three domains (pain, stiffness and function) is a valid index for the evaluation of lower limb osteoarthritis [1].

The management of gonarthrosis is multidisciplinary with rehabilitation as the mainstay.

Currently, aquatic gymnastics is more and more prescribed in the management of this pathology.

Objectives

The objective of our work was to compare the contribution of aquatic rehabilitation to classical one in patients with gonarthrosis through the WOMAC score.

Methods

This is a prospective, comparative study conducted over a period of 15 months, between September 2016 and December 2017, including 120 patients recruited at the Physical Medicine and Functional Rehabilitation Department of The HMPIT, in whom the diagnosis of gonarthrosis was made according to the ACR criteria.

The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a conventional rehabilitation program. The second group, called G2, received aquatic rehabilitation.

Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.

Results

The average age of the general population was 54.85 ± 9.5 years [40- 81 years].

The average age of G1 was 59.07 ± 10.2 years versus 50.63 ± 6.4 years for G2.

Among the 120 patients, 28 were male (23%) and 92 were female(77%) There were 6 males and 54 females in group 1 versus 22 males and 38 females in group 2.

Initially, the average WOMAC pain was 15.1 ± 3.9 in G1 and 12.3 ± 1.22 in G2.

There was a statistically significant difference between the 2 groups (p=0.01). After rehabilitation, there was an improvement in the WOMAC pain score of 17% in G1 and 50% in G2 with a statistically significant difference between the 2 groups (p<0.001).

The average WOMAC score for stiffness was initially 5.1 ± 2 in G1 and 3.2 ± 2 in G2 with no statistically significant difference between the 2 groups (p=0.076).

After rehabilitation, an improvement of this score was noted in both groups, it was 19% in G1 and 50% in G2 with a statistically significant difference between the 2 groups (p<0.001).

The average initial WOMAC function score was 42.32 ±15.7 in G1 and 33 ± 11 in G2 with a statistically significant difference between the 2 groups (p=0.002).

After conventional rehabilitation, this score had improved by 10% and after hydrotherapy, the improvement was 46% with a statistically significant difference between the 2 groups (p<0.001).

Conclusion

These results were aligned with the literature and confirmed the effectiveness of functional treatment whether aquatic or classic with better outcome for aquatic rehabilitation. The best would be to combine the different methods according to the needs of the patient and their functional capacities in order to ensure a better adherence.

References

[1]Guermazi M, Poiraudeau S, Yahia M, Mezganni M, Fermanian J, Elleuch MH, et al. Translation, adaptation and validation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for an Arab population. Osteoarthr Car- tilage. 2004;12(6):459-68.

Disclosure of Interests

None declared

AB1221 START BACK TOOL RISK SCORE: WHAT GUIDANCE TO GIVE IN A MILITARY LOW BACK PAIN POPULATION?

Background

The Keele start back Tool (SBT) is a 9-item self-reported questionnaire validated to identify individuals with non-specific low back pain (LBP) who have prognostic factors for persistent disabling pain. Thus, it is a useful component of stratified care, where patients’ prognostic subgroups are matched with appropriate treatment.

Objectives

The aim of our study was to report the prevalence of SBT-calculated risk for back pain disability in Tunisian military patients.

Methods

It was a cross sectional study. The SBT questionnaire was administered to patients > 18 years presenting with common low back pain in outpatient Military teaching hospital in Tunis, Tunisia (from January to Mars 2021). The normality of data distribution was checked by the Kolmogorov-Smirnov test. Quantitative variables were presented as mean ± standard deviation (SD) or median (interquartile range), as appropriate. The categorical variables were expressed as percentages.

Results

Out of 114 participants; the mean age at diagnosis was 79 +/- 12 years old, sex ratio was equal to 1, the median of symptom duration was 22 (6-36) months, 83 (72.8%) were employed, 54 (47.4%) were on active military duty.

Comorbidities reported in our patients were distributed as followed: 52 (45.6%) cases of overweight, 21 (18.4%) cases of obesity, 17 (14.9%) had hypertension, 13 (11.4%) suffered from type 2 diabetes, 10 (8.8%) had dyslipidemia, 6 (5.3%) cases of hypothyroidism and 3 (2.6%) cases of auto-immune diseases.

Seventy (61.4%) participants reported anxious thoughts, 75 (65.8%) patients expressed avoidance beliefs, 59 (51.8%) patients mentioned catastrophizing thoughts and 50 (43.9%) were dealing with low mood. Mean SBT psychological score was at 2.68 +/-1.5.

Patients reported a mean SBT score of 5.31+/-2.1 with the following risk stratification: 27 (23.7%) scored low-risk, 47 (41.2%) medium risk, and 40 (35.1%) high-risk.

Conclusion

This is the first study to report the prevalence of SBT-designated risk subgroups among Tunisian population. Medium or high-risk scores for back pain disability were more prevalent the surveyed sample. Also, rates of low mood and anxious thoughts indicate a need for future research to explore psychosocial factors in non-specific low back pain.

Disclosure of Interests

None declared

AB0800 Ultrasonography of supraspinatus entheses in axial spondyloarthritis

Background

Several scoring systems have been developed to quantify ultrasound (US) abnormalities of the entheses in patients with spondyloarthritis (SpA). These scores included entheses of the lower limb, triceps tendon, and lateral epicondylar tendon [1] [2].

Studies regarding the involvement of supraspinatus enthesis in patients with SpA are scarce.

Objectives

This study aimed to assess the supraspinatus enthesis in patients with axial SpA using ultrasonography.

Methods

We performed a cross-sectional case-control study including 74 subjects (148 entheses):

• G1: 37 patients with axial radiographic SpA diagnosed according to Assessment of SpondyloArthritis International Society (ASAS) criteria.

• G0: 37 age and sex-matched healthy controls.

All subjects underwent the US by a qualified-US rheumatologist.

The long axis of the supraspinatus was assessed with the patient’s hand placed near the ipsilateral hip and the elbow directed posteriorly.

Following parameters were evaluated at the bone attachment supraspinatus tendon: thickness, echogenicity, loss of normal fibrillar structure, calcifications, enthesophytes, erosions, cortical irregularities, bursitis, and vascularity at power Doppler.

Statistical analysis was performed using SPSS Statistics software version 21.

Results

The mean age was 44.62 + 12.31 years. There were 29 men and 8 women for each group. In G1, the mean disease activity using ASDAS-CRP was 3.03 with levels ranging from 0.10 to 5.66.

The mean thickness of supraspinatus tendon at its bone attachment was 4.54 ± 0.84 mm in G1 versus 4.02 ± 0.57 mm in G0 (p=0.03). Receiver Operator Curve (ROC) analysis showed the cutoff point with the best accuracy in distinguishing patients of controls to be 4.65 mm, with a sensitivity of 45.9% and specificity of 86.5% (air under the curve (AUC) value: 0.666 (p=0.014). Hypo-echogenicity and loss of normal fibrillar structure were noted in 27% (n =10 patients) and 5% (n = 2), respectively, in G1.

Structural damage lesions were found in 3 % in G0 (n= 1) and 51 % in G1 (n=19), p< 0.0001.

In G1, structural damage lesions included: calcifications (38%, n=14), erosions (30%, n = 11), cortical irregularities (16%, n=6), and enthesophytes (8%, n=3).

In G0, structural damage lesions comprised: calcifications (3%, n=1) and cortical irregularities (3%, n=1).

Vascularity at power Doppler was found in 11% in G1 (n= 4) and 0 % in G0.

Subacromial-subdeltoid bursitis was noted in 3% in G1 (n=1) and in 0% in G0.

Conclusion

Our study showed that structural damage lesions of supraspinatus enthesis were frequent in patients with SpA compared to healthy controls. A cutoff of 4.65mm supraspinatus’s thickness was able to discriminate patients with SpA from healthy controls. This finding suggests that supraspinatus enthesis evaluation can be added in entheses US scores.

References

[1]de Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. févr 2009;68(2):169‑74.

[2]Balint PV, Terslev L, Aegerter P, Bruyn GAW, Chary-Valckenaere I, Gandjbakhch F, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. déc 2018;77(12):1730‑5.

Disclosure of Interests

None declared

AB1003 EFFECTIVENESS OF CLASSIC VERSUS AQUATIC REHABILITATION IN GONARTHROSIS: LEQUESNE SCORE

Background

Gonarthrosis is a benign knee condition, but it can become disabling if poorly managed. The evaluation of the functional impact of gonarthrosis is based on Lequesne’s algofunctional index [1], thus judging the effectiveness or failure of the proposed treatment.

Water gymnastics is increasingly prescribed in the management of this pathology.

Objectives

The main aim of our work was to compare the efficacy of aquatic gymnastics with conventional rehabilitation in patients with gonarthrosis using Lequesne’s algofunctional index.

Methods

This is a prospective, comparative study conducted over a period of 15 months, between September 2016 december 2017, including 120 patients recruited at the outpatient clinic of the Physical Medicine and Functional Rehabilitation Department of The HMPIT, in whom the diagnosis of gonarthrosis was made according to the ACR criteria.

The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a conventional rehabilitation program. The second group, called G2, received water gymnastics.

Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.

Results

The mean age of the general population was 54.85 ± 9.501 years [40- 81 years]. The mean age of G1 was 59.07 ± 10.275 years versus 50.63 ± 6.425 years for G2.

Thus, there was a female predominance with a sex ratio M/F of 0.11 in G1 and 0.57 in G2.

Lequesne’s algofunctional index was initially 11.46 ± 3.2 in G1 patients and 8.7 ± 1 in G2 patients with a statistically significant difference between the 2 groups (p<0.001). The discomfort according to the Lequesne algofunctional index was very important and unbearable in 69% of the cases in G1 against 41% of the cases in G2. The Lequesne index was ≥ 10 in 46 patients in G1 (i.e. 77%) versus 32 patients in G2 (i.e. 53%). After conventional rehabilitation, there was a 10% improvement in this index compared with a 28% improvement after water gymnastics with a statistically significant difference between the 2 groups (p<0.001).

Conclusion

The effectiveness of functional treatment whether aquatic or classic was well demonstrated by Lequesne’s algofunctional index, with better result for aquatic rehabilitation. The best would be to combine the two according to the initial functional capacities of the patient to ensure his adherence to the rehabilitation program.

References

[1]Guermazi M, Mezganni M, Yahia M, Poiraudeau S, Fermanian J, Elleuch MH, et al. Translation and construct validity of the Lequesne index for Arab speaking North African patients with osteoarthritis of the knee. Ann Readapt Med Phys. 2004;47(5):195-203.

Disclosure of Interests

None declared

AB0421 ASSESSEMENT OF LIVER STIFFNESS IN RHEUMATOID ARTHRITIS PATIENTS UNDER METHOTREXATE

Background

Methotrexate (MTX) is recommended as a first-line disease-modifying antirheumatic drug for treating rheumatoid arthritis (RA) in monotherapy or combinational therapy. A concern about MTX-related liver fibrosis in patients with rheumatoid arthritis (RA) is still unsolved.

Objectives

The aim of the study cutoff of cumulative dose discriminating patients with normal from those with abnormal liver stiffness.

Methods

We conducted a cross-sectional study including consecutive RA patients diagnosed according 2009 ACR-EULAR criteria. Liver stiffness (LS) was assessed by Fibroscan in the gastroenterology department by an experienced operator.

The LS is measured in kilopascals (kPa). It is normal when < 6.2 kPa. Above this rate it is considered pathological. Substantial liver fibrosis was defined as liver stiffness of greater than 8 kPa.

We collected the following parameters: age, disease duration, disease activity assessed by DAS28, cumulated dose of MTX and duration of this treatment, and the body mass index (BMI). Patients underwent blood testing exploring hepatic function: alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl tansferase (GGT), total bilirubin (TB), albumin (ALB) and prothrombin time (PT).

Statistical analysis was performed using SPSS software.

Results

There were 18 men and 36 women. The mean age was 51.9 + 11.49 [22-83]. The mean BMI was 27.27 + 3.40. The mean disease duration 8.08 + 6.28 years. The mean DAS28CRP was 3.96 + 1.49.

The mean cumulative dose of MTX was 3670 + 3432.61mg and mean MTX duration was 55.75 + 50.89 months. The mean of LS was 4.6 + 1.64 kPa.

The means of the liver blood tests are as follows: AST 20.83 + 8.58 UI/L, ALT 19.60 + 9.39 UI/L, ALP 84.65 + 38.68UI/L, TB 9.50 + 4.79 UI/L, GGT 25.88 + 14.26UI/L, ALB 35.19 + 5.47 g/L, PT 94.60 + 9.02.

Eight patients had abnormal LS values and two patients had advanced liver fibrosis. However, hepatic blood tests (AST, ALT, GGT, TB, ALB, PT) were normal in these patients.

A correlation was found between LS and following parameters: cumulative dose of MTX (r: 0.347, p: 0.013), the methotrexate duration (r: 0.363, p: 0.010) and total bilirubin rate (r:0.390, p: 0.005).

Receiver Operator Curve (ROC) analysis showed the cutoff point of cumulative dose of MTX with the best accuracy in distinguishing patients with normal LS from those with LS higher than 6.2 kPA was 7330 mg, with a sensitivity of 50% and specificity of 91.3% (air under the curve (AUC) value: 0.732 (p=0.03).

Conclusion

Our study showed that LS correlated to both MTX duration and cumulative dose. Patients with a cumulative dose of MTX higher than 7330 mg required a close follow up of liver elastometry and monitoring of hepatic function.

Disclosure of Interests

None declared

AB0784 SPINAL HYDATID CYST DISEASE: WHAT FEATURES IN SURGICAL DEPARTMENTS?

Background:

Cystic echinococcosis (CE) is a zoonosis caused by the larve of Echinococcus granulosus. Cysts can develop in any part of the body, although the liver and lungs are most frequently involved. Bone echinococcosis is one of the rarest forms of the disease, accounting for 0.5 to 4.0% of all echinococcosis. Spinal cysts are disabling causing destruction similar to malignant bone lesions, with high risk of neurological deficit.

Objectives:

To increase awareness of this disease, the clinical data of eight patients with spinal CE were analyzed retrospectively.

Methods:

Clinical data of eight patients with spinal CE were analyzed retrospectively, collected over ten years on the department of orthopedics in the Military hospital of Tunis.

Results:

The mean age of the patients was 49 years. The median disease duration was five years. All patients presented with back pain and paresthesia without neurological deficit. Radicular pain was reported by two patients. The diagnosis of spinal CE was made after the diagnosis of visceral CE in two patients. Former X rays showed nonspecific abnormalities and patients were treated initially by symptomatic treatments based on paracetamol and nonsteroidal antiinflammatory drugs without any improvement. All of the patients needed Magnetic resonance imaging (MRI) to explore chronic back pain with paresthesia, revealing spinal CE. The typical MRI appearance is a multilocular cyst. Six patients had cervical and thoracic spinal cysts, one patient had a lumbar spinal cyst and one patient had cervical, thoracic and lumbar cysts. Further examinations with Computed tomography scans (CTscans) were needed before surgery for better examination bone destruction. All patients underwent surgery. Cysts were removed with spinal fixation. All the patients showed relapses and needed at least three surgical interventions.

Conclusion:

Bone echinococcosis is rare and often misdiagnosed. Radiographic and CT images lack disease-specific characteristics whereas MRI images offers a greater chance of direct diagnosis. Treatment of spinal hydatid disease is entirely surgical with high risk of relapses.

Disclosure of Interests:

None declared

POS1290 CYTOKINE BIOMARKERS IN COMMON LOW BACK PAIN

Background:

Common low back pain (LBP) is a common health problem affecting 50 to 80% of working age adults. It is one of the common and costly health problems in Tunisia. Actually, the role of the immune response and inflammatory cytokines in the pathogenesis of chronic pain has been of growing interest.

Objectives:

The aim of this study was to assess whether pro and anti-inflammatory cytokines could be detected in serum in patients with LBP compared with healthy subjects and whether they could be related to pain severity and to clinical findings.

Methods:

It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology, orthopedics and immunology at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized clinical assessment.

Levels of serum cytokines IL-6, IL-8, IL-1β and TNF- α, were measured using the chimiluminescence technique. Serum concentration of IL-10 was assayed by the enzyme-linked immunosorbent assay technique (ELISA). The normal levels of cytokines were determined in 50 healthy controls.

Results:

The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. LBP duration was 66.4 months. The mean lumbar visual analog scale (VAS) was 4.5 ± 1.9, and the root VAS was 2.6 ± 2.5. Neuropathic pain was found in 26% of patients. The average BMI was 27 ± 3.7 kg/m2. Only serum level of IL-8 was significantly higher in subjects with LBP compared to healthy controls (p <10-3). IL-1β was indetectable in both patients and controls. Positive correlations were found between IL-8 levels and anxiety/functional scores (r = 0.3; p = 0.02/ r = 0.3; p = 0.04). IL-6 was positively correlated with BMI, and negatively correlated with the Schober test. No correlations were found between serum levels of IL-6, IL-8, IL-10, TNF-α and pain intensity (VAS), neuropathic pain (DN4), fibromyalgia (FIRST), depression (HAD) and various radiological data.

Conclusion:

Interleukin-8 is a biomarker of common low back pain and correlate with anxiety and functional disability. These results suggest that IL-8 may be a therapeutic target to reduce chronic back pain and reduce the social and profession impact.

Disclosure of Interests:

None declared

AB0836 DIAGNOSIS VALUE OF INTERLEUKIN 17 IN SPONDYLOARTHRITIS

Background:

Interleukin 17 (IL-17) is pro-inflammatory cytokine that plays a crucial role in spondyloarthritis via the Th17/IL-17 axis. (1)

Objectives:

We aimed to study the diagnosis value of IL-17 serum in spondyloarthritis.

Methods:

We conducted a case-control study, including 104 subjects divided into 2 groups:

-G1: 52 patients meeting the Assessment of SpondyloArthritis International Society (ASAS) criteria for spondyloarthritis (SA)

-G2: 52 healthy controls matched for age and sex.

The IL-17 level was measured using Enzyme-linked immunosorbent assay (ELISA).

We performed a ROC analysis and computed the air under the curve (AUC) at IL-17 to assess the ability of IL-17 to diagnose SA.

Statistical analysis was performed using “IBM SPSS Statistics” software version 25.

Results:

Eighty per cent of the patients were men (n=41). The mean age was 44.96 ± 13.09 years. The mean age at the onset of the disease was 35.07 ± 12.66 years. The disease duration was 9.25 ± 8.09 years. Axial radiographic spondyloarthritis and peripheral involvement were found in 53.8% (n=28) and 44.2% (n=23) of cases, respectively. Psoriasis was noted in 46% of cases (n=24). The mean ASDAS-CRP was 3.21 ± 1.64.

IL-17 level was significantly higher in patients compared to healthy controls (92.76 ± 71.85 pg/mL and 2.67 ± 9.01 pg/mL, respectively, p<0.0001).

As shown in Figure 1, the AUC value to distinguish between spondyloarthritis and healthy control was 0.987 (p<0.0001). IL-17 cut-off was 13.79 pg/mL (Sensibility= 94.2%, specificity=98.1%).

Figure 1.

AUC at IL-17 between SA patients and healthy controls 0.987 (p<0.0001)

Conclusion:

According to previous studies, our study showed that serum IL-17 level is significantly higher in SA patients compared to healthy controls (2).

Interestingly, IL-17 was able to distinguish between SA patients and healthy controls with a cut-off of 13.79 pg/mL. This finding suggests that IL-17 may be useful for the diagnosis of SA.

References:

[1]Ruiz de Morales JMG, Puig L, Daudén E, Cañete JD, Pablos JL, Martín AO, et al. Critical role of interleukin (IL)-17 in inflammatory and immune disorders: An updated review of the evidence focusing in controversies. Autoimmun Rev. janv 2020;19(1):102429.

[2]Chen W-S, Chang Y-S, Lin K-C, Lai C-C, Wang S-H, Hsiao K-H, et al. Association of serum interleukin-17 and interleukin-23 levels with disease activity in Chinese patients with ankylosing spondylitis. J Chin Med Assoc. juill 2012;75(7):303-8.

Disclosure of Interests:

None declared