AB0492 DETERMINING FACTORS RELATED TO POOR QUALITY OF LIFE IN PATIENTS WITH SPONDYLOARTHRITIS: A REAL LIFE STUDY

Background:

When treating people with spondyloarthritis (SA), rheumatologists are focused on reducing disease activity based on activity measurement scores; but there may be other factors not directly captured by these tools, which impact on quality of life.

Objectives:

We aim to identify factors associated with poor quality of life in patients with spondyloarthritis.

Methods:

A cross-sectional study was performed in 100 patients with spondyloarthritis. Data on sociodemographic and disease characteristics were collected as well as specific scores: Visual analogue scale (VAS) for fatigue and pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP), Bath Ankylosing Spondylitis Functionnel Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI). EuroQol-5D (EQ5D) was used to assess health-related quality of life.

Results:

A total of 100 Patients were enrolled (73 men and 27 women); the mean age was 43.68 ± 10.3 years. Thirteen percent of patients had high level of education (> 12 years), 47% had BMI ≥ 25 and 47% were smoking. Sixty seven percent of patients had ankylosing spondylitis, 17% had rheumatism associated with inflammatory bowel disease and 16% had psoriatic rheumatism. The average disease duration was 12.24 ± 8.73 years. Mean age at onset was 33.2 ± 10 years. The average diagnostic delay was 2.41 ± 3 years. Sacroiliac pain has been noted in 69 patients, lumbar or cervical stiffness in 78 patients and peripheral joint involvement in 18 cases. Thirty one percent of patients had hip joint involvement and 49% had extra-articular manifestation. Fifty percent had inflammatory biological syndrome, 63% were treated with anti-TNFα and 58% needed symptomatic treatment regularly. The mean fatigue and pain VAS was respectively 5.58 ± 2.5 and 5.56 ± 2.9. The mean BASDAI was 4.4 ± 2.4, the average BASFI was 4.6 ± 2.7 and the average ASDAS-CRP was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. EQ5D questionnaire showed that: 37 patients had no problems with mobility, 61 had some problems and two had extreme problems; 39 patients had no problems with self-care, 55 had some problems and six had extreme problems; 35 patients had no problems with performing usual activities, 60 had some problems and five had extreme problems; 13 patients had no pain or discomfort, 61 had moderate pain or discomfort and 26 had important pain or discomfort; 42 patients had no anxiety or depression, 46 had moderate anxiety or depression and 12 had extreme anxiety or depression. The mean EQ5D score was 0.485 ± 0.378 [-0,448-1] and the mean general health EQ5D VAS was 59 ± 25% [7-100]. Poor quality of life was associated with smoking (p=0.03), physical inactivity (p<0.001), cervical and lumbar stiffness (p=0.001), peripheral joint involvement (p=0.006), inflammatory biological syndrome (p<0.001), need of symptomatic treatment (p<0.001), BASDAI > 4 (p<0.001), ASDAS > 2.1 (p<0.001), BASFI > 4 (p<0.001) and BASMI > 4 (p<0.001).

Conclusion:

Active disease and reduced physical function are the main causes of poor quality of life in patients with spondyloarthritis. Good disease management, smoking cessation and encouragement of physical activity can potentially improve patients’ quality of life.

Disclosure of Interests:

None declared.

THU0602 EXTENDED BONE HYDATIDOSIS IN THE HIP AND FEMUR WITH EXTENSION TO THE SOFT PARTS: A CASE REPORT

Background:

Osseous hydatid cyst is an uncommon disease with weak response to treatment.hydatid disease should be included in the differential diagnosis of cystic lesions of bone in endemic regions. Bone cysts account for only 0.5 to 2.5% of all hydatid cysts in humans.

Objectives:

To report a case of osseous hydatid disease extended on hip and femur

Methods:

We report a case of osseous hydatid disease

Results:

A 49 YEAR OLD BRICKLAYER, with no past-medical history and no animal contact, was admitted to our department for a left hip pain. the patient was apyretic and in a good general health condition. He had a very painful walk. the mobilility of the left hip joint was very painful and restricted.

The pelvis X-rays showed osteolytic lesions in the ischiopubic branch and in the left femur and proximal extremity of the tibia.

The C-Reactive protein value, the protein electrophoresis were normal. tumor markers test was negative.

An ultrasound of the hip showed a low abondance intra-articular effusion. The Pelvic MRI showed multilocular appearance extending over the bone and muscle with breach of the bone cortex of the femur very suggesting of the diagnosis of a bony and muscular echinococcosis.

NO other localization of hydatidosis were detected, body ct scan was normal

Conclusion:

Hydatid disease occurs worldwide and mainly associated with sheep farming. The liver and lungs are the most common locations. Bone cysts are uncommon but severe. Although immunofluorescent assays are useful, the final diagnosis depends on histology. The treatment is almost surgery. Recurrence is common

Disclosure of Interests:

None declared

AB0962 LOW BACK PAIN AMONG MEDICAL STUDENTS: PREVALENCE AND RISK FACTORS

Background:

Low back pain (LBP) is a common health problem among all age groups. Medical students do not seem to be spared. In fact LBP is one of the most common musculoskeletal disorder and its prevalence is variable ranging from 41% to 72%.

Objectives:

The aim of our study was to determine the prevalence of LBP among Tunisian medical students and to assess its associated factors.

Methods:

We conducted a cross-sectional study over 2 months carried out on medical students in a Tunisian medical college. A digital questionnaire entered by Google forms was sent by e-mail and was completed by the students. Our study included students from the first year of the first cycle of medical studies up to the third year of the second cycle. Socio-demographic, personal characteristics and life habits were collected. LBP was assessed using the Nordic musculoskeletal health questionnaire. The impact of low back pain was assessed using the Oswestry disability index (ODI).

Results:

One hundred and seventy-nine students were included. The mean age was 22.9 ± 2.3 years [19.64-38.21]. The sex ratio was 0.29. The average body mass index was 23.55 ± 4.22 kg / m2 [17.67-43.07]. 82% of the students were in the second cycle of medical studies. 26.4% of the students had a regular sports activity. 91.2% spent more than 4 hours a day in a sitting position. The point, annual, and lifetime prevalence of LBP among medical students was 41.2%, 80.4% and 90.6%, respectively. Low back pain was acute in more than 58.8%, subacute in 14.9% and chronic in 26.3%. The mean ODI score was 10.32% ± 8.48% [0-32%]. Students with LBP were significantly younger than students without LBP (p = 0.015). LBP was more common in students who spent more than 4 hours in a sitting position with a difference at the limit of significance (p = 0.059). Being in the 2nd cycle was significantly associated with the occurrence of LBP (p = 0.006). Poor screen projection in the amphitheater was significantly associated with the occurrence of LBP (p = 0.029).We found a statistically very significant relationship between the occurrence of LBP and the poor layout of the amphitheaters (p = 0.000). The feeling of depression was significantly higher among LBP students (p = 0.018). Feelings of fatigue, being overwhelmed, irritability and worry were more frequently found in LBP students, but this difference was not statistically significant. In a multivariate analysis, the only factors that remained statistically significant were feeling of depression (p = 0.046, OR = 3.88; CI = [1,3-11,55]) and the poor layout of the amphitheaters (p = 0.006, OR = 8.99; CI = [2.55-31.69]).

Conclusion:

The annual prevalence of LBP was 80.4%. These results testify to the magnitude of this health problem. The factors associated to LBP seemed to be essentially modifiable factors. This encourages special attention from medical schools to increase students’ awareness of low back pain and to provide appropriate measures at reduce this musculoskeletal disorder.

Disclosure of Interests:

None declared

AB0320 BDMARDS SURVIVAL: THE TUNISIAN DATA

Background:

The advent of biotherapies in the late 90s radically changed the face of inflammatory diseases including rheumatoid arthritis. The survival of these innovative therapies is an indicator, in clinical practice, of their long-term efficacy and safety.

Objectives:

The objective of this study was to assess their use in Tunisia through their survival during rheumatoid arthritis as well as to determine the factors that may influence their therapeutic maintenance in real life.

Methods:

This is a retrospective study including RA patients (ACR/EULAR 2010 criteria) and putted on biotherapy between 01-01-2014 and 12-31-2016. They were followed until 12-31-2018. The therapeutic maintenance rate at 12, 24, 36 and 48 months as well as the survival curves of biotherapies were analyzed using the Kaplan-Meier survival curves and compared by the Log-rank test. Reasons for interruption and patterns of biological change have been reported. Finally, an analysis of factors influencing survival was performed using Cox regression.

A p<0.05 was considered statistically significant.

Results:

Three hundred seventy-four patients were included in the study; sex ratio was 0,147. The baseline age was 55 ± 12.5 years [20 – 90] and the average disease duration was 11.7 ± 6.7 years [2 – 41]. Rheumatoid factor and ACPA were positive respectively in 79% and 71% cases. After failure of cDMARD, 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, with an average DAS28 at baseline 6.01 ± 0.89 [5,37 – 6,50]. Association with methotrexate was observed in 59,6% case and with corticosteroid in 57.2% case. Drug persistency rate at 12 months was 85.8%; at 24 months, 69.9%; at 36 months, 60.6% and at 48 months, 55.9%. Survival was on average 41.7 months with 95% CI (39.47 - 43.91). The presence of rheumatoid factors, the co-prescription of methotrexate as well as good initial therapeutic response were predictor of a better survival of biologicals at a statistically significant level p<0.01 (Hazard Ratios for pursuit of biotherapy were respectively 1.79, 1.91 and 2,3). The use of glucocorticoids was a negative predictor of retention (Hazard Ratio for therapy pursuit was 0.47 p < 0.001). This first biotherapy was stopped in 39% of cases and ineffectiveness was the major reason of interruption (52.7%). The anti-TNFα cycling was the most adopted therapeutic strategy with 64.6% of cases. The survival rates of the second biotherapy at 12, 24 and 36 months were 91%, 76.4% and 72.1%, respectively.

Conclusion:

Our study provides information about biotherapy prescription practices in Tunisia and their effectiveness in “real life”. It informs us about the use of these new therapies in our country and has shown an efficacy and a tolerance profile close to those reported in international registers.

Disclosure of Interests:

None declared

AB0287 HEMATOLOGICAL SIDE EFFECTS OF BIOLOGICAL THERAPY IN RHEUMATOLOGY: DATA FROM THE TUNISIAN REGISTER

Background:

During the last decade, the treatment of chronic inflammatory rheumatism (CIR) has been greatly improved with the advent of biotherapy.However, the use of biological treatment can lead to a number of side effects including abnormalities in the blood count.

Objectives:

The aim of this study was to assess the different hematological side effects of biological treatment in patients with rheumatoid arthritis (RA) and spondyloarthitis (SA).

Methods:

This study included patients with RA (ACR/EULAR 2010) and SA (ASAS 2009) registred with the Tunisian Biologic National Registry (BINAR).Patients were followed and treated with biologics for 2 years of less. Clinical data relative to biological treatment, including haematological side effects, have been collected.

Results:

Two hundred and ninety-eight patients (178 women and 111 men) were included in the study.

The mean age was 49.2 ± 14.1 years. The male/female ratio was 0.6. The mean diseases durations for RA and SA were respectively 6.7 ± 3.5 years and 6.5 ±3.6 years.

Anti-TNFα agents were prescribed in 87.9% of patients (n = 263) with respectively: Infliximab (20.4%) Etanercept (23.1%), Adalimumab (24.6%) and Certolizumab (26.5%).

Tocilizumab and Rituximab were prescribed in 10.4% and 5% of the patients, respectively.

Blood count abnormalities were noted in 15.4 % of patients (n=46).

Neutropenia was the most frequently anomaly met on the hemogram (9.1%) followed by anemia (3.4%) and thrombocytopenia (3%). Pancytopenia was found in 11.4% of patients (n=34).

The median time between biological therapy initiation and the onset of hematologic manifestations was 4.8 months [1-12]. Biological treatment was interrupted in two patients.

In the other cases, the biological treatment was maintained with close monitoring of blood cell count. No case of death related to these hematological disturbances has been reported.

Conclusion:

In our registry, hematological side effects of biological treatment were found in 15.4% of cases and were noted with a median delay of 4.8 [1-12] months after the treatment initiation. Further studies are needed to confirm our preliminary results.

Disclosure of Interests:

None declared

FRI0618-HPR EFFECTS OF MUSIC THERAPY ON PAIN, ANXIETY, AND VITAL SIGNS IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES PATIENTS DURING BIOLOGICAL DRUGS INFUSION

Background:

Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.

Objectives:

The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.

Methods:

Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.

Statistical package for social sciences (SPSS) was used for analysis.

Results:

The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.

Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.

During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).

This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.

Conclusion:

The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.

References:

[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.

Disclosure of Interests:

None declared

Dating of recent sediments from Lago Maggiore and Lago di Lugano (Switzerland/Italy) using 137Cs and 210Pb

This paper presents the results of ¹³⁷Cs and ²¹⁰Pb dating of sediments from the northern and western basins of Lago Maggiore and the southern basin of Lago di Lugano. Vertical distributions of ¹³⁷Cs in sediment cores taken in 2017/18 were compared to those of the sediment cores taken almost two decades ago at the same positions. This comparison showed that ¹³⁷Cs peaks do not alter their shape significantly over time and ¹³⁷Cs remains a reliable time-marker for many decades. ²¹⁰Pb dating using for the first time the piecewise "constant rate supply" (CRS_PW) model constrained with ¹³⁷Cs time-markers is performed for sediment cores of Lago Maggiore and Lago di Lugano. "Event-linked" mass accumulation rates (MARs) were derived from the CRS_PW model. In combination with the dry bulk density, organic matter content, ⁴⁰K and ²¹⁰Pb activity concentrations, these "event-linked" MARs were used for the identification of one or more event layers (turbidites, detrital layers) in 1-cm thick sediment samples. "Continuous" mean MARs which are independent of the event layers were estimated: in Lago Maggiore sediment cores they are 0.066-0.090 g cm^-2 yr^-1; in Lago di Lugano they vary in the range of 0.032-0.057 g cm^-2 yr^-1 with higher values in the time interval 1963-1986 as compared to 1986-present.

Hybrid clustering system using Nystagmus parameters discrimination for vestibular disorder diagnosis

BACKGROUD AND OBJECTIVE

The control of clinical manifestation of vestibular system relies on an optimal diagnosis. This study aims to develop and test a new automated diagnostic scheme for vestibular disorder recognition.

METHODS

In this study we stratify the Ellipse-fitting technique using the Video Nysta Gmographic (VNG) sequence to obtain the segmented pupil region. Furthermore, the proposed methodology enabled us to select the most optimum VNG features to effectively conduct quantitative evaluation of nystagmus signal. The proposed scheme using a multilayer neural network classifier (MNN) was tested using a dataset involving 98 patients affected by VD and 41 normal subjects.

RESULTS

The new MNN scheme uses only five temporal and frequency parameters selected out of initial thirteen parameters. The scheme generated results reached 94% of classification accuracy.

CONCLUSIONS

The developed expert system is promising in solving the problem of VNG analysis and achieving accurate results of vestibular disorder recognition or diagnosis comparing to other methods or classifiers.

Supervised classification approach of biometric measures for automatic fetal defect screening in head ultrasound images

This paper presents an advanced approach for foetal brain abnormalities diagnostic by integrating significant biometric features in the identification process. In foetal anomaly diagnosis, manual evaluation of foetal behaviour in ultrasound images is a subjective, slow and error-prone task, especially in the preliminary treatment phases. The effectiveness of this appearance is strictly subject to the attention and the experience of gynaecologists. In this case, automatic methods of image analysis offer the possibility of obtaining a homogeneous, objective and above all fast diagnosis of the foetal head in order to identify pregnancy behaviour. Indeed, we propose a computerised diagnostic method based on morphological characteristics and a supervised classification method to categorise subjects into two groups: normal and affected cases. The presented method is validated on a real integrated microcephaly and dolichocephaly cases. The studied database contains the same gestational age of both normal and abnormal foetuses. The results show that the use of a support vector machine (SVM) classifier is an effective way to enhance recognition and detection for rapid and accurate foetal head diagnostic.

Clinical and diagnostic features of trochanteric tuberculosis

Trochanteric tuberculosis is a very rare localization of musculo-skeletal tuberculosis. The diagnosis is difficult and is often made in a late stage. The authors describe five cases of trochanteric tuberculosis. The mean age of patients was 46.6 years. Time to diagnosis was long (7.6 months on average). The tuberculosis was plurifocal in all cases. Diagnosis was based on positive Lowenstein culture in one case, on the presence of caseum granuloma in one case and through a pathognommonic manifestation in one case. For the remaining two cases, diagnosis was established on clinical and paraclinical arguments. The patients recovered after medical treatment alone.

-643C > T RANKL gene polymorphism is associated with osteoporosis in Tunisian postmenopausal women

OBJECTIVES

The dynamic nature of the skeleton is achieved by a remodeling process. Receptor activator of nuclear factor kappa B (RANK) ligand (RANKL) stimulates bone resorption by activating RANK signaling. Therefore it is considered as a candidate gene regulating susceptibility to osteoporosis. In the current study, we have investigated the association between the RANKL gene -693G > C and -643 C > T polymorphisms and bone mineral density (BMD) in a population of postmenopausal Tunisian women.

METHODS

Polymorphic sites in RANKL gene (rs9533155 -693G > C and rs9533156 -643 C > T polymorphisms) were determined using PCR-RFLP analysis in 566 postmenopausal Tunisian women. All statistical analysis were examined by SPSS software.

RESULTS

We have detected a significant difference in lumbar spine and hip BMD for -643C > T genotypes. For -693G > C genotypes, a significant difference was detected only in hip BMD. The distribution of -643C > T genotypes and alleles between three groups (osteoporotic, osteopenic and normal women) revealed a significant association of the TT genotype with development of osteoporosis (p = 0.01; odds ratio 2.15), although for the -693G > C polymorphism, no significant results were found.

CONCLUSION

We have demonstrated the association of the -643C > T polymorphism with BMD variation and osteoporosis risk in postmenopausal Tunisian women.