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Rekik S, Boussaid S, Tbini H, Jemmali S, Rahmouni S, Zouaoui K, Sahli H, Elleuch M. AB1079 INFECTIOUS SACROILIITIS ACCORDING TO THE GERM: ABOUT 42 CASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundInfectious sacroiliitis is a rare rheumatological emergency. Its semiology is misleading due to the deep location of the joint. The responsible germs play an important role in its semiology.ObjectivesThe objective of this work was to identify the germs responsible for infectious sacroiliitis and their effect in the sacroiliac joint.MethodsWe conducted a retrospective study, including 42 patients hospitalized for infectious sacroiliitis over a period from 2000 to 2020. Demographic, clinical, biological and radiographic data were collected.ResultsA total of 42 Patients were enrolled (11 men and 31 women). The mean age was 36,7 years [29-76]. Low back pain with difficulty walking were the most common manifestations (88%). The inflammatory syndrome was present in 70% of cases.Standard radiographs showed loss of cortical margins with erosion of the sacroiliac joints in 34 cases and were normal for the rest of the patients.MRI and CT scan were performed to confirm the diagnosis in 28 and 13 cases respectively.A puncture guided by ultrasound or scanner was performed in 24 patients. In the cases of absence of germ on the conventional examinations, we performed a sacroiliac biopsy and histological examinations.Pyogenic germs were responsible for 46% of infectious sacroiliitis: Staphylococcus Aureus in 11 cases (28%), Escherichia Coli in 7 cases (16 %) and Streptococcus in one case (2%). Tuberculosis and Brucella were responsible for 38% and 7% of the cases respectively. A subcutaneous abscess was associated with tuberculous sacroiliitis in 4 patients.The outcome was favorable in 36 cases (86%) under appropriate antibiotic therapy. Eight patients presented a treatment-related complication. Progression to multifocal bone tuberculosis and chronic brucellosis was noted in one case each. In 3 cases, rapid ankylosis was found on radiological control.Unfortunately, one patient died from septic shock.ConclusionCommon germs are most responsible for infectious sacroiliitis and seem to have the best prognosis. Tuberculosis is responsible for various complications and its treatment has a high iatrogenic risk. Chronicity is the most feared development, mainly during Brucella sacroiliitis and would be related to a loss of antibiotic efficacy.Disclosure of InterestsNone declared
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Rekik S, Boussaid S, Tbini H, Jemmali S, Rahmouni S, Zouaoui K, Sahli H, Elleuch M. AB1364 IMAGING DIAGNOSIS OF BRUCELLAR SPONDYLODISCITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSpondylodiscitis is the most common location in the musculoskeletal involvement of brucellosis.ObjectivesThe aim of this study is to describe magnetic resonance imaging (MRI) and computed tomography scan (CT) results in patients with brucellar spondylodiscitis.MethodsA retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis and having benefited from a CT scan and/or an MRI of the spine.ResultsEighteen patients were included. In all cases spinal pain was reported, associated with radiculalgia in 8 patients. Low back pain was the most common symptom, present in 17 cases, associated with back pain in 3 cases including one case with neck pain. Isolated neck pain was noted in one patient.Neurologic examination was normal in all cases.Standard Radiographs showed disc narrowing in 14 cases, erosions in 9 cases and hazy changes of the vertebral end plate in 2 cases.A CT scan was performed in 11 cases. It showed disc narrowing in 6 cases, erosions in 3 cases and endplate destructions in 5 cases. Abscesses were found in 4 patients.Complementary MRI was performed in three of the patients who had already undergone CT. The MRI results were consistent with those of the CT scan, except for one patient in whom it revealed spondylodiscitis while the CT scan revealed degenerative lesions.Eleven patients underwent MRI in total. It showed unifocal and multifocal spondylodiscitis in 5 and 6 cases respectively, epiduritis in 6 cases, spinal cord compression in 2 cases and abscesses in 4 cases.ConclusionOur study showed that CT and spinal MRI allow early diagnosis of spondylodiscitis. They help to identify asymptomatic lesions and neurological complications.Disclosure of InterestsNone declared
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Rekik S, Boussaid S, Zeineb Z, Jemmali S, Rahmouni S, Zouaoui K, Sahli H, Elleuch M. AB1224 NON-CONTIGUOUS MULTIFOCAL SPONDYLODISCITIS: A RETROSPECTIVE OBSERVATIONAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundNon-contiguous multifocal spondylodiscitis (mSpD) is a serious infection. Although literature data highlight the opportunity to miss a non-contiguous spondylodiscitis (SpD), recommendations for which cases an MRI of the entire spine should be performed are missing.ObjectivesThe aim of the study was to assess the clinical features of mSpD to reveal risk factors underlining the need for screening a multifocal spine involvementMethodsWe retrospectively evaluated the data of patients with confirmed non-contiguous multifocal spondylodiscitisResultsTwelve patients suffered from mSpD were included (6 males, 6 females). The mean age was 60 years. Four patients had underlying chronic comorbidity, Diabetes (n=3), hepatitis C virus (n=1). Most patients had spine pain (11 patients,), radiculalgia in one patient, neurologic deficit (3 patients), worsening health status (7 patients). Symptoms onset was acute (n=1) or sub-acute (n=3) or long term (n=8) before admission. The mean duration between the diagnosis and the onset on symptoms was 9,6 months. Tubercular spondylodiscitis was the most detected etiology (n=8), confirmed by histological analysis (n=3) then brucellar, confirmed by serlology lab test, and pyogenic SpD in two patients each. Non-contiguous multi-level involvement in the lumbar, thoracic, and cervical spine was detected in one patient for each region. Seven patients suffered from a lumbar and thoracic spine involvement and SpD occurs in the three regions in two patients. Elevated inflammatory biomarkers (CRP and ESR) were present in all cases. Entire spine MRI was performed for almost all patients, confirmed the diagnosis, showed para-vertebral abscess (n=3), epidural inflammation (n=6), and spinal cord compression (n=3). The majority of cases showed a favorable evolution with appropriate antibiotic therapy. One patient maintain a neurologic deficit, and one suffered from a severe degree of pain. Surgical approach was not indicated.ConclusionIn our study, mSpD did not appear to be associated with a particular pattern. Tuberculosis was the dominant etiology. That suggests, an MRI of the entire spinal column should be performed for each patient with suspicious SpD, especially when tuberculosis is evocatedDisclosure of InterestsNone declared
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Hannech E, Boussaid S, Rekik S, Jemmali S, Rahmouni S, Sahli H, Elleuch M, Dhahri R, Gharsallah I. AB0342 EVALUATION OF SELF-CARE SAFETY SKILLS AND THERAPEUTIC KNOWLEDGE OF RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC DRUGS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe management of rheumatoid arthritis (RA) was revolutionized by the use of biologic therapies (bDMARD). Nevertheless, bDMARDs may carry some specific risks such as infection. However, data about self-care safety skills are poor [1]. An assessment of the level of information and education is therefore essential for patients followed for RA.ObjectivesThe purpose of our study was to assess knowledge and safety skills of RA patients under bDMARDs.MethodsWe conducted a descriptive, bi-centric, and cross-sectional study, including RA patients receiving intravenous (IV) or subcutaneous (SC) bDMARD for at least 3 months. Sociodemographic, clinical, and paraclinical data were collected. Knowledges and self-care safety skills were assessed by a pre-specified questionnaire.The questionnaire was divided into three domains:- Five questions about general theoretical knowledge domain: assessing patient’s knowledge of the name of the current bDMARD, duration and rate of intake, and a question on annual cost estimation.- Three questions about the current bDMARD management: assessing cold chain compliance and management of the biologic in SC emphasizing adherence to the steps to be taken prior to giving the injection.- Tow questions about knowledge regarding safety skills in special situations: infection, cough, contraception, surgery, vaccination, and regarding the need to inform others about the use of bDMARD.Based on the data analysis, patients were divided into 3 groups according to their knowledge level:- Group A (low knowledge level: percentage of correct answers <40%)- Group B (moderate knowledge level: percentage of correct answers >40% and <60%)- Group C (high level of knowledge: percentage of correct answers > 60%).ResultsSeventy-five patients with RA were collected. Their mean age was 56.92 ± 9.06 years [34-80]. The mean duration of bDMARD was 37.17 ± 39.44 months [4-248] with a mean rank of 1.41 ± 0.9 [1-5]. The SC route was used in 41 patients (54.7%) followed by the IV route in 34 patients (45.3%)The most prescribed molecules were Infliximab, Certolizumab and Tocilizumab (22.7% respectively). The average order of the current biologics was 1.41 ± 0.9 [1-5] in combination with a csDMARD in 48 patients (64%).Safety skills were low in 24 patients (32%), moderate in 36 patients (48%), and high in 15 patients (20%).The mean percentage of correct answers for each domain was respectively: 56.53 ± 18.4% [20-100] for general theoretical knowledge domain, 68.44 ± 26.21% [0-100] for the management of current biologic treatment domain, and 40.8 ± 16.87% [6.67-80] for knowledge regarding safety skills in special situations.Safety skills levels were significantly related to occupational status (p=0.001), DAS28 CRP (p=0.04), joint deformities (p=0.01) and radiographic erosions (p=0.006), number of previous bDMARDs (p=0.009), and the rank of the current bDMARD (p=0.009).ConclusionThe major finding of our study was the insufficient level of knowledge and safety skills of RA patients under bDMARDs. We highlight the importance of involving patients in the decision-making process and emphasize the role of the therapeutic patient education programs.References[1]Orefice D, Beauvais C, Gossec L, Flipon E, Fautrel B, Marguerie L, et al. Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease. Joint Bone Spine. 2014;81(6):502‑7Disclosure of InterestsNone declared
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Ben Aissa R, Khlif MA, Boussaid S, Eleuch H, Zitouna K, Barsaoui M. AB1217 CHRONIC LOW BACK PAIN AND MUSCULAR HYDATIDOSIS: THE TREE THAT HIDES THE FOREST. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHydatid cyst disease is a zoonosis caused by Echinococcus granulosus. The parasite implants most commonly in the liver and lung. Musculoskeletal involvement is rare.ObjectivesTo describe clinical and imaging presentation of spinal and muscular hydatidosis.MethodsWe report two cases of chronic low back pain caused by hydatid cyst.ResultsCase 1: A 36-year-old woman living in a rural area presented with a three-years history of lumbar back pain complicated with right-sided sciatica and intermittent episodes of urinary retention. The pain was gradually worsening and resisting conventional analgesics and physiotherapy. On physical examination, she had tenderness of the lumbar back and left sacroiliac joint with limited mobility. Biological findings were normal and X-ray features showed osteolytic lesions of L5 left side. The magnetic resonance imaging (MRI) results revealed septated multilocular hydatic cysts with high signal intensity in T2-weighted images and low signal intensity in T1-weighted images along L5 and the sacrum left side. Serological test for hydatid disease was positive. The treatment was wide surgical resection combined with Albendazole (400 mg/day) for one year postoperatively.Case 2: A 62-year-old woman presented with a one-year history of lumbar back pain with gait instability and right flank swelling. Biological findings and X-ray features were normal. The patient first was explored by uro-CT to assess for nephrolithiasis and it revealed retro and sub-peritoneal two multilocular hydatic cysts (60x80mm, 36x35mm) along right iliopsoas and adductor muscles. MRI showed same cystes described on the CT (Figure 1). No other localizations were detected. The diagnosis of hydatidosis was confirmed perioperatively after visualization of the cyst. Wide resection was performed but signs of recurrence were detected by MRI at the 3-month follow-up.Figure 1.MRI showing two multilocular cysts along right iliopsoas (white arrow) and adductor muscles (black arrow).ConclusionIn endemic areas, bone and muscle involvement from echinococcosis should be considered during clinical investigation of chronic lumbar pain.Disclosure of InterestsNone declared
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Hannech E, Boussaid S, Rekik S, Rahmouni S, Jemmali S, Ajlani H, Sahli H, Elleuch M, Dhahri R, Gharsallah I. AB0338 BELIEFS ABOUT BIOLOGIC DRUGS AMONG RHEUMATOID ARTHRITIS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease requiring a long-term follow-up and the use of chronic therapies. The management of this disease is based on a multidisciplinary care, requiring total patient involvement. Previous personal experiences, the experiences of others and the daily impact of the disease on patients fuel their perceptions of the treatment especially biologic one. There are few studies evaluating patient’s beliefs about these drugs [1,2].ObjectivesThe aim of our study was to investigate beliefs about biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) among patients with RA and to identify factors related to specific beliefs.MethodsWe conducted a bi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARDs associated or no to conventional synthetic (sc) DMARDs. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ).ResultsThere were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. The mean age was 56.92 ± 9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed. Sixty-four patients (85.3%) were married. The mean disease duration was 14.85 ± 8.5 years [2-39]. Thirty-three patients had joint deformities. Twenty-seven patients had extra-articular manifestations and thirty-six patients had comorbidities. The mean disease activity scale (DAS28 CRP) was 3.94 ± 1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low disease activity, and 19% were in remission. The mean functional impairment scale (HAQ) was 0.64 ± 0.48 [0-2.2]. Twelve patients had moderate to severe disability and only one patient had severe to very severe disability. The mean duration of the current bDMARD was 37.17 ± 39.44 months and the mean rank of the current biotherapy was 1.41 ± 0.9 [1-5].Regarding the BMQ, the mean score for General Overuse was 14 ± 2.37 [6-20]. The mean score for General Harm was 10.82 ± 4.42 [4-20].The mean score of patients’ specific beliefs regarding the necessity of taking the current bDMARD (Specific Necessity) was 20.62 ± 5.71 [5-25]. The mean Specific Concerns score regarding the current bDMARD was 10.33 ± 3.29 [5-25]. Necessity about taking bDMARD was reported by 77.3% patients in the present and 61.3 % patients consider maintaining the bDMARD in the future.There were 4% of patients who reported concerns about taking bDMARD. Twenty four percent of patients reported concerns about long term effects, and 16% about becoming too dependent on bDMARD.Beliefs about the necessity to stop occasionally chronic therapies were reported by 13.3% of patients.Specific necessity was correlated to the current bDMARD duration (p=0.01), Patient Global Evaluation (p=0.03), VAS pain scale (p<10-3), the number of nocturnal awakenings (p=0.01), tender joint count (p<10-3), swollen joint count ((p<10-3), HAQ (p=0.005), DAS28 (CRP) (p<10-3). Specific concerns were correlated to the actual bDMARD rank (p=0.01).ConclusionOur study showed stronger beliefs in the necessity of taking biologic drugs if indicated. Disease activity parameters and functional impairment influence those beliefs. Further studies are required to evaluate the impact of beliefs on biologic drug adherence.References[1]Cea-Calvo L, Raya E, Marras C, Salman-Monte TC, Ortiz A, Salvador G, et al. The beliefs of rheumatoid arthritis patients in their subcutaneous biological drug: strengths and areas of concern. Rheumatol Int. 2018;38(9):1735‑40.[2]Heuckelum M van, Linn AJ, Vandeberg L, Hebing RCF, Dijk L van, Vervloet M, et al. Implicit and explicit attitudes towards disease-modifying antirheumatic drugs as possible target for improving medication adherence. Plos One. 2019;14(8):e0221290.Disclosure of InterestsNone declared
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Hannech E, Boussaid S, Rekik S, Jemmali S, Rahmouni S, Ajlani H, Sahli H, Elleuch M, Dhahri R, Gharsallah I. AB0365 BELIEFS AND ADHERENCE IN RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC DRUGS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with chronic rheumatic diseases play an important role in their disease management. Adherence to their long-term therapies may depend on their therapeutic beliefs [1].ObjectivesThe purpose of our study was to investigate the relationship between beliefs and adherence among patients with rheumatoid arthritis (RA) on biologic therapies (bDMARDs).MethodsWe conducted a multi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARD. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ) and about their therapeutic adherence.ResultsThere were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. Their mean age was 56.92±9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed (15%). The mean disease activity scale (DAS28 CRP) was 3.94±1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low activity, and 19% were in remission. The mean duration of the current bDMARD was 37.17±39.44 months [4-248]. The mean Specific Necessity score was 21.02±5.38 [5-25] for adherent patients and 13.5±7.54 [5-19] for non-adherent patients.The mean Specific Concerns score was 10.07±3.13 [5-15] for adherent patients and 15±2.82 [5-20] for non-adherent patients.A statistically significant association was found between Specific Concerns beliefs and adherence behavior (p=0.009) and between Specific Concerns beliefs and adherence behavior (p=0.003). No statistically significant association was noted between general beliefs (General Harm and General Overuse) and adherence behavior (p=0.4 and p=0.6 respectively).ConclusionBeliefs about therapeutic were identified as a key factor of adherence among rheumatic disease patients. Practitioners should detect negative patient beliefs and perceptions earlier to prevent nonadherence.References[1]Suh YS, Cheon YH, Kim HO, Kim RB, Park KS, Kim SH, Lee SG, Park EK, Hur J, Lee SI. Medication nonadherence in Korean patients with rheumatoid arthritis: the importance of belief about medication and illness perception. Korean J Intern Med. 2018 Jan;33(1):203-210.Disclosure of InterestsNone declared
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Rekik S, Zeineb Z, Boussaid S, Jemmali S, Rahmouni S, Zouaoui K, Sahli H, Elleuch M. AB1077 INFECTIOUS SPONDYLODISCITIS IN ELDERLY: IS IT MORE SEVERE DISEASE? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSpondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms. In older patients, there are often difficulties in diagnosis and management.ObjectivesThis retrospective study aimed to assess the characteristics of infectious spondylodiscitis in patients over 65 years of age.MethodsThis retrospective, monocentric study included patients aged over 65 years olds hospitalized in our department of rheumatology for spondylodiscitis.ResultsA total of 20 consecutive patients (10 males, 10 females) aged over 65 years were analyzed. The mean age of patients was 74 years (65-85). The most common comorbidities included diabetes (20%), chronic renal failure (5%). A history of nodal tuberculosis (10%), a tuberculosis contagion (30%), and raw milk ingestion (15%) were reported. The average delay for diagnosis was 10 months. The most common symptom was axial back pain (100% patients), then worsening health status (34%), and one patient had a significant neurological deficit. C-reactive protein was elevated in 95%. The most common involvement was in the lumbar vertebrae (13 patients, 65%), followed by thoracic and cervical level disease respectively in 3 patients (15%) and 2 patients (10%). Two patients (10%) had a multifocal spondylodiscitis. All patients underwent an MRI exam that confirmed the diagnosis. A percutaneous spine biopsy was performed in 80%. Pyogenic spondylodiscitis was the most common etiology (50%), followed by tuberculosis (35%) and brucellosis (15%). Antibiotic therapy was indicated to all patients with spinal immobilization in 65% of cases. Two patients underwent percutaneous drainage of paravertebral abscesses. The outcome was favorable in almost all cases until 12 months of following-up after completion of treatment. One patient died of septic shock and multi-visceral failure.ConclusionElderly patients with infectious spondylodiscitis have fewer clinical symptoms leading to a delayed presentation. Increasing morbidity and mortality make rigorous monitoring necessary.Disclosure of InterestsNone declared
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Mrabet M, Boussaid S, Troudi SB, Rekik S, Jemmali S, Rahmouni S, Ajlani H, Sahli H, Elleuch M. AB1482 PROGNOSTIC FACTORS FOR TUBERCULOUS SPONDYLODISCITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). It accounts for 46% to 64% of infectious spondylodiscitis and is the most common form of vertebral tuberculosis. Pott’s disease still poses a public health problem in Tunisia due to the endemicity of tuberculosis and the increase in extra-pulmonary forms.ObjectivesOur aim was to study factors impacting SPDT outcome.MethodsWe conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. The diagnosis was based either on a range of highly evocative clinical, biological and radiological arguments or on the disco-vertebral biopsy puncture. The study included correlations of the promoting factors of SPDT (tuberculosis infection, history of tuberculosis, diabetes, corticosteroids and trauma), epidemiological, clinical, biological, radiological and therapeutic data with good clinical outcome in the fourth week of the anti-tuberculosis drugs treatment.ResultsFifty-two cases of SPDT were collected (37F/15M). The mean age was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were aged under 65 years versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The diagnosis of SPDT was based either on a range of highly evocative clinical, biological and radiological arguments (71.2%) or on the disco-vertebral biopsy puncture (28.8%). Among the clinical arguments suggestive of tuberculous SPD were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contibutive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. The treatment was based on anti-tuberculosis drugs for at least nine months. Only four factors had an unfavourable predictive value (p ≤ 0.05): Normochromic normocytic anemia observed in 53.8% of our patients (p = 0.018; Odds Ratio = 6.66), initial lymphocytosis (p = 0.048), fever in 36.5% of our patients (p = 0.01; Odds Ratio = 9.6) and standard X-ray vertebral compression in 67.3% of our cases (p = 0.001; Odds Ratio = 13).ConclusionTuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Poor prognosis factors have been identified to provide insight into disease progression.Disclosure of InterestsNone declared
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Ben Aissa R, Boussaid S, Rekik S, Jemmali S, Rahmouni S, Srairi Sahli H, Elleuch M. AB1459 IMPACT OF SOCIOECONOMIC FACTORS ON THE DISEASE ACTIVITY: DATA FROM THE TUNISIAN BINAR REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDespite the considerable therapeutic progress of inflammatory rheumatic diseases, access to treatment still challenging in developing countries because of scarce health resources and low socioeconomic status.ObjectivesTo determine the influence of socioeconomic factors on disease activity in a national registry cohort, the Biological National Registry (BINAR) in Tunisia.MethodsWe enrolled patients with inflammatory rheumatic diseases under the first received biological drug and included in the BINAR registry from 2016 to 2020. Data on the inflammatory rheumatic disease (rheumatoid arthritis (RA) and spondyloarthritis (SA)), disease activity of RA and SA (DAS28-CRP and ASDAS-CRP respectively) at baseline, gender, active smoking, marital and work status and educational attainment were collected. Two groups were identified: Groupe 1 (G1) for patients with remission or low disease activity and groupe 2 (G2) for moderate or high disease activity according to DAS28-CRP and ASDAS-CRP.ResultsThe study included 298 patients with a mean age of 49.2 years [18-79]. The mean disease duration was 6.7 ± 3.5 years [1-14] in patients with RA and 6.5 ±3.6 years [1-12] in patients with SA. G1 was made of 13 patients and G2 of 285 patients. The were no significant difference between G1 and G2 for (49.5 ± 11.9 versus 49.5±14.2, p=0.93) gender (% of females, 46.2% versus 37.1%, p=0.51) and marital status (% of single patients, 30.8 % versus 33.7%,p=0.82). Patients of G1 had better employability than G2 (61.5% % versus 45.6%) but this difference was not significant (p=0.26). Smoker patients had better disease outcomes comparing to nonsmokers but this difference was not significant (23.1 % versus 13.7%, p=0.34). Illiterate patients had more active diseases, comparing to literate, but this difference was not significant (30.8% versus 40.4%, p=0.49).ConclusionOur results did not confirm any difference in disease activity according to the collected socioeconomic factors. Data on the personal income, health insurance type and geographic distribution of our population should be further studied.Disclosure of InterestsNone declared
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Boussaid S, Saadaoui K, Jemmali S, Hassayoun M, Rekik S, Rahmouni S, Sahli H, Elleuch M. AB0193 BIOLOGIC DRUGS RETENTION IN ELDERLY RHEUMATOID ARTHRITIS: WHAT FEATURES? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe elderly RA population is expanding. The management of RA in elderly patients can be challenging because of comorbidities, the frequency of adverse events. The efficacy and safety of RA therapies; particularly biologics drugs (bDMARDs); are poorly studied in this age group.ObjectivesTo investigate the therapeutic response to bDMARDs in elderly rheumatoid arthritis.MethodsWe conducted a cross-sectional and observational study. Files of patients with RA on biologics drugs (archived from the files of patients on the National Health Insurance Fund of Tunis) were studied. The characteristics of RA, and the current treatments were studied. We have divided our population into two age groups. G1 aging under 65 years and G2 aged 65 or over. The therapeutic maintenance rate as well as the biologics survival was analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.ResultsThree hundred and seventy-four files were selected. Their average age was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41]. Subjects over the age of 65 represented 22.2% of the workforce, i.e. 83 patients. The first biotherapy prescribed was etanercept in 54% of cases, adalimumab in 14% of cases, certolizumab pegol 13%, infliximab 6%, tocilizumab 6% and rituximab in 7% of cases. The 4-year survival was 54.41% and 60.94% for subjects under 65 and 65 or older, respectively. Treatment maintenance for RA in the elderly (≥ 65 years old) was 42.21 months, [53.51–46.92]. In our study, age did not influence the survival of biologics with a Hazard Ratio (HR) = 0.997 (p=0.667).ConclusionRA therapy is generally effective and safe in elderly patients. We did not find any influence of age on survival and therapeutic maintenance of biological treatments. Further studies with a broader spectrum are needed to better understand this notionDisclosure of InterestsNone declared
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Hamdi O, Jemmali S, Kammoun W, Boussaid S, Rahmouni S, Rekik S, Sahli H, Elleuch M. POS1516-HPR CHRONIC INFLAMMATORY RHEUMATISMS: DOES PERIODIC FASTING REDUCE THE DISEASE ACTIVITY? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundMany experimental studies have emphasized the role of periodic fasting in the adaptive responses that reduce inflammation.ObjectivesOur purpose was to assess the impact of periodic fasting on the activity of chronic inflammatory rheumatisms (CIR).MethodsWe conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). CIR activity was assessed during the period of Ramadan (periodic fasting) and three months following Ramadan 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 C-reactive protein (CRP); disease activity scores including the SDAI, CDAI and DAS28 CRP for RA, BASDAI and ASDASCRP for SpA. An analysis of variance (ANOVA) was used to assess the statistical relationship between fasting and CIR activity.ResultsWe enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. RA was erosive in 92% of cases. Rheumatoid factor and anti-citrullinated peptides antibodies were positive respectively in 82% and 84% of cases. Seventy-five percent of RA patients were on corticosteroids with a mean dose of 10.20 mg/day of prednisone equivalent, and 81% of SpA patients were on non-steroidal anti-inflammatory drugs. Eighty-three percent of our patients were treated with conventional synthetic DMARD, and 40% with biological DMARD. The following parameters were lower in the month of Ramadan compared to the period following Ramadan in RA patients: mean PGA 4.3 vs 4.6 (p=0.01); mean morning stiffness 1.1 vs 1.5 (p=0.01); mean SJC 4.7 vs 8.5 (p=0.01); mean DAS28 CRP 3.56 vs 4.25 (p= 0.05); mean CDAI 17.5 vs 20.35 (p= 0.01), and mean SDAI 13.87 vs 18.44 (p=0.01). As for SpA, the following parameters were lower in the month of Ramadan compared to the period following Ramadan: mean morning stiffness 1.3 vs 2.1 (p= 0.01); mean ASDASCRP 2.9 vs 3.3 (p= 0.01), and mean BASDAI 3.6 vs 4.9 (p= 0.05). However, we found no statistically significant correlation between periodic fasting and VAS pain score, nocturnal awakenings, TJC, and CRP.ConclusionOur study concluded that periodic fasting was associated to a lower CIR activity. The incorporation of periodic fasting may promote optimal health and reduce the activity of some chronic inflammatory diseases.Disclosure of InterestsNone declared
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Rekik S, Nouicer S, Boussaid S, Jemmali S, Rahmouni S, Zouaoui K, Sahli H, Elleuch M. AB0321 ADHERENCE TO MEDITERRANEAN DIET AND PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRheumatic diseases (RD) are autoimmune inflammatory arthritis. However involvement to other organs can occur and leads to atherosclerosis and cardiovascular (CV) risk factors. Mediterranean diet (MD) has attracted considerable interest because it seems to offer significant benefits to that end.ObjectivesTo evaluate the role of MD in the development of the cardiovascular risk factors in RD.MethodsWe conducted a cross-sectional study including patients with RA (ACR-EULAR 2010 criteria) or with SA (ASAS 2009 criteria), in remission or in low activity disease and with no history of cardio vascular risk factors before the diagnosis of their RD. Sociodemographic and disease related data were collected: Disease Activity Score (DAS28-CRP), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP) and medication. We asked the patients to complete the 14-items MD adherence questionnary. We evaluated the association of adhrence to MD with cardiovascular risk factors: obesity, type-2 diabetes, hyperlipidemia and hypertension. We estimated odds ratios for each cardiovascular risk factors and their 95% confidence intervals. In all analyses, the high adherence category of MD adherence score [10–14) was considered the reference category.ResultsWe included 61 patients (40 women and 21 men) with a mean age of 42.2 ± 1.1 years old [20-66]. Among them, 32.7% belong to urban environment and 26.2% were professionally active. The mean disease duration was 83.2 months [9-180]. The mean DAS28-CRP was 1.2 [0.8-1.9] and the mean ASDAS-CRP was 1.8 [1.1-2.01]. Methotrexate was used by 52.4%, either as monotherapy or combination and biological in 47.6 %. Thirty patients had high adherence to MD (H-MD) and thirty-one had medium or low adherence to MD (L-MD). We found that higher adherence to the MD is inversely associated with the prevalence of each of the four cardiovascular risk factors, results are shown in Table 1.Table 1.Prevalence of cardiovascular risk factors and odds ratio in high adhrence to Mediterranean diet in rheumatic diseases.Prevalence %Odds ratio95% confidence intervalsObesity57.40.017[0.03-0.93]Type-2 diabetes50.80.01[0-0.019]Hyperlipidemia50.80.126[0.04-0.3]Hypertension42.60.13[0.43-0.4]ConclusionOur results suggest that the healthy effects of the MD observed in epidemiologic studies are exerted partly through plausible mechanisms: low prevalence of obesity, of type2 diabetes, of hyperlipidemia and of hypertension. Interventional studies may eventually provide stronger evidence. In the meantime, an increasing of knowledge supports the Mediterranean diet as a useful tool in managing individuals with RD, who are at high risk ofcardiovascular diseases.Disclosure of InterestsNone declared
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Rekik S, Boussaid S, Tbini H, Rahmouni S, Jemmali S, Zouaoui K, Sahli H, Elleuch M. AB1078 SPECTRUM OF INFECTIONS DURING RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundImmunosuppression during rheumatoid arthritis (RA) induced by the disease but especially immunomodulatory treatments, is responsible for an increased frequency of infections in these patients.ObjectivesThe purpose of this study is to assess the incidence of infections during RA and to determine their nature and management.MethodsA retrospective study over a period of 10 years, including 150 patients with RA. We identified 33 patients who had at least one infectious episode during their follow-up.ResultsThere were 19 women and 14 men. The mean age was 51 years old [39-63]. RA was immunopositive and erosive in all cases. The average disease duration was 8 years. A comorbidity was associated with RA in 14 patients (42%): diabetes in 7 cases, hypertension in 3 cases, ethylism in 2 cases and history of pulmonary tuberculosis in 2 cases.As an extra-articular manifestation, 15% of patients had Sjogren’s syndrome and 18% had pulmonary interstitial fibrosis (3 cases) or pulmonary nodules (3 cases).The most prescribed DMARDs was Methotrexate, prescribed in monotherapy at the average dose of 17.5 mg/week [10-25mg] in 18 cases. The other patients received Methotrexate associated to Hydroxychloroquine in 4 cases, Sulfasalazine in 3 cases and biotherapy in 8 cases. Corticosteroid therapy at an average dose of 7.5 to 15 mg/day was received in 16 cases (48.5%).All infections noted in our population were community acquired. Urinary tract infection was the most common infection noted in 15 cases: pyelonephritis in 3 cases and cystitis in 12 cases. Other infection sites were ENT in 4 cases, bronchopulmonary in 6 cases including 2 cases of tuberculous infection and viral hepatitis (B and C) in 4 cases. Osteo-articular infections were noted in 3 cases: one cervical spondylodiscitis and two septic arthritis. Finally, one case of RA treated with rituximab was complicated by staphylococcal sepsis.Germs causing these infections were identified in 14 cases (42%).ConclusionThe risk of infections is increased during RA, this is due to lymphocyte and autoimmune abnormalities but also to treatments and comorbidities that predispose to the emergence of infectious agents.Disclosure of InterestsNone declared
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Rekik S, Zeineb Z, Boussaid S, Rahmouni S, Jemmali S, Zouaoui K, Sahli H, Elleuch M. AB1578-PARE A PATIENT-REPORTED OUTCOME SCALE: RASQ FOR MEASURING SYMPTOMS OF RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatient-reported outcome (PRO) instruments are used to assess the patient experience of rheumatoid arthritis (RA) symptoms and impacts and can capture RA treatments effects. Also, there are often discrepancies between patient and physician perspectives.ObjectivesThe objective of our study was to proceed with a psychometric evaluation of patients with RA using the Rheumatoid Arthritis Symptom Questionnaire (RASQ).MethodsAdults with clinically confirmed RA, as defined by the ACR/EULAR criteria, were recruited for this cross-sectional study, and then completed the RASQ. Medical records were reviewed, clinical features, treatments, and outcomes were analyzed.ResultsIn total 28subjects (82% females) with RA were included. The meanagewas58.5years (31-79 years). Comorbiditieswerepresentin86 %, diabetes (50%), high blood pressure (32,1%), dyslipidemia (25%), thyroid disease (3,7%), Depression (7.1%).The mean duration since RA diagnosiswas9,8 years. Almost all the patients had at least one of the disease severity criteria, high level of CRP (76%), radiographic erosion (96%), C1-C2 involvement (18%), or hip involvement (14,2%). All of the patients received CsDMARDs and biological therapy. Disease activity evaluated by the DAS28 score was in remission or very low disease activity in 38%, moderate (46%), and high (16%). Functional impact evaluated by the Health Assessment Questionnaire (HAQ)was an average of 1.1 (0.2–3). The RASQ total symptomwas6.6 (2-10). The mean of each item was joint pain (5.4), joint swelling (5.5), joint stiffness (6.1), joint tenderness (4.1), joint warmth (4.3), muscle pain (6), tiredness (5.7). The RASQ total symptom was statistically significantly different (p=0.01) across the DAS28severityrankings but only the first two single items of the RASQ were not statistically significantly different (p=0.9 and p=1,6). A medium positive correlation was found between subjects’ HAQ score and the total symptom score of the RASQ (r=0,38).ConclusionThe primary goal of treating patients with RA is to maximize the long-term health-related quality of life. In this order, measurement of all of the signs and symptoms of RA that are significant and relevant to patients living with the disease is important to achieve this main objective.Disclosure of InterestsNone declared
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Hannech E, Boussaid S, Rekik S, Jemmali S, Rahmouni S, Ajlani H, Sahli H, Elleuch M. Comorbidités et biothérapies au cours de la pandémie Covid-19 : quel impact chez les patients atteints de polyarthrite rhumatoïde ? Rev Med Interne 2022. [PMCID: PMC9212720 DOI: 10.1016/j.revmed.2022.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hamdi O, Jemmali S, Boussaid S, Rahmouni S, Rekik S, Sahli H, Elleuch M. POS1515-HPR CONJUGAL RELATIONSHIPS IN MARRIED PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISMS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe consequences of chronic inflammatory rheumatisms (CIR) on the sexuality and the relationships between the subject and his/her partner are still underestimated and insufficiently studied.ObjectivesThe aim of this study was to investigate the impact of CIR on conjugal relationships.MethodsWe conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). All the patients included in the study were married. We collected demographic data, and participants were asked to complete a questionnaire on their conjugal relationships.ResultsWe enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. The mean duration of marriage was 9.5 ± 2.6 years. The mean age at marriage was 27 ± 6.41 years [19-33]. The mean number of off-springs was 4. Forty-nine percent of patients and 22.3% of the partners had a profession, respectively. Forty one percent of the partners had a chronic disease: diabetes (n=12), hypertension (n=10), dyslipidemia (n=7), CIR (n=7), coronary disease (n=3), and other conditions (n=5). A psychiatric illness was noted in 22.6% of cases: depression (n=9), anxiety (n=6), and bipolar disorder (n=2). Sixty-four percent of patients consider their spouses sympathetic to their illness. Eighty-nine percent of participants have noticed a change in their life as a couple before and after the CIR onset. According to 64% of participants, the CIR had a negative impact on their married lives. The spouses’ emotional reactions to the disease were as follows: indifference (30.6%), denial (29.3%), anger (26.6%), and fear (13.6%). Patients reported being accompanied by their spouses to their medical appointments in 36% of cases, and 40% of them were asked questions by their spouses about their disease and treatment. The CIR has resulted in the termination of the marriage in 2.6% of cases.ConclusionPatients suffering from chronic diseases such as CIR are more frequently exposed to difficulties in their conjugal relationships. The disease has thus important consequences on the subject’s quality of life, emotional and interpersonal state. A better compliance with the chronic disease and its treatment may improve the couples’ relationships.Disclosure of InterestsNone declared
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Ben Aissa R, Boussaid S, Rekik S, Rahmouni S, Jemmali S, Ajlani H, Srairi Sahli H, Elleuch M, Souissi A, Mokni M. AB0950 Detection of asymptomatic entheseal involvement in patients with psoriasis: A case-control ultrasound study. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEnthesopathy is one of the major features of psoriatic arthritis (PsA). The clinical screening for enthesopathies and synovitis in patients with psoriasis is nonspecific during the subclinical phase. Ultrasonography (US) has already demonstrated its ability to study entheses and joints in early stages of PsA.ObjectivesTo evaluate the prevalence of ultrasonographic subclinical synovitis and enthesopathies in psoriasis patients with no clinical evidence of PsA compared with controls.MethodsA cross-sectional study conducted on 40 patients with psoriasis and 40 healthy sex- and age- matched controls. The Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada (SPARCC) were used to evaluate entheseal involvement. US examination of 18 joints (wrists, metacarpophalangeal, and proximal interphalangeal joints) was performed along with 22 entheseal sites (deep flexor of the fingers, lateral epincondyle, triceps, quadriceps, patellar and calcaneal tendons and plantar fascia). Inflammatory-score (thickening, hypoechogenocity, bursitis and Doppler signal) and damage-score (calcifications, enthesophytes and erosions) were calculated (0= absent, 1=present for each abnormality). A total-score was obtained by adding these two scores.ResultsThe mean age of psoriatic patients 51,90±15,90 [19 -76] and the sex ratio of males to females was 3:2. US synovitis were more frequent in psoriatic patients 7/1040 (0,68%) than in controls 3/1040 (0,29%) but this was not significant (p= 0,420). Patients with psoriasis had more US enthesopathies 37 (92,5%) comparing to controls 16 (40%) (p < 0,001). The total number of enthesopathies was higher in the psoriatic group 184/880 (20,90%) comparing to controls 42/880 (4,78%) (p < 0,001). Entheses with more US abnormalities in the psoriasis group comparing to controls were deep flexor tendons of the fingers entheses (p<0,001), distal patellar tendon entheses (p<0,001) and calcaneal tendon entheses (p<0,001). LEI and SPARCC scores were positively correlated to higher number of US enthesopathies (p=0,046, p=0,006). SPARCC was positively correlated to inflammatory-score and damage-score (p=0,009, p=0,024). The mean C-reactive protein level was higher in psoriatic arthritis 5,77±10,10 mg/L than in controls 2,15±3,26mg/L (p=0,037).ConclusionOur results confirm that US enthesopathies and synovitis are more frequent in patients with psoriasis comparing to healthy population. The US screening for subclinical enthesopathies should be the object of longitudinal investigations to define its value in predicting the clinical onset of PsA.Disclosure of InterestsNone declared
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Mrabet M, Boussaid S, Abdelkefi T, Rekik S, Rahmouni S, Jemmali S, Ajlani H, Sahli H, Elleuch M. AB1225 TUBERCULOUS SPONDYLODISCITIS: DIAGNOSTIC DELAY AND OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTuberculous spondylodiscitis (SPDT) is a serious clinical condition that must be treated promptly. Despite the actual availability of more effective diagnostic tools, early diagnosis of SPDT remains difficult and a high index of suspicion is needed due to the chronic nature of the disease and its insidious and variable clinical presentation.ObjectivesOur aim was to study the correlation between the diagnostic delay of SPDT and its outcomes.MethodsWe conduct a monocentric retrospective and descriptive study in a rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2001-2021) who have been diagnosed with SPDT. An early diagnosis is defined by a diagnosis within the first six months versus a late diagnosis that is retained after 6 months of symptoms.ResultsFifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21±17.79 years [19-91]. Late diagnosis was more common: 41 patients (78.8%) versus 11 patients (21.2%) diagnosed early. Complications were more frequent (61%) in patients diagnosed late, but with no statistically significant difference (p=0.1). Disease-related complications, such as spinal compression, spinal deformation and recurrence of the disease, was statistically higher (45.5%) in early diagnosed patients (p < 0.001). Drug complications, such as disruption of liver balance, hyperuricemia and major intolerance to anti-tuberculosis, were more frequent (36.6%) in patients diagnosed late (p = 0).ConclusionDespite highly sensitive imaging techniques, the diagnosis of tuberculous spondylodiscitis is often late, which may lead to severe deformity and early or late neurological complications.Disclosure of InterestsNone declared
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Nouicer S, Jemmali S, Boussaid S, Rahmouni S, Rekik S, Zouaoui K, Sahli H, Elleuch M. AB1572-PARE VIEWPOINTS OF YOUNG TUNISIAN WOMEN WITH RHEUMATOID ARTHRITIS REGARDING THE IMPACT OF THE DISEASE ON FERTILITY: ARE THEY AWARE ENOUGH? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRheumatoid Arthritis (RA) is one of the most common chronic inflammatory disease in women in reproductive age. It seems difficult to acheive parenthood in RA, therefore, reproductive health in these patients is an important issue. Many factors may interfere with procreation such as high disease activity and medication. Female perception and behavior towards fertility are not often assessed.ObjectivesWe aimed to evaluate the fertility perceptions and related behavior among young women with RA.MethodsWe conducted a cross sectional study involving young female patients with RA (2010 ACR-EULAR criteria). Sociodemographic data and the following disease-related parameters were collected: diseases activity score (DAS28CRP) and NSAID (Non steroidal Anti-inflammatory Drugs), prednisone and DMARDs being used. We asked the patients about their knowledge about the risk of infertility due to the disease itself, the activity of RA and medication.ResultsSixty-two females patients were included. The average age was 26.1 ±2.1 years [20-35]. The majority of patients, 54 women, live in rural enviroment and 8 women live in urban enviroment. Forty-two women (67%) were illiterate, ten women (16%) had primary or secondary school level and ten women (16%) had university school level. Only twenty percent (20%) were employed. There were no smokers included. Sixty-six percent (66%) were married. Forty-one women (66%) aimed to have children: 35 women got pregnant and 6 still didn’t get pregnant. The average of gestity was 1.6 [0-4]. The average of parity was of 1.2 [0-3]. The average of time to pregnancy (TTP) was 12 months ± 2 [6-24]. Pregnancy resulted in a live-born baby in 30 women (73%), 4 women (9%) miscarried and there was one intra-uterine fetal death (2%). Ten pregnant women had had fertility treatment to get pregnant. The mean duration of the RA was 3.1 years ± 1.2 [2-10]. The mean DAS28CRP were 3.1 ± 1.25[2-3.9]. Both rheumatoid factor and anti-citrullinated peptides antibodies were positive in 58 women (93%). RA was erosive in 48 cases (76.1%) and deformed in 2 cases (3%). Half of patient were using NSAID daily and 60% were using prednisone with an average daily dose of 5.1 mg/day [2.5-7.5]. Sixty-one percent (61%) of patients were using Methotrexate with an average weekly dose of 15.1 mg/week [10-22.5], 10% Leflunomide, 10% Sulfasalazine, and 45% biotherapy. About half of patient think that RA may cause fertility problems, infertility in 60% and abortion in 40% and they had this information in 60% from media, 30% from siblings and only 10.1% from their rheumatologist. None of patients think that disease activity may interfere with pregnancy and that they should strive low disease activity before trying to conceive. None of patients think that NSAID or COX2 inhibitor or prednisone may interfere with fertility and about 10 women used NSAID in pregnancy. About 24% think that DMARDs may interfere with procreation especially infertility (100%) with respectively: MTX (70%), Leflunomide (3%), Sulfasalazine (5%), biotherapy (20%). Women who didn’t get pregnant accused their impaired fertility to their DMARDs and eight women stopped their DMARDs in pregnancy for fear that it affected their baby. Only 5 women (8%) saw a rheumatologist in the preconception period.ConclusionThe relationship between RA and fertility seems to be misunderstood in young women with RA. Clinicians must routinely discuss this issue with these young patients to preserve their fertility by learning them the mechanisms by which RA may affects their fertility: the disease itself and medication. Appropriate information about fertility can help women in productive age reach and carry a healthy pregnancy.Disclosure of InterestsNone declared
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Rekik S, Boussaid S, Tbini H, Jemmali S, Rahmouni S, Zouaoui K, Sahli H, Elleuch M. AB1080 BRUCELLAR SPONDYLODISCITIS: EPIDEMIOLOGICAL, CLINICAL AND BIOLOGICAL ASPECTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBrucellosis is a systemic infection characterized by significant clinical polymorphism and non-specific manifestations. The spine is a common location for brucellosis.ObjectivesThe aim of this study was to describe the epidemiological, clinical and biological characteristics of brucellar spondylodiscitis.MethodsA retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis on clinical, biological and/or imaging data.ResultsEighteen cases were collected (13 men and 5 woman). The mean age was 52 years [19-76].The main symptom was unifocal or diffuse spinal pain associated or not with radiculalgia. Inflammatory pain was reported in 12 cases.Thirteen patients consumed raw milk, eleven had contact with farm animals or professional exposure.The average duration of symptoms was 5.7 months [0.5-12], the disease had a progressive onset in 13 patients.The general signs were frequent: deterioration of general condition (13 cases), fever (12 cases) and night sweats (6 cases). All patients had a biological inflammatory syndrome.Wright’s serology, performed in 17 patients, was positive in 15 cases. The Rose Bengal test was positive in 13 of the 15 patients tested. Diagnosis by indirect immunofluorescence, performed in 11 patients, was positive in nine cases. However, the blood cultures, carried out in 13 patients and the disco-vertebral biopsy, carried out in 9 patients, did not find the causal agent.ConclusionThe diagnosis of brucellar spondylodiscitis must be based on epidemiological, clinical arguments and biological examinations. Immunological examinations, however, seem to be more contributory and should be performed in case of diagnostic doubt and negative bacteriological investigation.Disclosure of InterestsNone declared
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Boussaid S, Saadaoui K, Rekik S, Jemmali S, Rahmouni S, Sahli H, Elleuch M. POS0612 COMORBIDITIES IN RHEUMATOID ARTHRITIS DO NOT INFLUENCE BIOLOGICS DRUG RETENTION: DATA FROM THE NATIONAL HEALTH INSURANCE FUND OF TUNIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe advent of biologics in the late 1990s radically changed the profile of inflammatory diseases, in particular rheumatoid arthritis (RA). The survival of these innovative therapies is an indicator, in clinical practice, of their long-term efficiency in patients with RA.ObjectivesTo study the influence of comorbidities on biologics drugs retention rates.MethodsWe conducted a cross-sectional, observational study. Data were identified from the files of the National Health Insurance Fund of Tunis. It included patients with RA on biologics. Epidemiological characteristics such as age, sex, and comorbidities, were collected. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The therapeutic maintenance rate at 12, 24, 36, and 48 months as well as the biologics survival were analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.ResultsThree hundred and seventy-four files were selected. The average age of our cohort was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41].First biogics prescription was: etanercept 54%, adalimumab 14%, certolizumab pegol 13%, infliximab 6%, tocilizumab 6% and rituximab 7%. First-line survival rates at 12, 24, 36, and 48 months were 85.8; 69.9; 60.6, and 55.9% respectively. Biologics drug survival was, on average, 41.7 months [39.47-43.91]. Comorbidities were assessed by the CCI in 373 patients (99.7%). Ninety patients had an ICC of 0 and 103 patients had an ICC of 1. Only one patient had an ICC of 8. The median value of this score was equal to 1, the mean was 1.64 ± 1.48. Osteoporosis was the most observed comorbidity with 78 patients (20.9%). The study of drug survival according to the ICC did not show any significant difference between the different curves (p=0.809). The Hazard Ratio was 0.999. Similarly, we did not find a discriminating threshold for the Charlson score, allowing it to be decisive for the survival of biologic drugs.ConclusionThis study did not identify the influence of comorbidities on the biologics survival during RA. Comorbidities can have an impact not only on our therapeutic choice but also on the efficacy and maintenance of biomedicines as well as the quality of life of patients and consequently the prognosis of RA (1). The few studies that have looked at this subject have produced variable results.References[1]Estíbaliz Loza, Cristina Lajas, Jose Luis Andreu, Alejandro Balsa, et al. Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis. Rheumatol Int 2015 Mar;35(3):445-58.Disclosure of InterestsNone declared
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Boussaid S, Saadaoui K, Hassayoun M, Jemmali S, Rahmouni S, Rekik S, Sahli H, Elleuch M. AB0191 OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS: IMPACT ON BIOLOGIC DRUGS TOLERANCE AND SURVIVAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundOsteoporosis is one of the main comorbidity of RA and leads to an increased risk for fragility fractures, which further impair functional ability, quality of life, and life expectancy. The influence of this condition on the maintenance and survival of biotherapies has rarely been studied.ObjectivesTo assess the influence of osteoporosis on efficacy, tolerance, and biologic drugs survival.MethodsWe conducted a cross-sectional and observational study. Files of patients with RA on biologics drugs (archived from the files of patients on the National Health Insurance Fund of Tunis) were studied. Epidemiological characteristics such as age, sex, and comorbidities, were collected. All patients had a bone mineral density measurement. The patients were divided into two groups (a group with G1 osteoporosis and a group without osteoporosis G2). The therapeutic maintenance rate at 12, 24, 36, and 48 months as well as the biologic survival were analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.ResultsThree hundred and seventy-four files were selected. The average age of our cohort was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41]. Osteoporosis was observed in 78 patients (20.9%). First biogics prescription was: tocilizumab 6% and rituximab 7%, etanercept 54%, adalimumab 14%, certolizumab pegol 13%, infliximab 6%.The maintenance of the first biotherapy was 40.53 [35.64-45.43] in G1 and 41.44 [39.01-43.86] in G2. The biologic survival curve study did not find any significant difference between the two group p= 0.598.The presence of osteoporosis would increase the risk of stopping biotherapy without being a statistically significant factor (HR = 1.109, p = 0.602)The therapeutic maintenance of the 1st biotherapy, in the presence of osteoporosis, was on average 40.53 months [35.64-45.43].ConclusionOsteoporosis has not hitherto been retained as a determining factor in therapeutic maintenance (1), as was indeed the case in our study. Nevertheless, screening and early management of osteoporosis are necessary since it alone constitutes a risk factor for mortality.References[1]Leon L, Rodriguez-Rodriguez L, Rosales Z, Gomez A, Lamas JR, Pato E, et al. Long-term drug survival of biological agents in patients with rheumatoid arthritis in clinical practice. Scand J Rheumatol. 2016;45(6):456-60.Disclosure of InterestsNone declared
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Boussaid S, Majdouba MB, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M. Unknown Extra-Articular Manifestation of Spondyloarthritis: What About Retroperitoneal Fibrosis? A Case Based Literature Review. Curr Rheumatol Rev 2022; 18:362-367. [PMID: 35331116 DOI: 10.2174/1573397118666220324142421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/26/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Retroperitoneal fibrosis (RPF) is a rare disease characterized by fibro-inflammatory tissue proliferation in the retroperitoneum. It results in a chronic inflammatory and fibrosis condition, possibly leading to compression of the retroperitoneal structures, especially to encasement of the ureters and the inferior vena cava. It may have an idiopathic or a secondary origin. Spondyloarthritis (SpA) is one of the rare conditions described among the secondary forms. CASE Herein, we report a new case of RPF in a patient with AS. Who presented with acute abdominal pain radiating to the lumbar region and the left testicle. On clinical examination, we found a mild stiffness of the lumbar spine and a decrease in chest expansion. Sacroiliac joint pain was also found. The rest of the physical examination was normal. Laboratory tests showed inflammation with increased C-reactive protein (130 mg/l) and creatinine (112 micromol/l) levels. The computed tomography scan revealed a soft tissue density mass located around the sub-renal aorta. Diagnosis of idiopathic RPF associated with AS was retained. The patient was treated by a daily dosage of 1 mg/kg of oral glucocorticoid with good outcome. CONCLUSION RPF is a rare condition that can be either idiopathic or secondary. Its association with spondyloarthritis, mainly in its ankylosing spondylitis form, seems to be more than anectodal. Treatment may involve medical therapy and/or surgical management. KEY MESSAGE In the presence of back pain, fatigue, weight loss, and low grade fever in spondyloarthritis patients, physicians should screen for retroperitoneal fibrosis as it could be a possible cause.
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Boussaid S, Makhlouf Y, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M, Ben Saad H. The effects of autoimmune rheumatic-related diseases on male reproductive health: A systematic review. J Reprod Immunol 2022; 150:103472. [PMID: 34998078 DOI: 10.1016/j.jri.2021.103472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Autoimmune rheumatic-related diseases (ARRDs) have physical and psychological impact on patients, including their sexual life. While many studies have investigated fertility problems in females, data on males-related fertility are scarce, which explains the lack of guidance. The main objective of this systematic review was to evaluate the reproductive health in males with ARRDs. This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed and Scopus, published until September 16, 2021, and tackling the effects of ARRDs and/or ARRDs treatments on male fertility and/or pregnancy outcomes, were included. A total of twenty-five studies met the inclusion criteria. They were published between 1981 and 2018. The studied ARRDs were spondyloarthritis (n = 9), systematic lupus erythematosus (SLE, n = 6), Behcet disease (BD, n = 5), rheumatoid arthritis (RA, n = 5), antiphospholipid syndrome (n = 1), and dermatomyositis (n = 1). The most reported effects of ARRDs on fertility are i) high levels of reproductive hormones, mainly in RA and SLE; ii) impaired semen quality in SLE, spondyloarthritis, and BD; and iii) higher rate of varicocele in BD and spondyloarthritis. Regarding the treatments effects, i) conventional synthetic disease-modifying anti-rheumatic drugs (e.g.; methotrexate and salazopyrine) increase testosterone level, ii) cyclophosphamide impairs fertility, iii) anti-tumor necrosis factor agents are associated with improvement in semen quality, and iv) no increased number of miscarriages or congenital abnormalities in children fathered by BD was reported. To conclude, both ARRDs and their treatments alter fertility in males with ARRDs. In practice, in addition to the conventional semen analysis, screening for infertility seems legitimate in males with ARRDs.
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