AB0698 CORONAVIRUS 19 DISEASE VACCINE: PERCEPTIONS AND INTENTIONS OF TUNISIAN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Coronavirus disease 2019 (covid-19) has now spread to millions of persons worldwide to become a global pandemic. Covid-19 is asymptomatic for some individuals and for others it can cause symptoms ranging from flu-like to acute respiratory distress syndrome, pneumonia and death. Several vaccine candidates are now available, and patients with chronic inflammatory disease such as rheumatoid arthritis (RA) are encouraged to get vaccinated.

Objectives:

The aim of this study was to determine perceptions of RA patients about the covid-19 vaccine.

Methods:

We conducted a cross-sectional study including Tunisian patients with RA (ACR/EULAR 2010). Demographic and disease parameters were collected: age, gender, educational status, disease duration, erythrocyte sedimentation rate (ESR), disease activity score (DAS28), and treatments being used. All patients responded to a questionnaire on their perceptions and concerns about the covid-19 vaccine, and whether they intended to get vaccinated or not. A p value inferior to 0.05 was considered significant.

Results:

We included 54 patients (45 women and nine men) with a mean age of 55±11 years old [23-69]. Thirty-one percent of patients were illiterate. The mean disease duration was 9.9±5.9 years [0-20]. The mean DAS28 ESR was 4.68±1.35 [1.50-7.16].

NSAIDs were used in 13% of patients, corticosteroids in 63% of patients at a mean daily dose of 8mg [2.5-20] of prednisone equivalent, methotrexate in 63% of patients, sulphasalazine in 13% of patients, leflunomide in 3.7%, and biologics in 22.2% of patients.

None of these patients had contracted the covid-19. Seventeen percent of patients had been in close contact with someone positive for the disease. All the patients reported that they respected the preventive measures. Fifteen percent of patients had stopped their treatment because they were afraid of the covid-19: Methotrexate (n=4), sulphasalazine (n=1), tocilizumab (n=2), and rituximab (n=1).

More than half of patients (67.7%) reported that they didn’t want to get vaccinated against covid-19. The reasons given by these patients were: presumed adverse events (100%), religious beliefs (86.7%). presumed inefficiency (83.3%), no recommendation from their doctor (80%), fear that the vaccine would interact with their treatment (76.7%), lack of trust in the pharmaceutical laboratories (76.7%), fear from vaccines in general (53.3%), fear that the vaccine would make RA worse (50%), and presumed overprice of the vaccine (30%).

A significant association was noted between educational status and, religious beliefs (p=0.001), lack of trust in the pharmaceutical laboratories (p=0.007), fear that the vaccine would make RA worse (p=0.008) or interact with other treatments (p=0.022), and presumed overprice of vaccine (p<0.001).

Conclusion:

Most of RA patients expressed their unwillingness to get vaccinated against covid-19. Doubts about the vaccine’s efficiency and security and religious beliefs were the main reasons for this choice.

Disclosure of Interests:

None declared

AB0650 SCREENING TESTS FOR LATENT TUBERCULOSIS OF CANDIDATES TO BIOLOGIC THERAPY: DATA FROM THE TUNISIAN BINAR REGISTRY

Background:

The screening and treatment of latent tuberculosis infection (LTBI) is required before starting biologic therapy. Tuberculin skin test (TST) and interferon γ gamma release assay (IGRA) are the two commonly used tests.

Objectives:

The aim of our study was to analyze data from the Biological National Registry BINAR between 2016 and 2020 in order to compare the diagnostic value of TST and IGRA tests.

Methods:

We collected data of patients diagnosed with LTBI (having had a TST and/or IGRA before receiving any biotherapy) from the BINAR registry (a National Tunisian registry of patients with inflammatory rheumatic diseases under biologic therapy since less than two years from the inclusion date).

Results:

From a total of 298 patients included in our study, 199 patients (66.8%) were screened by TST and 159 patients were screened (53.4%) by IGRA.

Thirty-four patients (11.4%) had a positive TST and 27 patients (9.1%) had a positive IGRA test.

Three patients having negative TST and two having negative IGRA developed tuberculosis.

There was no significant difference in our study between these two tests for LTBI diagnosis. The reactivation of tuberculosis can occur even when LTBI screening is negative using TST and IGRA tests.

Conclusion:

Our results show that the predictive diagnostic value for these two tests is the same. It would be more interesting to practice one of those tests prior to biotherapy.

Disclosure of Interests:

None declared.

AB0910-HPR LEVELS OF DEPRESSION AND ANXIETY DURING COVID-19 PANDEMIC: AT WHAT DEGREE ARE HEALTH CARE WORKERS AFFECTED IN TUNISIA?

Background:

Since December 2019, a novel pneumonia caused by coronavirus-19 (COVID-19) has been spreading internationally. Facing this critical pandemic, health care workers who are involved in treating these patients are at risk of developing psychological distress.

Objectives:

To evaluate mental health outcomes among health care workers treating patients exposed to COVID-19.

Methods:

This cross-sectional study collected demographic data and mental health measurements from health workers in different hospitals using an online questionnaire. Participants were divided in two groups: G1 included participants working in a COVID-19 unit and G2 included those who worked in a normal ward. Participants were asked to complete the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder scale (GAD-7). The total scores of these measurement tools were interpreted as follows: PHQ-9 normal (0-4), mild (5-9), moderate (10-14) and severe (15-21) depression; GAD-7 normal (0-4), mild (5-9), moderate (10-14) and severe (15-21) anxiety. We compared the two groups in terms of psychological distress using a Chi-square test.

Results:

A total of 155 individuals with a mean age of 31.3 ± 25 years [26-45] and a sex-ratio of 0.3 completed the online questionnaire. Seventy-two participants (46%) worked in a COVID-unit. The mean number of nightshifts per month in the COVID-unit was 9.5 in G1 and 1.3 in G2 respectively. The mean number of work hours per day in the COVID unit was 5 hours in G1, and 0 in G2. G2 participants worked in COVID-units during nightshifts only. An increase in workload compared to the pre-epidemic was noted only in G1. Depression and anxiety scores were higher among participants of G1 compared to G2 (Table 1).

Table 1.

Comparison of the participants according to the PHQ-9 and GAD-7 scores:

ScoreG1G2pMild depression33%12%0.001Moderate depression14%9%0.000Severe depression7%0.9%0.002Mild anxiety29%17%0.005Moderate anxiety18%7.3%0.002Severe anxiety8.4%2.1%0.001

G: Group

The need for psychological support was more frequent in G1 compared to G2 (38% vs 9%; p=0.005). Participants of G1 were diagnosed with depression (9 cases), anxiety (9 cases) and burn-out (3 cases). In G2, 4 participants were diagnosed with anxiety. The prescribed treatments were: antidepressants (5 cases), anxiolytic (10 cases), and psychotherapy (12 cases).

Conclusion:

Individuals experience varying levels of distress during pandemics. In our study, health care workers in the frontline of COVID-units experienced high levels of anxiety and depression. Thus, necessary measures should be attached to psychological support strategies for health care workers.

Disclosure of Interests:

None declared

AB0593 PERCEPTION OF THE EFFECTIVENESS OF TOPICAL ANALGESICS IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE

Background:

Osteoarthritis of the knee is one of the most common joint diseases. It mainly manifests as pain and can become disabling over time. Several symptomatic therapeutic methods are used to relieve patients with knee osteoarthritis and give them more autonomy. Topical analgesics are considered as an interesting alternative for old and poly-medicated patients.

Objectives:

The aim of this work was to assess the perception of the effectiveness of topical analgesics by patients followed for knee osteoarthritis.

Methods:

A prospective study has been conducted collecting 66 patients followed for knee osteoarthritis at different stages of the disease and under topical analgesic treatment. Epidemiological data, physical examination and x-ray data were collected. The impact of knee osteoarthritis was evaluated by the Lequesne and WOMAC indices. Patients were asked to evaluate their perception about: the time that makes the medication to act, the duration of action and overall satisfaction with the topical analgesic by rating it from 0 to 5. Zero represents complete dissatisfaction while 5 represents complete satisfaction. Patients were also asked about the side effects observed after the use of the topical treatment and whether they recommended this treatment to a friend or a parent.

Results:

In the studied population, the majority of patients were women (87%) with an average age of 55 years. The most common comorbidities were high blood pressure (61%), diabetes (38%) and osteoporosis (36%). Sixty-nine percent of patients were taking more than two oral treatments. The average duration of development of osteoarthritis of the knee was 9 years. The most common radiological stage was stage 1 (58%). The site was femorotibial in 88% of cases, patellofemoral in 4% of cases and bi or tri compartmental in 8% of cases. The osteoarthritis most often affected both knees in 86% of cases.

The average of the Lequesne index was 11. The average WOMAC index was 12 for pain, 1.5 for stiffness and 48 for dysfunction.

All the patients surveyed were on topical non-steroidal anti-inflammatory drugs (NSAIDs), 37.7% combined local herbal medicine with local NSAIDs, 53% were taking oral analgesics, and 19% were using oral non-steroidal anti-inflammatory drugs in the past month.

The average rating for time that takes the topical treatment to act was 2.9, for duration of action was 1.2, and for overall satisfaction was 2.8. No adverse effects of topical treatment have been reported.

For patients over 60 years old, better satisfaction was noted (the average score for overall satisfaction was 3.2).

Patients with a WOMAC Pain Index greater than 10 were less satisfied (the average overall satisfaction score was 1.1). Patients who took both topical NSAIDs and topical herbal medicine reported that topical NSAIDs were more effective in 66% of cases. Forty percent of patients recommended topical treatment to a friend or a family member.

Conclusion:

In patients with chronic pain associated to osteoarthritis of the knee, topical analgesics are considered a good long-term therapeutic alternative. Patients are generally satisfied with the effectiveness of the local treatment, in particular the immediate effect felt after application, but less satisfied with the duration of action. Perception of effectiveness appears to be affected by age and degree of pain.

References:

[1]D. Y. Wall, “Topical Nonsteroidal Anti-Inflammatory Drugs for Chronic Musculoskeletal Pain in Adults,” p. 3, 2017.

[2]R. L. Barkin, “The Pharmacology of Topical Analgesics,” null, vol. 125, no. sup1, pp. 7–18, Jul. 2013, doi: 10.1080/00325481.2013.1110566911.

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

Each patient underwent a US scanning of the painful shoulder in four sites based on US technical guidelines of the European society of musculoskeletal radiology: long head of Biceps (LHB), subscapularis recess, posterior recess and axillary recess. The presence of a subdeltoid or subcoracoid bursitis or the presence of transfixiant tear of the suprasupinatus were notified if present. Intra and inter-observer reliabilities were calculated.

Results:

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

Conclusion:

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

References:

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

Disclosure of Interests:

None declared

AB0174 FATIGUE IN RHEUMATOID ARTHRITIS: A CASE-CONTROL STUDY

Background:

Fatigue is a common symptom in many chronic inflammatory diseases, including rheumatoid arthritis (RA). It is considered one of the most frustrating, uncontrollable, and overwhelming symptoms. However, most of rheumatologists do not assess fatigue despite its clinical significance and its impact on patients’ lives.

Objectives:

The aims of this study were to determine whether RA patients express more fatigue than healthy controls, and to analyze its correlation with disease activity.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010) and healthy controls matched for sex and age. Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Demographic data and the following clinical parameters were collected: pain Visual Analog Scale (VAS), Global Patient Assessment (GPA), tender joint count (TJC) and swollen joint count (SJC), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), and Health Assessment Questionnaire (HAQ). Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. A p value inferior to 0.05 was considered significant.

Results:

We included 100 RA patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. The mean disease duration was 87.3 months [1-360]. The mean pain VAS was 49 cm [0-100] and the mean GPA was 47.8 cm [0-100]. The mean TJC and SJC were 5.3 [0-36] and 1 [0-9] respectively. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33] and the mean HAQ score was 0.90 [0-2.75].

Thirty-nine healthy controls were enrolled including 35 women and 4 men with a mean age of 51.2 years old [30-64].

The mean FACIT-F score was 27.1 [0-51] in RA patients versus 46.2 [0-52] in healthy controls (p<0.001). Among RA patients, 57% had moderate fatigue and 26% had severe fatigue.

A significant negative correlation was noted between the FACIT-F score and the following parameters in RA patients: TJC (r=-0.568, p<0.001), SJC (r=-0.274, p<0.001), pain VAS (r=-0.605, p<0.001), GPA (r=-0.658, p<0.001), ESR (r=-0.405, p<0.001), CRP (r=-0.149, p<0.001), DAS28 (r=-0.837, p<0.001) and HAQ (r=-0.634, p<0.001).

Conclusion:

Fatigue was significantly more observed in RA patients. This symptom was correlated with disease activity and disability. It is important to recognize and manage fatigue in order to improve patients’ quality of life.

Disclosure of Interests:

None declared

AB0590 ARTHRITIS OF THE KNEE AND BALANCE DISORDER

Background:

Knee osteoarthritis has been identified as a risk factor for falls and balance disorders. Several clinical scales have been put in place to assess this risk.

Objectives:

The aim of this work was to assess the risk of falls in patients followed for osteoarthritis of the knee.

Methods:

A prospective study was conducted over a period of 4 weeks. Sixty-six patients followed for knee osteoarthritis at different stages of the disease were included into this work. Epidemiological data, physical examination data and x-ray data were collected. The impact of knee osteoarthritis was evaluated by the Lequesne and WOMAC indices. The patients were asked about the history of a fall since the onset of knee osteoarthritis and they had the Tinetti test where a score less than 20 reflects a very high risk of falling, from 20 to 23 significant risk, from 24 to 27 moderate risk and 28 means a normal test.

Results:

In the studied population, the majority of patients were women (87%) with an average age of 55 years and an average body mass index of 29kg /m2. The most common comorbidities were high blood pressure (61%), diabetes (38%) and osteoporosis (36%). Sixty-nine percent of patients took more than two oral treatments. The average duration of development of osteoarthritis of the knee was 9 years. The most common radiological stage was stage 1 (58%) followed by stage 2 (31%). The site was femorotibial in 88% of cases, patellofemoral in 4% of cases and bi or tri compartmental in 8% of cases. The arthritis most often affected both knees: 86% of cases. The average of the Lequesne index was 11. The mean WOMAC index was 12 in pain, 1.5 in stiffness and 48 in dysfunction.

Patients who had a normal Tinetti score represented 39% of the studied population, those who had a score from 24 to 27 were 35% of the studied population, those who had a score between 20 and 23 were 14% of the studied population, and those who had a score below 20 were 12% of the studied population.

Patients reporting a history of one or multiple falls were 19%. Among these patients 93% were women and 88% were hypertensive under antihypertensive treatment. The average age of these patients was 61 years. The Tinetti test revealed in this group of patients that 40% had a very high risk of falling, 48% had a high risk of falling, 10% had a moderate risk and 2% had a normal Tinetti test. These patients had been followed for knee osteoarthritis for an average of 10 years. The average Lequesne index was 12.5. The average WOMAC index was 12 for pain, 2 for stiffness and 55 for dysfunction.

In the following Table 1 we summarized the different stages of risk of falling according to the Tinetti score according to the epidemiological data and the characteristics of knee osteoarthritis:

Tinetti scoreLess than 20From 20 to 23From 24 to 27Equal to 28Average age (years)66655647Women (%)78818889Men (%)22191211Average BMI (kg/m2)31,730,429,328,6High blood pressure (%)77606757Average Lesquene12,5111110,5WOMAC pain14121210WOMAC stiffness21,511WOMAC dysfunction58494644

Conclusion:

The epidemiological characteristics as well as the knee osteoarthritis characteristics are statistically close in the different groups of stages of risk of fall according to Tinetti test. Indeed, according to this study, knee osteoarthritis does not represent a significant risk factor for falls.

References:

[1]Mat S, Tan MP, Kamaruzzaman SB, Ng CT. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015 Jan;44(1):16-24. doi: 10.1093/ageing/afu112. Epub 2014 Aug 22. PMID: 25149678.

[2]Köpke S, Meyer G. The Tinetti test: Babylon in geriatric assessment. Z Gerontol Geriatr. 2006 Aug;39(4):288-91. doi: 10.1007/s00391-006-0398-y. PMID: 16900448.

Disclosure of Interests:

None declared.

AB0173 FACTORS ASSOCIATED WITH FATIGUE AND PERSISTENT FATIGUE IN RHEUMATOID ARTHRITIS

Background:

Fatigue is a common and debilitating symptom in patients with rheumatoid arthritis (RA). Fatigue in RA is poorly understood and appears to be multifactorial. Interactions between three factors were suggested: ‘personal’, ‘disease processes’, and ‘cognitive, behavioural’.

Objectives:

The aim of this study was to determine factors associated with fatigue and persistent fatigue in RA.

Methods:

We conducted a longitudinal study including patients with RA (ACR/EULAR 2010). Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Patients were evaluated at inclusion (T0) and 12 months later (T12). Demographic and disease-related data were collected: age, gender, professional status, physical activity, disease duration, Rheumatoid Factor (RF), Anti-citrullinated peptides antibodies (ACPA), pain Visual Analog Scale (VAS), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), and Health Assessment Questionnaire (HAQ). Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. We defined ‘persistent fatigue’ as reported fatigue at T0 and T12. A p value inferior to 0.05 was considered significant.

Results:

We included 100 patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. Among them, 25% were professionally active and 15% had a regular physical activity. At inclusion, the mean disease duration was 87.3 months [1-360]. RF and ACPA were positive in 75% and 72.6% of cases respectively. The mean pain VAS was 49 cm [0-100]. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33] and the mean HAQ score was 0.90 [0-2.75].

The mean FACIT-F score was 27.1 [0-51] at T0. Fifty-seven percent of patients had moderate fatigue and 26% had severe fatigue. At T12, the mean FACIT-F score was 33.4 [5-50]. Persistent severe fatigue was noted in 17% of patients.

A significant negative correlation was noted between FACIT-F score at T0 and the following variables: age (r=-0,258, p=0.01), pain VAS (r=-0,605, p<0.001), ESR (r=-0,621, p<0.001), DAS28 ESR (r=-0.744, p<0.001), and HAQ (r=-0.634, p<0.001).

A significant negative correlation was noted between FACIT-F score at T12 and the following variables: age (r=-0,229, p=0.022), disease duration (r=-0,296, p=0.003), pain VAS (r=-0,754, p<0.001), ESR (r=-0,405, p<0.001), CRP (r=-0,468, p<0.001), DAS28 ESR (r=-0.744, p<0.001), and HAQ (r=-0.678, p<0.001).

Fatigue and persistent fatigue were not associated with gender, professional status, physical activity, and immunological profile.

Multivariable analysis showed that DAS28 ESR (OR=-0.157, 95% CI [-4.614;-0.153], p=0.036) and HAQ (OR=-0.563, 95% CI [-6.916;-2.995], p<0.001) were independently associated with persistent fatigue.

Conclusion:

Fatigue is a frequent and complex symptom in RA. Higher disease activity and greater disability are suggested as predictors of persistent fatigue.

Disclosure of Interests:

None declared

AB0736 JUVENILE IDIOPATHIC ARTHRITIS IN ADULTHOOD: TRENDS OF THE DISEASE AND SOCIO-PROFESSIONAL FUTURE

Background:

Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood that may lead to physical disability and reduced quality of life, thus hindering the ability of the patients to achieve a meaningful adult life.

Objectives:

The aim of this study was to assess the trends of the disease and socio-professional future.

Methods:

We conducted a retrospective study including adult patients aged > 18 years with a history of JIA according to the International League of Associations for Rheumatology (ILAR). Collected data included age, sex, the characteristics of the disease (subtype of JIA, disease duration). The level of education, marital status as well as the profession were recorded.

Results:

The study included 32 patients with a female perdominance: sex ratio was 1,5. The mean age was 29,5 years old [18-64]. The mean age of onset of the disease was 6 years and 2 months [2-17]. The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 14), polyarticular without rheumatoid factor (n=9), systemic (n= 2), enthesitis-related arthritis (n=7), oligoarthritis (n= 5). Four patients suffered from bilateral cataract due to corticosteroid intake. Polyarticular RF+ and RF- progressed into an authentic seropositive and seronegative RA in 71.4% and 66.7% respectively. Among oligoarticular subtype, an extension of the disease to a polyarticular FR+ form (n=1) and to a seronegative rheumatoid arthritis (n=1) was noted. Systemic JIA forms remained in remission with an articular involvement. All the patients with ERA developed spondylarthritis. Although forty–two percent of the patients were married, only half of them had children. Ten percent of patients stopped attending school because of disease flares and deformation. A university level was found in 16% of cases. Only Thirty patients had a profession. Of the patients, 74.4% had received disease-modifying anti-rheumatic drugs (DMARDs) and 36.3% of them were still taking a DMARD. Ten patients were on biologics. Severe disability was found in 20% of patients and concerned mainly the hip (57,2%), the wrist (28,5%) and the elbows (14,3%). Prosthetic joint replacement was found in 2% of cases with a revision of the latter in one patient.

Conclusion:

Adults with JIA often have significant levels of disability, usually related to severe joint complications. There is a clear requirement for a better transition to adulthood and a socio-professional rehabilitation.

Disclosure of Interests:

None declared

AB0592 ASSESSMENT OF KNOWLEDGE OF THE APPLICATION OF TOPICAL ANALGESICS

Background:

In chronic osteoarticular pain, especially knee osteoarthritis, topical analgesics and topical non-steroidal anti-inflammatory drugs represent an interesting therapeutic alternative for patients with several comorbidities in order to avoid side effects and medical interactions.

Objectives:

The aim of this work was to assess how patients apply a topical analgesic.

Methods:

A prospective study has been conducted over a period of 4 weeks. Sixty-six patients followed for knee osteoarthritis at different stages of the disease and under topical analgesic treatment were integrated into this study. Epidemiological data, physical examination and x-ray data were collected. The impact of knee osteoarthritis was evaluated by the Lequesne and WOMAC indices. Patients were asked about how long they apply the treatment, how often they use the treatment per week and whether they are massaging the aching area while applying the treatment.

Results:

In the studied population, the majority of patients were women (87%) with an average age of 55 years. Forty percent of the patients were illiterate as long as 21% received a college education. Patients’ occupations were distributed as follows: 59% housewives, 21% retirees, 12% manual occupations and 8% non-manual occupations.

The most common comorbidities were high blood pressure (61%), diabetes (38%) and osteoporosis (36%).

The average duration of development of osteoarthritis of the knee was 9 years. The most common radiological stage was stage 1 (58%). The site was femorotibial in 88% of cases, patellofemoral in 4% of cases and bi or tri-compartmental in 8% of cases. The osteoarthritis most often affected both knees: 86% of cases

The average of the Lequesne index was 11. The average WOMAC index was 12 for pain, 1.5 for stiffness and 48 for dysfunction.

All the interviewed patients were on topical analgesics for an average of 5 years.

The average frequency of application of topical analgesics was 9 times per week. Housewives and retirees used the treatment on average 14 times per week while working patients use the treatment on average 5 times per week. Seventy-two percent of patients reported that they performed an average massage lasting 11 minutes with each application.

Among patients with secondary and university education, 64% of patients reported that they performed a massage on the painful knee while applying the medication.

Patients followed for knee osteoarthritis for more than 10 years tend to apply the local analgesic for a shorter period of time (an average of 5 minutes).

Conclusion:

Patients followed for osteoarthritis of the knee who are taking topical analgesics tend to make misuse, including massaging for a long time and applying treatment less frequently than recommended. The level of education does not seem to play a role in knowing the right way to apply. However, patients who have been followed for a longer period for knee osteoarthritis use the treatment more correctly.

References:

[1]Flores MP, Castro AP, Nascimento Jdos S. Topical analgesics. Rev Bras Anestesiol. 2012 Mar-Apr;62(2):244-52. doi: 10.1016/S0034-7094(12)70122-8. PMID: 22440379.

[2]Barkin RL. The pharmacology of topical analgesics. Postgrad Med. 2013 Jul;125(4 Suppl 1):7-18. doi: 10.1080/00325481.2013.1110566911. PMID: 24547599.

Disclosure of Interests:

None declared.

AB0597 COMPLIANCE WITH CLINICAL PRACTICE GUIDELINES IN KNEE OSTEOARTHRITIS

Background:

Knee osteoarthritis (OA) is a leading cause of disability among older adults. Recently, evidence-based guidelines for the comprehensive management of osteoarthritis (OA) were developed by the American College of Rheumatology (ACR).

Objectives:

The aim of this study was to assess compliance of doctors with ACR 2019 clinical practice guidelines for the management of knee OA.

Methods:

We conducted a prospective study including rheumatologists and general practitioners. The doctors were invited to answer a structured questionnaire via Google Form. The outcomes of interest concerned the medical management of knee OA as well as alternative medicine.

Results:

The study included 100 doctors: 75 rheumatologists and 25 general practitioners. Almost half of them (49%) have been practicing medicine for more than 10 years. Forty four percent of doctors see between 10 to 20 patients with knee OA per month and 47% of them declared seeing more than 20 patients. Regarding the pharmacological treatment of knee OA flares, oral Non-steroidal Anti-inflammatory drug (NSAIDs) was the initial molecule of choice (91%) followed by grade I analgesics (86 %) and topical NSAIDs (68%). Tramadol and non-Tramadol opioids as well as intraarticular glucocorticoid injections were prescribed respectively in 41% and 46 % of cases. Glucosamine and chondroitin sulfate were prescribed in 49% and 54% of cases respectively and as a combination in 20% of cases. The reasons for non-prescribing these molecules were non-affordable prices (n=19), a lack of efficacy (n=6) and potential sides effects (n=1). Seventy three percent of doctors prescribe hyaluronic acid injections, with a frequency of three weekly injections in 38.7 % of cases and according to the response to the first injection in 61.3% of cases. The combination of both corticosteroids and hyaluronic acid injection was preferred in 38% of cases. The majority of doctors (84%) referred their patients to physical therapy as a first-line prescription (82.1%) or after medical treatment failure (17.9%). The use of alternative medicine was at follows: acupuncture (42.7%), prolotherapy (28.1%) and platelet-rich plasma injections (16.7%). Thirty eight doctors recommended against alternative medicine.

Conclusion:

Our study showed a poor compliance to guidelines regarding the use of intra-articular injections and alternative medicine. Even though, these guidelines provide direction for clinicians, doctors and patients should engage in shared decision-making that accounts for patients’ values, preferences, and susceptibilities.

Disclosure of Interests:

None declared.

AB0673 THE ROUTINE HEALTH CARE OF PATIENTS WITH RHEUMATIC DISEASES DURING THE PANDEMIC OF COVID-19

Background:

The coronavirus pandemic poses a great threat to patients with rheumatic diseases (RD). Because of the state of immunodepression, they are perceived as vulnerable and at high risk of contracting the virus. This may lead to a delay in the health care routine.

Objectives:

The aim of our study was to assess the routine of patients with rheumatic diseases in the era of covid-19.

Methods:

We conducted a prospective study after the outbreak of Covid-19 including patients with RD: rheumatoid arthritis (RA) and Spondylarthritis (SpA). All of them were invited to answer a questionnaire about adherence to protective measures, health services, hospital visits, treatment modalities, as well as the level of satisfaction with the medical support or information received for COVID-19. We also evaluated the post-traumatic state (PTS) with the Impact of Event Scale-Revised (IES-R). A cut-off point fixed at 33 provided the best diagnostic accuracy for PTS. The level of significance was fixed at 0.05.

Results:

The study included 60 patients with a female predominance (sex ratio=1.7). The mean age was 51.3 ± 13.1 years [18-75] and the mean disease duration was 11.9 ±5.6 [1-23] years. Forty-two patients had RA and 18 patients had SpA. The majority of respondents were women (63.3%), married (81.7%), with a household size of 3–5 people (67.9%). The mean DASS depression and anxiety subscale was 9.5 ±7.6 [2-32] and 12.6 ± 8.2 [1-35] respectively. PTS was found in 25% of cases. Twenty-two patients stopped working in the second outbreak. The adherence to protective measures was as follows: compliance with lock-down (92.5%), adherence to stay home warnings (82%), wearing masks (96.3%), social distancing (68%), and washing hands immediately after sneezing (59.3%). Information was mainly sourced from both social media and the Internet in 78.2% of cases. Most of the patients were satisfied with the information provided and only 5 demanded more information about vaccination protocol. Of the patients having direct contact with a person affected with Covid-19 (20%), seven patients experienced symptoms. Three patients were diagnosed with SARS-COV2 and three other patients were hospitalized because of flares. The majority of the respondents (98.2%) had confidence in their own doctors’ ability to recognize Covid-19. The majority of patients (91%) were afraid of getting sick and 83.1% feared stigma and discrimination after the infection. Fifty patients did attend their consultation appointment and 13.3% had a phone consultation. About a third of patients (26.7%) of patients experienced a delay in treatment. A positive correlation was found between marital status and the fear of other family members getting Covid-19 (p=0.029). Patients who did not consult experienced more PTS and severe anxiety than those who did not delay hospital visits (p=0.07, p=0.04 respectively).

Conclusion:

Our study showed that during the outbreak of Covid-19, patients with RD exhibited a high level of protection towards the virus. Despite these precautionary measures, a delay in hospital routine was observed.

Disclosure of Interests:

None declared

AB0886-HPR ASSESSMENT OF SEASONAL VARIATIONS ON CHRONIC INFLAMMATORY RHEUMATISMS ACTIVITY

Background:

Although rheumatoid arthritis (RA) and spondyloarthritis (SA) activities have been described to vary under the influence of several factors, little is known about the influence of seasonality on the activity of chronic inflammatory rheumatisms.

Objectives:

To assess the influence of seasonality on the activity of chronic inflammatory rheumatisms.

Methods:

We conducted a cross-sectional study involving patients with RA (2010 ACR/EULAR criteria) and SA (2009 ASAS criteria). Chronic inflammatory rheumatisms activity was assessed during the summer (June-September) and winter (December-February) using clinical parameters including the Patient’s Global Assessment of disease activity (PGA), 10-cm Visual Analog Scale (VAS) pain score, morning stiffness, nocturnal awakenings, and joint count for RA (tender joint count (TJC) and swollen joint count (SJC)); biological parameters including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); disease activity scores including the SDAI, CDAI and DAS28for RA, BASDAI and ASDASCRP for SA. An analysis of variance (ANOVA) was used to assess the statistical relationship between seasonality and rheumatisms activities.

Results:

We enrolled 175 patients (100 RA and 75 SA) with a sex ratio of 0.5 and a mean age of 57.75 ± 10.53 years [23-83]. The mean chronic inflammatory rheumatisms duration was 12.38 ± 4.6 years. RA was erosive in 91% of cases. Rheumatoid factor and anti-citrullinated peptides antibodies were positive respectively in 84% and 85% of cases. Seventy-five percent of RA patients were on corticosteroids with a mean dose of 10.14 mg/day of prednisone equivalent and 79% of SA patients were on non-steroidal anti-inflammatory drugs. Eighty percent of our patients were treated with conventional synthetic DMARD and 44% with biological DMARD. Small joints were more affected than large joints regardless of the season in RA patients (p=0.05). The following parameters were higher in winter than in summer in RA patients: mean PGA 4.73 vs 4.64 (p=0.01); mean morning stiffness 1.6 vs 1.1 (p=0.01); mean SJC 8.7 vs 7.5 (p=0.01); mean DAS28 ESR 4.56 vs 3.99 (p= 0.05); mean DAS28 CRP 4.6 vs 3.41 (p= 0.05), mean SDAI 21.8 vs 19.5 (p= 0.05); mean CDAI 20.5 vs 18.75 (p= 0.01) and mean ESR 45.6mm/h vs 38.2 mm/h (p=0.01). As for SA, the following parameters were higher in winter than in summer: mean morning stiffness 2 vs 1.4 (p= 0.01); mean ASDASCRP 3.9 vs 3.1 (p= 0.01) and mean BASDAI 6.2 vs 4.9 (p= 0.05). However, we found no statistically significant correlation between seasonal changes and VAS pain score, nocturnal awakenings, TJC, and CRP.

Conclusion:

Chronic inflammatory rheumatisms activity was higher in winter. Health care professionals should take seasonal changes into account in order to improve therapeutic care.

Disclosure of Interests:

None declared

POS1155 INFECTIOUS RISK DURING BIOLOGIC THERAPY FOR INFLAMMATORY RHEUMATIC DISEASES: DATA FROM THE TUNISIAN BINAR REGISTRY

Background:

The development of biologics for the treatment of systemic rheumatic diseases increased the risk of infections. The management of this complication deserves particular attention since it remains a major cause of morbidity and mortality.

Objectives:

The aim of our study was to determine infection frequency under biological treatment and consequences on the therapeutic management.

Methods:

Patients included in the Biological National Registry (BINAR) from 2016 to 2020. Data related to the disease, biological agents, and infections occurring under biologic disease-modifying antirheumatic drugs (bDMARDs) were collected.

Results:

The study included 298 patients with a mean age of 49.2 years [18-79] 175 patients with rheumatoid arthritis and 123 with spondyloarthritis (Axial Spondyloarthritis=48, Enteropathic Arthritis=41, Psoriatic Arthritis=34). Anti Tumor necrosis factor-alpha (Anti-TNF) agents were the most prescribed bDMARDs in 87.9% (n=263) of patients: Infliximab 20.4% (n=61),Etanercept 23.1%(n=69), Adalimumab 24.6%(n=74) and Certolizumab (n=79). No patients were treated with Golimumab. Tocilizumab and Rituximab were prescribed respectively in 10.4% (n=31) and 5% (n=15) of patients. Infections occured in 9 patients (3.1%) with a total of 13 infectious episodes 12 bacterial and a viral one. The site of infections was: respiratory (38%), urinary (15%), cutaneous (23%), ORL (8%), infective endocarditis (8%), and other (8%). The infectious agent was identified in only 3 patients. The outcomes were favorable in most cases except in one patient where there was a definitive interruption of bDMARDs. The patient was hospitalized for sepsis complicating a cutaneous infection with favorable outcomes under antibiotics within a week. The biological agent with higher risk of infections was Tocilizumab (p = 0.056), unlike Rituximab (p = 0.483) and Anti-TNF (p = 0.082). All patients who had an infectious episode were under corticosteroids.

Conclusion:

Our results confirm that bDMARDs are predisposing to infections, but data from BINAR showed that most infections were trivial with no serious outcomes. Therefore, infections should be assessed in patients under bDMARDs for an early therapeutic intervention.

Disclosure of Interests:

None declared.

AB0814 PREGNANCY COURSE ASSESSMENT IN PATIENTS WITH RHEUMATIC DISEASES COMPARED TO CONTROLS

Background:

Rheumatic diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SA) may occur among women of childbearing age. Adverse events during pregnancy including disease flare, preterm delivery, and neonatal or fetal death have been reported.

Objectives:

Our aim was to assess the impact of rheumatic diseases on the course of pregnancy.

Methods:

We conducted a cross-sectional study involving patients with RA (2010 ACR/EULAR criteria) and SA (2009 ASAS criteria) (study group) as well as healthy controls (control group) matched by age and gender. All women included had at least one pregnancy. Data were collected through telephonic interviews. We used the Student t test to compare the study group and the control group.

Results:

We enrolled 57 patients (30 RA and 27 SA) and 57 controls. The mean age in the study and the control groups were respectively 43.2 ± 8.2 years [26-48] and 37.5 ± 6 years. The mean chronic inflammatory rheumatisms duration was 13.81 ± 6.2 years. A history of primary sterility was found in 3 patients (1 RA and 2 SA) and none in the control group. The mean age during the first pregnancy was significantly higher in the study group (28 ± 6.2 years versus 24 ± 7 years in the control group) (p=0.01). Eight patients (5 RA and 3 SA) had a history of spontaneous miscarriage. A terminated pregnancy was noted in 3 patients (1 RA and 2 SA). Complications during pregnancy in the study group were gestational diabetes (0.3%), premature delivery (0.3), premature rupture of membranes (0.3%), abortion threat (0.3%) and pre-eclampsia (6%). Pregnancy was more associated with complications in the study group (p=0.05). Cesarean section was more used in the study group (28 patients versus 9 in the control group; p= 0.00). The main indications of cesarean section in the study group were macrosomia (11 patients), scar uterus (6 patients), sacroiliitis (4 SA patients), twin pregnancy (2 patients), and undetermined reasons (6 patients). Fetal presentation in the study group was the seat presentation (3%), top presentation (4%), face (2%), and forehead presentation (0.3%) with no significant difference with the control group. Complications of childbirth in the study group were hemorrhage of delivery (10.3%), cord widening (6.6%), perinatal asphyxia (4.9%), and dystocia (1.9%). However, no statistically significant differences were found between the two groups in the prevalence of complications of childbirth. During pregnancy, 5 patients were on salazopyrine, 2 on corticosteroids and, 1 on non-steroidal anti-inflammatories.

Conclusion:

Our study showed that pregnancies with rheumatic diseases were at increased risk of having maternal complications and adverse neonatal outcomes.

Disclosure of Interests:

None declared

OPTIMAL ASSESSMENT OF FATIGUE IN RHEUMATOID ARTHRITIS: VISUAL ANALOG SCALE VERSUS FUNCTIONAL ASSESSMENT OF CHRONIC ILLNESS THERAPY – FATIGUE

Background:

Fatigue is an important outcome for patients with rheumatoid arthritis (RA). As recommended by the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) task force in 2008, fatigue should be measured in all RA clinical trials whenever possible. Despite these recommendations, it is largely ignored and rarely assessed in clinical practice.

Objectives:

The aim of this study was to compare the scales being used to measure fatigue in RA.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Demographic and disease-related data were collected. Fatigue was assessed using two scores. The fatigue Visual Analog Scale (VAS) ranging between 0 and 100 cm. Fatigue was considered mild if the fatigue VAS was <20 cm, moderate if 20≤VAS<50 and severe if VAS>50 cm. The Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. We used Cohen’s kappa (κ) to determine the agreement between fatigue VAS and FACIT-F. The κ result was interpreted as follows: values ≤ 0 as indicating no agreement and 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement. A p value inferior to 0.05 was considered significant.

Results:

We included 100 RA patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. The mean disease duration was 87.3 months [1-360]. RF and ACPA were positive in 75% and 72.6% of cases respectively. The mean pain VAS was 49 cm [0-100]. The mean numbers of tender and swollen joints were 5.3 [0-36] and 1 [0-9] respectively. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33].

The mean fatigue VAS was 49.1 cm [5-100]. Fatigue was mild in 9% of patients, moderate in 31% of patients, and severe in 60% of patients.

The mean FACIT-F score was 27.1 [0-51]. Fatigue was mild in 26% of patients, moderate in 57% of patients and severe in 17% of patients.

A fair agreement was noted between the two scores (κ=0.303, p<0.001).

The fatigue VAS and FACIT-F were both correlated with the following variables: pain VAS (r=0.685, p<0.001 and r=-0.605, p<0.001), ESR (r=0.384, p<0.001 and r=-0.405, p<0.001), and DAS28 ESR (r=0.684, p<0.001 and r=-0.744, p<0.001).

Conclusion:

The fatigue VAS and FACIT-F are easy, brief and valid measures for monitoring this symptom and its effects on patients with RA. A fair agreement was noted between the two scores.

Disclosure of Interests:

None declared

POS0577 EVALUATION OF COPING STRATEGIES IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Studies have shown that the association of pain, stiffness, disability, and social restrictions in rheumatoid arthritis (RA) patients induce a significantly increased level of depressed mood and stress. The use of favorable coping strategies could lead to improve physical and psychological well-being.

Objectives:

To evaluate coping strategies of RA patients and their associations with health-related quality of life (HRQoL) outcomes.

Methods:

A cross-sectional sample of patients with established RA was evaluated using measures of coping: the Brief-COPE (scores presented for the two overarching coping styles: Approach coping including active coping, emotional support, use of informational support, positive reframing, planning and acceptance, and Avoidant coping including self-distraction, denial, substance use, behavioral disengagement, venting and self-blame), the HRQoL (Mental and Physical Components [MCS/PCS] of the Short Form 12), and the Rheumatoid Arthritis Impact of Disease score (RAID]. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQoL outcomes.

Results:

The study sample comprised 45 patients with a female predominance (91.9 %), and a mean age of 55.7± 9.9 years [38-77]. The median disease duration was 10 years [38-77]. The majority of patients (82.8 %) were positive for either rheumatoid factor or anti-CCP. Half of the patients were on biological disease-modifying antirheumatic drugs. Two active coping strategies were identified: Approach coping (E = 4.29) and Avoidant Coping (E=3.86), which explained 40% of the total variance. Mean RAID was 4.8± 1.6, while the mean PCS and MCS were 31.9 ± 9.4 and 39.7 ± 9.4, respectively. Approach coping and avoidant coping were associated with PCS (r= 0.4, p = 0.03), (r=0.3, p=0.008) respectively. However, no association was found between coping strategies and MCS or RAID (p>0.05). In the multivariate model, approach coping and avoidant coping were significant to explain lower disease-specific HRQoL (PCS) (Beta= 0.4, p= 0.008), (Beta=0.3, p=0.02) respectively.

Conclusion:

Approach and avoidance are associated with lower disease-specific HRQoL (PCS) but not with lower disease-specific HRQoL (MCS). Doctors should not forget to help their patients developing adaptive coping strategies.

Disclosure of Interests:

None declared

AB0717 PREVALENCE OF MIGRAINE AND NEUROPATHIC PAIN AMONG PATIENTS WITH RHEUMATIC DISEASES

Background:

Pain in rheumatic diseases (RD) is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is yet to be fully evaluated and described, with a particular attention to the distinction with nociceptive pain [1].

Objectives:

The aim of our study was to assess the prevalence of migraine and neuropathic pain in patients with RD and to explore factors associated with NP.

Methods:

Prospective study including patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) were invited to complete a validated self-assessment questionnaires. Sociodemographic data as well as disease related characteristics were recorded. Migraine was diagnosed according to the IHS migraine diagnostic criteria. NP was evaluated using DN4 (Douleur Neuropathique 4 Questions) and Pain DETECT questionnaire (PDQ). Neuropathic pain was retained in case of a total score of 4 or more at DN4-interview questionnaire or a score ≥19 with the PDQ.

Results:

A total of 60 patients with RD were included (42 RA/18 SpA). Females outnumbered males (sex-ratio=1.7). The mean age was 51.3 ± 13.1 years [18-75] and the mean disease duration was 11.9 ±5.6 [1-23] years. The prevalence of migraine was 15%. This latter was higher among women than men and among RA patients than SpA (18% vs 9%, 16.6% vs 11.2%) with no statistically significant correlation (p=0,329, 0,581 respectively). Parameters associated with a higher prevalence of migraine were an older age (p=0,042). However, there was no correlation between the presence of migraine and the type of the RD, disease duration or the level of anxiety (p=0,059, p=0,459 respectively). Chronic pain with neuropathic characteristics was found in 21.7% with the DECT score and 16.7% with DN4 questionnaire. NP was most prevalent among patients with comorbidities (28.5% vs 6%, p=0.021) and with higher body mass index (p=0.01). Prevalence was significantly higher in the RA group (19%) than in the SpA group (11%) without a statistically significant correlation (p=0.45). Similarly, NP was not associated with Salazopyrine intake (p=0.9).

Conclusion:

We found a high prevalence of migraine and NP in our sample of patients with RD. It seems therefore important to check the presence of migraine or NP especially in patients with comorbidities and older ones.

References:

[1]Bailly F, Cantagrel A, Bertin P, et al. Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic. RMD Open. 2020;6:e001326.

Disclosure of Interests:

None declared

AB0615 ASSESSMENT OF THE IMPACT OF OBESITY ON BONE LOSS

Background:

Most of the available evidence supports a lower risk of vertebral fracture in obese adults. This belief was partially suggested by the positive correlation between bone mineral density (BMD) and body mass index (BMI).

Objectives:

We aimed to assess the association of BMI with BMD and to explore their relation with age and gender.

Methods:

This is a cross-sectional study including Tunisian patients referred for an assessment of BMD through dual-energy X-ray absorptiometry (DXA). BMD was measured using standard methods over the lumbar spine L1-L4, the total proximal femur. The results were expressed as T-scores according to the World Health Organization definition. Patients were sub-grouped according to age (≤50 and >50 years). Association between BMD and age as well as BMI was also assessed (G1: obese patients and G2: non-obese patients). The level of significance was fixed for p<0.05

Results:

The study included 100 patients with a female predominance (sex ratio =10.1). The mean age for women was 61.9 ±13 [18-83] years and the mean age for men was 59.7± 7.5 [47-72] years. The mean body mass index was 29.1± 5 kg/m2 [15-45] for women and 27.6 ±3.6 Kg/m2 [22.8-32.9] for men. Forty percent of all patients were obese with a mean BMI of 32.9 kg/m2 ± 4.3. Osteopenia was diagnosed in half of the men (55.5%) and most of the women (70%). Twenty-nine percent of patients suffered from osteoporosis. BMD of the spine was similar between men and women (p=0.53). Men had higher BMD of the hip than women (p=0,038). The mainstream of the subjects >50 years had more vertebral fractures, suffered more from osteoporosis and had a higher BMI than those < 50 years (95% % vs 5%; p=0.04), (92.3% vs 77 %; p=0.03) and (82.5% vs 17.5%; p=0.05) respectively. There was no correlation between BMD of the spine and higher BMI (0.94 in G1 vs 0.98 in G2, p=0.3). Similarly, there was no correlation between BMD of the hip and higher BMI (0.9 in G1 vs 0.84 in G2, p=0.2). Moreover, Obese patients had less a vertebral fracture but with no statistically significant correlation (21% in G1 vs 25% in G2; p=0.2).

Conclusion:

Our study showed that obesity was frequent among Tunisian patients but was not associated with a higher BMD. Older age was directly associated with a lower BMD and higher risk for vertebral fracture.

Disclosure of Interests:

None declared.

AB0499 PHYSICAL ACTIVITY ASSESSMENT IN TUNISIAN PATIENTS WITH SPONDYLOARTHRITIS: THE IPAQ EVALUATION

Background:

The occurrence of Spondyloarthritis (SpA) often conditions patients’ quality of life and hinders their well-being. Physical activity (PA) is associated with various health-related benefits among adults with chronic inflammatory rheumatism but may be insufficiently performed.

Objectives:

This study aimed to assess PA in patients with SpA and explore its associated factors.

Methods:

This is a single-center cross-sectional study, involving patients with SpA, visiting our outpatient hospital over eight weeks. Patients responded to the International Physical Activity Questionnaire-Short form (IPAQ-S).

Results:

Sixty patients were included (39 M/21 F) with an average age of 45.8 years [25-78]. The mean duration of SpA was 13.2 years [1-25]. About 80% of patients were from an urban setting. Sixty-three percent of patients had a professional activity, while 13.3% were retired. Twenty-nine patients (48.3%) had axial and peripheral form, 18 patients (30%) had SpA with enteropathic arthritis, 8 (13.3%) with psoriatic arthritis, 3 patients (5%) had axial spondyloarthritis, and only 2 patients (3.3%) with SAPHO-Syndrom. About 23% of patients had hip arthritis and only 5% had uveitis. Fifty-eight patients were on TNF-inhibitor (21/58 Adalimumab, 15/58 Infliximab, 14/58 Etanercept, 8/58 Golimumab). The average BASDAI was 2.7/10. The average ASDASCRP was 2.1/10. The average BASFI was 3.3/10. IPAQ results were distributed as follows: 78.3% of patients were in the « low physical activity » category, 21.7% were in the « moderate physical activity » while none of the patients were in the « high physical activity ». Patients without employment had lower levels of physical activity (29.7%) but no association was observed between those two items (p=0.082). Disease activity objectified with BASDAI was related to low physical activity (p=0.045) whereas no association was observed with ASDASCRP (p=0.870) or BASFI (p=0.056). Otherwise, TNF-inhibitor treatment was not related to different levels of PA (p=0.09).

Conclusion:

Tunisian patients with SpA don’t perform enough physical activity. Except for high disease activity, the different levels of PA did not appear to be explained by other disease-related variables. Thereby, physical activity should be encouraged in SpA.

References:

[1]Fabre, S., Molto, A., Dadoun, S. et al. Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients. Rheumatol Int 36, 1711–1718 (2016).

Disclosure of Interests:

None declared.

POS1110 RELIABILITY OF VERTEBRAL FRACTURE ASSESSMENT ON DUAL-ENERGY X-RAY ABSORPTIOMETRY

Background:

Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers. Yet, the assessment of vertebral fracture (VF) status has not become standard practice.

Objectives:

Our study aimed to evaluate the reliability of VFA as assessed by a rheumatologist and a radiology technician.

Methods:

We conducted a cross-sectional study assessing the performance of low-radiation single energy x-ray absorptiometry VFA for the detection of VF. We selected patients who were assessed for osteoporosis according to screening protocols. Bone mineral densitometry was measured using standard methods over the lumbar spine L1-L4, the total proximal femur, and results were expressed as T-scores. All VFA were independently evaluated by 2 experienced readers: a rheumatologist and a radiology technician for the identification of VF (T4-L4). VF was classified according to the Genant grading system: grade 1 for an anterior, mid or posterior reduction of 20–25% in vertebral height; grade 2 for a reduction of 25– 40% and grade 3 for a reduction of more than 40% in vertebral height. A score for the inter-rater reliability between the readers was expressed using the kappa statistic.

Results:

One hundred patients were included with a mean age of 66.9 ± 9.5 years [46.7-83] years. There was a female predominance (91%). Nearly half of patients had osteopenia (48.9%), 27.7% had osteoporosis and 23.4% had a normal bone mineral density. On VFA scans, the non-visible vertebra was mostly located in the upper thoracic spine (60%). The mean number of VF was 1.2 [0-3] for both readers. According to the doctor’s evaluation, 25% of patients had at least one VF, of which 75.9% had a Genant grade 1, 17.2% had a Genant 2, and 6.9% had a VF grade 3. According to the technician evaluation, at least one VF was found in 36% of patients. A grade 1 was assessed in 91.7% of cases, a grade 2 in 8.3% of patients but no VF grade 3 was assessed. A kappa score for the inter-rater reliability between the readers for VFA was 0.545 (p=0.000). The overall agreement by grade between the readers was 0.785 (p=0,000). The exclusion of non-visible vertebra resulted in a better agreement (k=0.853). Further analysis excluding vertebra T4 to D10, revealed a very good agreement (k=0.9).

Conclusion:

Our study showed a low agreement between the readers on VFA and a better agreement when non-visible vertebrae were excluded. Thus, caution should be advocated when relying exclusively on this device.

Disclosure of Interests:

None declared.

Sexual dysfunction and its determinants in women with rheumatoid arthritis

OBJECTIVES

To evaluate sexual function in Tunisian women with rheumatoid arthritis (RA) and to examine factors that are predictors of female sexual dysfunction including sociocultural factors, disease activity, and psychological status.

METHODS

We conducted a cross-sectional study including 71 women with a confirmed diagnosis of RA according to the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria. Clinical and sociodemographic characteristics were collected. The participants were asked to complete the Female Sexual Function Index (FSFI), which contains 19 questions, assessing six areas of female sexual function in the previous 4 weeks. Sexual dysfunction was defined as an FSFI score less than or equal to 26.55. The psychosocial status was evaluated by the Hospital Anxiety and Depression (HAD) scale. Prevalence of sexual dysfunction and predictors of sexual difficulties were assessed.

RESULTS

The prevalence of female sexual dysfunction in women with RA was 49.3%. All areas were altered especially desire (2.92 ± 1.3), arousal (3.27 ± 1.5), and orgasm (3.77 ± 1.5). In univariate analysis, sexual dysfunction was correlated with the age of patients (p = 0.049), the age of partners (p = 0.013), pain (p = 0.001), number of night awakenings (p = 0.02), morning stiffness (p = 0.010), tender joints (p = 0.05), disease activity score (DAS28 ESR) (p = 0.043), fatigue (p = 0.028), and Health assessment questionnaire (HAQ) (p = 0.02). In multivariate analysis, the age of patients and pain were predictive factors of sexual dysfunction. By analyzing each area of the FSFI score, the age of patients was the independent variable associated with desire. Tender joints were associated with lubrication and the age of partners with arousal, orgasm, and satisfaction.

CONCLUSION

Our study suggests that rheumatoid arthritis has a negative impact on patients' sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function.