AB1408 WELL-BEING AND MENTAL HEALTH OF RHEUMATOLOGY AND FAMILY MEDICINE RESIDENTS

Background

Burnouts and poor well-being among medical residents are becoming a global concern for health institutions. Its negative consequences are far-reaching, affecting patients, coworkers, family members, and healthcare organizations as well as the burned-out resident.

Objectives

The aim of the study was to measure the extent of burnout among rheumatology and family medicineresidents’and to elucidate wellness status as well as barriers to wellness.

Methods

An online questionnaire was issued to rheumatology and family medicine residents. We collected sociodemographic data (Age group, gender, marital status, children, smoking and alcohol status, Sport and other activities, Specialty, Weekly working Hours,Vacation) and mental health measurements.

Participants were also requested to fill the 14-item Mental Health Continuum Short Form (MHC-SF) and the 5-item WHO-5 well-being form.

Multivariable logistic regression analysis was used to explain the relationship between well-being and the work circumstances.

Results

A total of 64 residents with a 0,28 sex-ratio completed the online questionnaire. Sixty-nine percent (69%) of responders were in the [25-29] age group.

Sixty three percent (63%) of responders were single and 14,1% had children.

Most residents were not smokers (76,6%) nor alcohol users(68,8%).

Eighty seven percent of responders were a family medicine resident.

Thirty four percent (34%) of responders practiced sports 2 to 4 times a year and 25% exercised 2 to 4 times a week.

The average working hours per week was 30 hours [10-70] with an average of 3,38 weeks’ vacation per year.

Seventy eight percent (78%) of residents worked overnight shifts in hospitals with an average of 1,83 shift per month.

Female sex (p=0,049), less physical activities (p=0,037) and long working hours (p=0,042) were associated with worst degree of quality of life (WHO5 Well-Being Index).

Residents who practice art and had fewer overnight shifts showed a significantly flourishing mental health (p=0,032, p=0,014) according to the MHC-SF.

Family medicine residents had more long working hours (p=0,039) and overnights shifts (p=0,047) than rheumatology residents.

Conclusion

Residents working more than 50 hours per week with more than 5 overnight shifts per month and those practicing fewer physical activities and art appear to be at high risk of developing languishing mental health according to the Who5 well-being index and the MHC-SF score. It is important to protect health care workers and to promote well-being to acquire a flourishing mental health.

Disclosure of Interests

None declared

AB0323 FACTORS ASSOCIATED TO CLINICAL INERTIA IN RHEUMATOID ARTHRITIS

Background

Clinical inertia in rheumatic diseases is defined as inability or undue delay to initiate or intensify therapy when the disease is active or de-escalate therapy when the disease is in remission. Understanding the various contributory factors to clinical inertia is helpful in ensuring appropriate planning to tackle the issue and achieving Treat-To-Target (T2T) goals.

Objectives

We aimed to identify medical therapeutic inertia in Rheumatoid Arthritis (RA) patients and to assess its contributing elements.

Methods

We conducted a monocentric study including 42 patients, fulfilling the 2010 ACR/EULAR classification criteria for RA, who consulted our outpatient department from november 2021 to January 2022. Study data collection included demographics, clinical and disease characteristics, and treatment history. The survey also contained the Satisfaction Questionnaire for Medication (TSQM) which provides validated score for four subscales: effectiveness, side effects, convenience, and global satisfaction. Treatment satisfaction was measured using a cutpoint global satisfaction score ≥ 80.

Results

Most patients were female (86%) with a mean age of 57±13 years and a mean disease duration of 10.8±4.7 years. The education level for most patients (62%) was secondary school education or less. Fifteen percent of patients were in full-time work, 27% were unemployed, and 54% were retired. RA impact on patients’ work-life was considerable, as 14.3% had retired early due to RA. Patients had moderate-to-high disease activity, with a mean DAS28 with C-reactive protein (CRP) of 4.2±1.4. Radiographic structural damage was apparent in 79% of patients. RA was immunopositive in 92% of patients. Most common comorbidities were cardiac disorders (32%), pulmonary disorders (13%), and metabolic/nutrition disorders (11%). Psychiatric disorders was present in 9.5% of patients. CsDMARDs were the most frequently prescribed medications, used in 69% cases, followed by bDMARDs used in 34% cases. A total of 54% received the anchor drug methotrexate as part of their treatment regime. Only 12% of patients used systemic glucocorticoids for RA. Only half (52%) of all patients had a planned switch of medication, despite long-standing disease and suboptimal symptom control with current DMARD therapy. Statistical analysis revealed that factors for switch decision to a different DMARD by the treating physician was: younger patient age (p=0.002), having a high disease activity by DAS28-ESR (p<0.001), worse HAQ score (p<0.001), lower global satisfaction score (p<0.001), and patient preference for oral administration (p=0.006). Predictors for not switching to a different DMARD included a higher number of comorbidities (p<0.001), lower current DAS28-ESR score (p<0.001) and lower number of concomitant medications (p=0.002). Mean TSQM scores were 62 for effectiveness, 45 for side effects, 65 for convenience, and 60 for global satisfaction. Only 16 % of patients were satisfied with their RA treatment.

Conclusion

Our study showed that patients with active RA may not be managed in consistency with recommendations. This phenomenon defined as clinical inertia, is multi-factorial including healthcare set-ups and providers, patients and their caregivers. That’s why before labelling management of rheumatic disease in an individual as a ‘failure’, careful consideration of relevant factors linked to clinical inertia may be helpful.

Disclosure of Interests

None declared

AB1227 ATTITUDES AND BELIEFS ABOUT LOW BACK PAIN OF TUNISIAN PATIENTS: A KEY PREDICTOR OF RECOVERY

Background

Low back pain (LBP) is a common problem related with significant disability and psychosocial dysfunction. Unhelpful beliefs about it are associated with higher levels of pain and may cause a delay in recovery due to unsuitable behaviours. Therefore, studies targeting these beliefs are necessary to modulate messages delivered to the population in order to decrease the burden of LBP.

Objectives

The aim of the present study was to assess the attitudes and beliefs in the management of patients with LBP.

Methods

We applied a cross sectional study including Tunisian patients with LBP. The arabic version of Back Pain Attitudes Questionnaire (10-item Back-PAQ) was used to evaluate back beliefs as a clinical screening tool. We analysed patients’ attitudes in 5 domains: vulnerability of the back (items 1 and 2), relationship between back pain and injury (items 3 and 4), activity participation during back pain (items 5 and 6), psychological influences on back pain (items 7 and 8), prognosis of back pain (items 9 and 10). For each item, the scale ranges from “False” to “True” which is the option that represents unhelpful beliefs for recovery. Intermediate labels are: “Possibly False”, “Unsure”, “Possibly True”. Responses were scored from −2 (“True”) to +2 (“False”). Unhelpful beliefs attract negative scores and vice versa.

Results

The questionnaire was completed by 32 participants (27 women and 5 men) with a mean age of 56.6 years [45-69]. The mean LBP’s duration was 9.1 years [2-28].

The mean Body Mass Index (BMI) was 29.4 [25.5-46.8]. The mean Schober’s Test and Fingertip-to-floor (FTF) were respectively 2.8 [1.5-4] and 13.2 [0-50].

The mean Visual Analogue Scale of pain (VAS pain) was estimated at 69 [40-100]. The mean Oswestry Disability Index (ODI) and Short form Health Survey (SF36) were 42.4 [28-66] and 48.3 [20-80] respectively.

Unhelpful beliefs were widespread. The mean Back-PAQ-10 score was -4 [-13 -3]. Women had significantly a lower score compared to men (-4.1 [-13-2] versus -1.6 [-5-3]) (p=0.01).

Vulnerability of the back had an average score of -2[-3-1]. The relationship between back pain and injury had a mean score of –2.4 [-4-0]. The activity participation during back pain had a mean score of -4 [-4-1]. The psychological influences and prognosis of back pain had an average score of -2[-3-0] and -1.6[-2-3] respectively.

Conclusion

The results of this survey reveal that Tunisian patients have high levels of negative beliefs about LBP. As beliefs and attitudes have been recognised as significant predictors of recovery from LBP, we should promote cognitive behavioural therapy aiming at coping with unhelpful beliefs.

Disclosure of Interests

None declared

AB1247 ASSESSMENT OF ARTICULAR AND EXTRA-ARTICULAR DAMAGE IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Juvenile idiopathic arthritis (JIA) affects patients’ well-being and can lead to disability and long-term damage. Evaluating damage in patients can be beneficial to make therapeutic decisions and take rehabilitation measures.

Objectives

To assess articular and extra articular damage in patients with JIA by the use of the Juvenile Arthritis Damage Index (JADI)1 and to identify variables that correlate with disease damage.

Methods

We conducted a cross-sectional study among patients with JIA who met the ILAR classification criteria and had a disease duration more than 12 months. Early clinical data was obtained from medical files. It included sociodemographic features, biological and radiological parameters, subtype of JIA, disease duration and ongoing treatments.

Damage was assessed in the last clinical visit using articular and extra-articular damage index1 (JADI-A and JADI-E).

Results

Thirty-two patients were enrolled in this study with a mean age of 23.8 ±11.6 years. Sex ratio was 0.6 (12 males and 20 females). The mean age of disease onset was 8.3 years [3-15], and the mean disease duration was 183.7 months [12-624].

At the last clinical examination, 71.9% of patients had joint damage with a mean JADI-A score of 5.09 ±5.4 and 40.6% of patients had extra-articular damage with a mean JADI-E score of 0.75±1.2. The most affected joints were: the elbows (43.8%), the hips (37.5%) and the wrists (25%). Extra articular damage was mainly: a growth failure (25%), osteoporosis (18.8%) and ocular damage (12.5%). Patients with polyarticular arthritis without rheumatoid factor had the highest JADI-A score with a mean of 7.83 while patients with systemic arthritis had the highest JADI-E score with a mean of 3.

Mean JADI-A score was significantly different between patients who received corticosteroids and those who did not receive them (8.5 Versus 3.4, p=0.004). Damage scores correlated with disease duration (p<0.001 for JADI-A score and p=0.034 for JADI-E score).

Damage scores were not significantly different between different classes of treatment (conventional dmards and biologic dmards).

Conclusion

Articular damage is frequent in patients with JIA. It is higher for patients on corticosteroids. Articular and extra articular damage correlate with disease duration, but they were not significantly different between classes of treatment.

References

[1]Viola and al: ‘Development and Validation of a Clinical Index for Assessment of Long-Term Damage in Juvenile Idiopathic Arthritis’.

Disclosure of Interests

None declared

AB1228 MEDICAL CARE CONSUMPTION BY TUNISIAN DOCTORS SUFFERING FROM LOW BACK PAIN

Background

Common low back pain (LBP) is a real public health problem. Indeed, LBP is associated with important socio-professional consequences and involves a raised cost for society due to absenteeism and medical consumption. Various studies show that it is also a major problem in workplace especially in hospitals.

Objectives

The aim of this study was to evaluate LBP medical consequences among doctors.

Methods

We performed a cross-sectional study including the medical staff of a Tunisian hospital. A standardized questionnaire was distributed to all departments and collected the following day. Doctors who had not responded to the questionnaire received two reminders before considering their exclusion. We defined two groups: Group 1 with acute LBP (<3 months) and Group 2 with chronic LBP (≥3 months). The following parameters were collected: consultation with a physician, self-medication, treatments used, hospitalization, use of imaging methods and objectified spinal abnormalities.

A p value inferior to 0.05 was considered statistically significant.

Results

Of the 217 questionnaires distributed to physicians, 107 (49.3%) were completed. The participants were composed of 85 women and 22 men. The mean age was 31.8 ± 7.7 years [25-57]. The mean BMI was 23.2±3.7 kg/m2 [16.6-36.7]. Consumption of tobacco and alcohol was noted in 16.7% and 20.4% of cases respectively. Five participants (4.6%) reported consumption of cannabinoids. Depression, anxiety and sleep disturbances were reported in 25.3%, 57.3% and 46.7% of cases respectively.

Among the participants, 84.3% reported having had LBP at least once in their life, and 71.3% reported LBP in the past 12 months. The mean duration of low back pain was greater than 3 months in 11.9% of cases. The mean pain intensity was 4.4 ± 1.9 [2-10].

Twenty participants (26%) consulted a doctor. It was a rheumatologist in 13 cases, an orthopedist in 7 cases, a neurosurgeon in 1 case and a family doctor in 1 case. More than half of the participants (57.5%) self-medicated.

Standard radiography was performed in 18 cases, computed tomography (CT) in 5 cases and magnetic resonance imaging (MRI) in 8 cases. The following abnormalities were objectified: degenerative disc disease (13.6%), herniated disc (22.7%) and posterior inter-apophyseal osteoarthritis (9%).

Medication use was noted in 56 cases (72.7%), functional rehabilitation in 9 cases (11.7%), back support belt in 3 cases (3.9%), epidural corticosteroid injection in 1 case (1.3%), thermal treatment in 1 case (1.3%), and surgery in 1 case (1.3%). Three doctors required hospitalization ranging from 2 to 15 days.

Medical care consumption was significantly more important in patients with chronic LBP: functional rehabilitation (6,8% in group 1 vs 50% in group 2, p<0.001), back support belt (1,6% vs 20%, p=0.046), epidural corticosteroid injection (0% vs 10%, p=0.035), thermal treatment (0% vs 10%, p=0.035), surgery (0% vs 10%, p=0.035) and hospitalization (0% vs 30%, p<0.001).

Conclusion

Medical care consumption was important among LBP and chronic LBP sufferers. Thus, a prevention strategy must be established in hospitals in order to reduce the socio-economic cost of LBP among caregivers.

Disclosure of Interests

None declared

AB0179 PATIENT’S SATISFACTION WITH TREATMENT IN RHEUMATOID ARTHRITIS: AN UNMET NEED

Background

Shared decision between rheumatologists and their patients has become an overarching principle in current treatment recommendations in rheumatoid arthritis (RA). Therefore, assessing satisfaction with pharmacological therapy, among patients, is becoming increasingly important in clinical settings.

Objectives

In this study, we aimed to assess the satisfaction of patients with RA about their treatment and to investigate the predictive factors.

Methods

A cross-sectional study was conducted including adults diagnosed with RA for more than a year and receiving their current Disease-modifying anti-rheumatic Drug(s) (DMARD(s)) for at least 12 months.

We used the treatment satisfaction questionnaire for medication (TSQM v1.4) to assess the treatment satisfaction among patients. Multivariable regression analysis was applied to determine the factors associated with treatment satisfaction.

Results

We included 70 patients (63F/7M) with a mean age of 57.8 ±10.6 [29-81] years at the time of the study. The mean disease duration was 13.71±7.2 [2-30] years.

Twenty-four (34,2%) patients were on a biologic DMARD (bDMARD).

Regarding the Disease Activity Score 28 (DAS28-ESR), 14.3% of patients had a low disease activity, 47.1% a moderate disease activity, 7.1% a high disease activity, and 31.4% were in clinical remission. The mean (SD) Rheumatoid Arthritis Impact Disease (RAID) overall score was 4.72 ±2.11. Mean (SD) TSQM scores were 65.42±14.77 for convenience, 68.71±18 for effectiveness, 70.60±24.5 for side effects, and 67.95±17.10 for global satisfaction.

Twenty percent of patients were satisfied with convenience, 38.6% were satisfied with effectiveness, 45.7% were satisfied with side effects and 30% were globally satisfied.

The multivariable regression analysis showed that the RAID overall score was inversely associated to global satisfaction (p=0.001) and to satisfaction with effectiveness (p=0.032).

Difficulty of coping (one of the RAID domains) was inversely associated to satisfaction with effectiveness and convenience.

It was, also, showed that satisfaction with side effects was inversely associated to the degree of interference of the RA on domestic work (p=0.020) and positively correlated to the degree of participation in treatment decision-making (p=0.014). In addition, satisfaction with current physician was positively associated to global satisfaction (p=0.029).

Satisfaction with convenience was inversely associated to bDAMARs (p=0.027).

Conclusion

We conclude from our data that despite the diversity of therapeutic strategies, almost two-thirds of patients remain not satisfied with their treatment. A better understanding of patients’ unmet needs and an individualized patient-centric approach would improve outcomes in RA.

Disclosure of Interests

None declared

AB0989 Plantar fasciitis in patients with knee osteoarthritis

Background

Knee osteoarthritis (OA) is a highly prevalent disease, it shares with plantar fasciitis similar risk factors including aging, occupation, obesity, and inappropriate shoe wear. The association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date.

Objectives

The aim of our study was to detect plantar fasciitis using ultrasound in patients with confirmed knee OA.

Methods

We conducted a cross-sectional study including 30 patients with symptomatic knee OA. Health status was evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The functional impairment of knee OA was determined by the Lequesne index. Ultrasound evaluation of heels was performed in all patients searching signs of plantar fasciitis (measure thickness, echogenicity, enthesopathy, calcification, erosion, doppler).

Results

The study included 30 patients. Mean age was 62.09 +/- 6.7 years. Patients reported lower back pain and heel pain in 67% (n=20) and 47% (n=14) respectively. Knee symptoms were evaluated by the WOMAC index: mean score for pain, stiffness, and physical function was 9.68 +/- 4.25, 4,18 +/- 7.55 and 27.27 +/- 16.39, respectively. Mean Lequesne index for the knee OA was 11,4 +/- 4,57. Physical examination revealed limited range of motion in knees in 33 % (n=10) with a genu flexum in two patients. Patella tap was positive in 20 % (n=6).

Heel ultrasound revealed thickening of the plantar fascia in 50% (n=15). Other sonographic abnormalities found were loss of fibrillar structure in 26.7% (n=8), perifascial collections in 13.3% (n=4), calcifications in 16.7 % (n=5) and erosions in 33.3% (n=10). No correlation was found between health status attested by WOMAC index and the presence of plantar fasciitis.

Conclusion

Our study showed that half of our knee OA patients have plantar fasciitis confirmed with ultrasound. More studies with larger cohorts are needed to explain the correlation between the two lesions.

Disclosure of Interests

None declared

AB0293 INDICATIONS AND THERAPEUTIC IMPLICATIONS OF HAND AND WRIST JOINT ULTRASOUND IN RHEUMATOID ARTHRITIS

Background

Ultrasound (US) has been increasingly used in the recent years for the diagnosis and follow-up of rheumatoid arthritis (RA) [1]. It is considered as a complement to physical examination with high sensitivity, specificity, and accuracy in detecting synovial thickening, synovial hypervascularization as well as cortical bone erosions [2].

Objectives

We aimed to study the indications of hand and wrist joint ultrasound and the implications of its findings on the management of RA.

Methods

A cross-sectional study was conducted on a sample of RA patients, fulfilling the ACR/EULAR 2010 RA classification criteria. We collected data about characteristics of the disease, its activity assessed by the Disease Activity Score 28 using C-Reactive Protein and erythrocyte sedimentation rate (DAS28-CRP, DAS28-ESR), treatment of RA (conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), biologics (bDMARDs), and corticosteroids (CS)), indication of hand and wrist joint US and the implications of its findings.

Results

Fifty-eight patients were enrolled in the study with 83% females, with a mean age of 58.5±11.8 years and a mean age at diagnosis of 46.8±12. years. RA was seropositive in 89.7% of patients and erosive in 84.5%. Most patients underwent csDMARDs treatment (67.3%), 29.3% underwent bDMARDs treatment, and 67.3% used oral CS with a mean dose of 4.9±4.4 mg/day of prednisone equivalent. Mean DAS28-CRP was 4.1±1.4, and mean DAS28-ESR was 4.9±1.5.

Hand and wrist joint US was performed for RA activity assessment in 93.1% of patients (n=54), for erosion assessment in recently diagnosed RA in 5.2% of patients (n=3), for erosion assessment in established RA in 1.7% of patients (n=1).

In patients who had US signs of active RA, treatment was modified in 73% of patients with initiation of a 3-day parenteral CS pulses (18.9%), initiation of oral CS (2.7%), escalation of oral CS dose (2.7%), escalation of csDMARD’s treatment (24.3%), adjunction of another csDMARD (5.4%), reintroduction of a csDMARD (2.7%), initiation of bDMARDs (24.3%), and switch of bDMARDs (5.4%). US findings had no implication in 27% of these patients. When inactive RA was assessed (31,5%), there was no implication on treatment strategy in 82.4% of patients, a decrease of oral CS dose in 11.8% and a single intra-articular CS injection in 5.9%.

Detecting ultrasonographic activity signs of RA in hand and wrist joint was more likely to have implications on treatment strategy than finding no activity signs (75% vs 22%, χ2=14.25, p<10-3).

The group of patients who had an implication of US findings on treatment strategy had significantly higher DAS28-ESR (5.53 vs 4.18, p=0.002).

Conclusion

Hand and wrist US had significant implications on treatment strategy of RA especially in patients with higher disease activity. However, it had no implications in some patients suggesting the complementary role of US compared to clinical determinants in RA treatment decision.

References

[1]do Prado AD, Staub HL, Bisi MC, da Silveira IG, Mendonça JA, Polido-Pereira J, et al. Ultrasound and its clinical use in rheumatoid arthritis: where do we stand? Advances in Rheumatology. 2018 Aug 2;58(1):19.

[2]Ceponis A, Onishi M, Bluestein HG, Kalunian K, Townsend J, Kavanaugh A. Utility of the Ultrasound Examination of the Hand and Wrist Joints in the Management of Established Rheumatoid Arthritis. Arthritis Care & Research. 2014;66(2):236–44.

Disclosure of Interests

None declared

AB1522 THE ASSESSMENT OF KNOWLEDGE OF NURSES BEFORE AND AFTER TRAINING ABOUT SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS

Background

Nurses’ education programs play an important role in the management of chronic diseases in rheumatology clinics. They can assume their own patient case-loads and provide an educative role to promote health.

Objectives

In order to foster educational programs, the present study aimed to assess the level of knowledge of nurses before and after targeted training sessions.

Methods

The nurses of the rheumatology department of Mongi Slim Hospital have been included initially during the month of September 2021, then later, after having followed a training during the month of January 2022.

Data were collected by two self-administrated tests. The rheumatoid arthritis knowledge assessment scale (RAKAS) (1) which consisted of 13 items, defined knowledge as awareness about the disease, its risk factors, symptoms and treatment and categorized it into four levels namely, excellent, adequate, low and poor knowledge. The tool had a maximum of 14 points. A nurse was designed to have excellent knowledge if the score was 11 and above, adequately knowledgeable if the score was between 8 and 10, low knowledge if the score was between 5 and 7 and poor knowledge if it was 4 or less. Spondyloarthritis knowledge assessment questionnaire (SPAKE) (2) with 14 questions and 72 possible responses, divided into four areas, (A) general knowledge, comprising etiology, symptoms, blood tests (score range 0-8), (B) immunogenetic test (B27 antigen) and inheritance (score range 0-3), (C) general management, including drug treatment and physical therapy (score range 0-9), (D) joint protection, pacing and priorities (score range 0-5)

The Wilcoxon signed rank test was used to assess the difference between test results before and after training. The level of statistical significance was set at p<0.05.

Results

Ten nurses were included with a sex ratio (M/F) of 0.3.

Initially, the average RAKAS score was 11.7 ± 1.2. Almost two thirds of the nurses had excellent knowledge (n= 7, 70%) and the rest (n= 3, 30%) had adequate knowledge.

The average SPAKE score was low (12.9±3.7). For the nurses interviewed in domain A, the maximum score was not reached and the average score was 5±1.6. For domain B, the maximum score was reached only once and the average score was 1.2±0.9. For domain C, the maximum possible score was not reached and the average score was 5.1±2.2. For domain D, the maximum score was not reached and the average score was low at 1.6±0.6.

For the post-training test, the average RAKAS score was 12.6±0.5 and all nurses had excellent knowledge (n= 10, 100%).

The average SPAKE score has risen (20.1±1.6). For the nurses interviewed in domain A, the maximum score was reached two times and the average score was 6.9±0.8. For domain B, the maximum score was reached four times and the average score was 2±0.9. For domain C, more than half of nurses have reached the maximum score (n=6, 60%) and the average score was 8.4±0.8. For domain D; the maximum score was not reached and the average score was 3.2±0.9.

Differences between pre- and post-training test scores were found to be statistically significant for the SPAKE questionnaire (p=0.005) but not for the RAKAS (p=0.077).

Conclusion

The nurses’ knowledge of rheumatoid arthritis was initially adequate, but not of spondyloarthritis, which improved significantly through the targeted training sessions.

References

[1]Naqvi AA, Hassali MA, Iffat W, Zia M, Fatima M, Shakeel S, et al. Development and validation of a novel rheumatoid arthritis knowledge assessment scale in Pakistani patients with rheumatoid arthritis. Int J Rheum Dis. nov 2019;22(11):2031‑44.

[2]Lubrano E. The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire. Rheumatology. 1 avr 1998;37(4):437‑41.

Disclosure of Interests

None declared

AB1517 SYNOVITIS COMPLICATING THE COURSE OF COMMON VARIABLE IMMUNODEFICIENCY: CAUSAL OR COINCIDENTAL?

Background

Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by hypogammaglobulinemia and an increased susceptibility to recurrent bacterial infections. Even though several immunological defects are involved in the pathogenesis of CVID, the genetic background of the disease remains unidentified [1]. Autoimmunity in CVID is not restricted to hematologic cells, as rheumatologic complications occur in perhaps 10% of patients, with females being more affected [1].

Objectives

Here by we report a case of a CVID complicated with RF negative synovitis.

Methods

We report a case of a 36-year-old woman who was referred to our department for oligoarthritis. She had a history of primary immune deficiency revealed at the age of 30 with recurrent pulmonary infections. The disease was complicated with type 1 diabetes and bronchiectasis and was treated with annual infusion of immunoglobulin. The patient presented with pain and swelling in both knees evolving for two months. On physical examination, she had synovitis in both knees. Laboratory investigations revealed normal blood count with elevated C-reactive protein (CRP) and erythrocyte sedimentation rate: 36.2mg/l, and 32 mm/h respectively. Synovial fluid aspiration analysis of the knee revealed an inflammatory liquid without crystals. Bacterial culture was negative. Her serum was negative for Rheumatoid Factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody and antinuclear Antibodies (ANA). Knee ultrasound revealed synovitis in both knees with Doppler signal. The Magnetic resonance imaging (MRI) of the knees showed active synovitis without any erosion. Ophthalmological assessment showed severe dry eye syndrome. As Sjögren’s syndrome was suspected, we performed a salivary gland biopsy that was normal.

Results

The patient did not fulfill criteria for auto-immune rheumatic related disease. She was treated with intraarticular glucocorticoids injections, with complete resolution of symptoms and disappearance of effusion on ultrasound. A follow-up was scheduled after one month. The synovitis has been attributed to rheumatologic involvement in the context of immune deficiency.

Conclusion

We report a rare case of RF negative synovitis complicating the course of CVID. Even though the symptoms could be mild compared to a typical RF+RA, it is important to educate clinicians as to the importance of maintaining a high index of suspicion about this rare, yet potentially treatable disease. Future research is indicated to understand the etiopathogenesis of rheumatologic manifestations in CVID.

References

[1]Yazdani R, Habibi S, Sharifi L, Azizi G, Abolhassani H, Olbrich P et al. Common Variable Immunodeficiency: Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis, Classification, and Management. J Investig Allergol Clin Immunol. 2020;30(1):14-34.

Disclosure of Interests

None declared

P032 Methotrexate and hepatic tolerance in Juvenile Idiopathic Arthritis

Background

Methotrexate (MTX) is considered as the main treatment for some juvenile idiopathic arthritis (JIA) subtypes. The hepatic toxicity of MTX has been reported in numerous studies in rheumatoid arthritis which have shown that prolonged treatment can induce hepatic fibrosis and a disturbance of the liver biologic tests. In patients with JIA, the potential hepatic toxicity of MTX needs to be confirmed.

Methods

A retrospective study of patients followed for JIA and treated with MTX was conducted. The results of the hepatic assessment looking for cytolysis or cholestasis performed during the pre-treatment assessment and then during regular checks were noted.

Results

Thirty-nine JIA patients were included. The mean age of disease onset was 8 years [1.5–17 years]. The JIA subtype was systemic in 11 cases, enthesitis related arthritis in 5 cases, rheumatoid factor seronegative polyarthritis in 15 cases and rheumatoid factor seropositive polyarthritis in 2 cases, and oligoarthritis in 2 cases. Patients were treated with low doses of corticosteroids (0.2–0.4 mg/kg) in majority of cases (82%). Non steroid anti-inflammatory drugs were used in 51% of cases. MTX was prescribed as monotherapy in 20 cases, in combination with Sulfasalazine in 6 cases and Anti TNF alpha in 12 cases. MTX has been used on average for 11 years [2 months-26 years]. This drug was stopped for ineffectiveness in 7 cases, for digestive intolerance in 2 cases and in one case for severe hepatic cytolysis after 2 years of treatment with a progressive normalization of hepatic laboratory tests after 6 months. During regular monitoring, no further disturbances of liver function were observed.

Conclusion

MTX hepatotoxicity appears to be very mild and rare in JIA. These results are reassuring given that MTX is a highly effective treatment in JIA.

P024 Efficacy and tolerance of methotrexate in patients with Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease for children. The therapeutic management depends on several factors and is based on different treatments including methotrexate (MTX). The aim of our study was to determine the efficacy and safety of MTX in JIA.

Methods

This is a monocentric retrospective study of 37 patients followed for JIA according to the 2001 International League of Association of Rheumatology (ILAR) criteria and treated with MTX. Socio-demographic, clinical, paraclinical and therapeutic data were collected. Disease activity was assessed by the JADAS score. Highly active JIA was defined as JADAS superior to 25.

Results

There were 25 boys (67.5%) and 12 girls (32.4%) with a median age of 6.3 years [4–13]. The average duration of the rheumatic disease was 2.7 years [2.5–5.3]. The type of JIA was: oligoarticular in 22 cases (59.4%), polyarticular in 10 cases (27%), arthritis related to enthesitis in 3 cases (8.1%) and systemic in 2 cases (5.4%). Twenty patients (54%) received oral corticosteroid therapy for a mean period of 1.7 years [0.6–3] with a mean daily dose of 10 mg/day of prednisone or equivalent.

Oral MTX was prescribed to all patients with a mean weekly dose of 10 mg/m2 body surface [10–15]. MTX was initiated after a mean period of 6.2 months [3.1–11.4] from diagnosis. The mean treatment duration was 50 months [34–66].

Observance of MTX was 80.5%. Remission with MTX was achieved in 28 patients (75.6%) after a mean treatment duration of 7.5 months [5–11], with a mean JADAS of 5.1 [3.5–10].

Despite good observance of MTX, eight patients (21.6%) continued to have high disease activity with a mean JADAS score of 32 [25–40].

Tolerance to oral MTX was good, with side effects occurring only with 5 patients (13.5%), such as epigastralgia in 2 cases (which disappeared after switching to the intramuscular administration), a skin reaction in one case, and hepatic cytolysis reversible when stopping the treatment in 2 other cases.

Conclusion

MTX still has a place in the therapeutic management of JIA and appears to be a well-tolerated and effective treatment.

P028 Impact of Juvenile Idiopathic Arthritis on schooling

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is one of the major causes of morbidity and physical disability. Due to frequent absences, children with chronic health impairments are also often confronted with educational difficulties. The aims of this study were to assess the impact of JIA on children’s schooling and to determine the factors that influence their school level.

Methods

This is a cross-sectional study including patients with JIA (ILAR criteria). A detailed questionnaire was completed for each participant by interviewing them or their parents as well as by information obtained from their medical records. Collected data included age, sex, subtype of JIA, disease duration, level of disability according to the Childhood Heath Assessment Questionnaire (CHAQ), visual analogue scale for patient’s overall assessment of disease activity (VASOA), duration of morning stiffness, tender joint counts (TJCs), swollen joint counts (SJCs), erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), Disease Activity Score (DAS28) for polyarticular and oligoarticular JIA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for Enthesitis-related arthritis. Medications used for JIA treatment were also documented.

Data on the school performance of patients and their siblings were obtained using telephone interviews (educational level, absenteeism, school delay by repetition, drop-out).

Results

A total of 43 patients with JIA were included, 25 female and 18 male, with a mean age of 26 years [12–51] and a mean disease duration of 237 months (5–496). The average age of the onset of the disease was 7.4 years [1.5–16].

The most common subtype was rheumatoid factor-positive polyarthritis (n = 18) followed by systematic (n = 8), oligoarticular (n = 8), rheumatoid factor-negative polyarthritis (n = 5) and Enthesitis-related arthritis (n = 4). The mean DAS28 was 3.02 [0.76 – 5.55] and the median CHAQ was 0.66 [0–3].

Twenty-nine of the children were receiving corticosteroid. Disease-modifying anti-rheumatic drugs were used by 38 of the 43 patients: methotrexate (n = 27), sulfasalazine (n = 8), leflunomide (n = 7), biotherapies (n = 16). Twenty patients had complications: Hip arthritis (n = 18), growth stunting (n = 14), uveitis (n = 5). Joint replacement was required in 11 cases.

Four patients were illiterate, 14 had dropped out of school, 24 reported repeated absences due to illness. A year of schooling was repeated by 50.85% of patients. Eleven out of 32 patients over the age of 20 had an university level. Almost 80% of patients were exempted of physical education.

There were no significant associations between the school-related problems, the socio-demographic characteristics and the various parameters of clinical and biological activity studied.

Conclusion

Our study suggested that JIA negatively affects schooling of children. More studies, with a larger sample of children, are needed to identify the variables associated with school failure in order to ensure the proper management of these patients and to increase their academic performance.

P019 Adulthood of juvenile idiopathic arthritis patients: professional outcome

Background

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of rheumatic diseases characterized by onset before the age of 16. Since the disease starts at an early age, it may lead to socio-professional difficulties in adulthood for JIA patients. This study aimed to describe the professional outcome of a series of 20 JIA patients.

Methods

A cross-sectional study including patients aged 20 years and more and fulfilling the ILAR criteria for the diagnosis of JIA was carried out. Telephone interviews were conducted. The responders answered questions about family status, current occupation, working h, eventual workplace adjustments, and sick leave frequency.

Results

Twenty patients answered the questionary; 14 males and 6 females. The mean age of the disease onset was 8 years. The mean age of patients at the time of the study was 24.27 years [20–36]. Polyarticular form was the most frequent (10 cases). Other subtypes diagnosed were systemic (4 cases), enthesitis-related arthritis (5 cases), oligoarticular (one case). Hip arthritis was observed in 8 patients and surgical intervention was needed in three. Eight patients were treated with csDMARDSs and 12 with bDMARDs.

Three of our patients were married (aged 24, 34, and 36). Five were still studying: 4 had good grades without absenteeism. However, one patient needed special aid to go to school and had a higher absence rate. Five other patients were full-time college students without absenteeism. Four patients were college graduates. Among them, two were searching for a job for &gt;6 months. The other two were full-time administrative workers with no absenteeism. One patient did need workplace adjustments. Six patients could not work because of their physical disabilities.

Conclusion

According to our results, a quarter of our patients could not access professional life. Disease activity and hip destruction are the two main factors causing JIA patients to miss out on important personal and professional opportunities.

P014 Use of prosthetic surgery in Juvenile Idiopathic Arthritis

Background

Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory rheumatism in childhood characterized by destructive potential. The involvement of weight-bearing joints constitutes an evolutionary turning point in the course of the disease, which may be responsible for a major functional handicap. In this context, arthroplasty constitutes a therapeutic alternative. Through this study, we aimed to determine the prevalence of the prosthetic surgery and its benefits in children with JIA.

Methods

This is a retrospective study of JIA patients. The diagnosis of JIA was selected according to ILAR criteria. All the patients included were followed for a minimum of 1 year. The parameters collected were: pain VAS, HAQ, Lequesnealgofunctional index (AFI), disease activity scores and mobility of the operated joint before and 6 months after surgery.

Results

Forty -four JIA patients were followed over an average period of 14 years (minimum of 1 year). The mean age of disease onset was 9 years [1.5–16 years]. Fifteen cases of coxitis (34%) and 4 cases of destruction of the knees (9%) were noted after an average course of the disease of 8 years [6 months–19 years]. Radiologically, coxofemoral ankylosis is reported in 6 cases, acetabular protrusion in 2 others and total destruction of the knee with misalignment in 2 cases. Eight patients required hip replacement surgery and 2 knee cases. In all cases, the hip prostheses were bilateral. Only one knee prosthesis was placed. The JIA subtype was rheumatoid factor seronegative polyarthritis in 5 cases and enthesitis related arthritis in 3 cases. Six months after surgery, the average AFI dropped from 15.4–4.5; the pain VAS from 73 mm to 50 mm and the HAQ from 2.5–1.06. In the polyarticular JIA, the DAS28 composite score decreased from 4.02–3.8 and in ERA patients the BASDAI decreased from 6.5–4.25 while BASFI remained stable. Recovery of joint mobility was partial in only one case. No immediate or late postoperative complications were noted.

Conclusion

Prosthetic surgery provided improvement in disease activity and recovery of gait pattern in children with severe JIA. However, the decision of an arthroplasty remains delicate in children, especially since this intervention can compromise the stature growth.

P030 Impact of methotrexate on growth in children with Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory disease which could be responsible for functional impairment and severe growth disturbance. Conventional disease-modifying antirheumatic drugs, such as methotrexate (MTX), may improve growth velocity especially by regulating systemic inflammation. The objective of this study was to evaluate the effect of MTX on growth parameters in pre-pubertal children with JIA and to determine the factors affecting the growth velocity.

Methods

We assessed height and changes in the height standard deviation score (SDS) at disease onset, at the onset of MTX and at the last follow-up visit in a cross-sectional study of JIA children. All patients were pre-pubertal when MTX began and were followed for at least 6 months afterward. We compared growth parameters (height, growth rate, weight and body mass index (BMI)) in responders and non-responders to MTX. The growth rate was defined as the number of millimeters of height acquired during 1 year. Associations between changes in the height SDS and discrete variables were evaluated using χ2 or Fisher’s exact tests. The significance level was set at 0.05.

Results

We enrolled 36 pre-pubertal children with JIA (34 boys and 12 girls) who had been treated with MTX orally. Median patient age was 6.2 years [4–13] at the onset of MTX and 8.4 years [6.1–14.9] at the latest follow-up. The median disease duration was 2.7 years [2.5–5.3]. Twenty-one patients (58.3%) had oligoarticular JIA, 2 patients (5.5%) had systemic JIA, 10 (27.7%) had polyarticular JIA and 3 (8.3%) had enthesitis-related arthritis. Nineteen children (52.7%) had received corticosteroids during an average period of 1.7 years [0.6–3] with a mean of 10 mg/day of prednisone or equivalent. The median duration of MTX at the latest follow-up was 3.1 years [0.62–5.5] with a mean MTX dose of 10 mg/m2/week [10–15]. Twenty-eight patients responded to MTX treatment and 8 did not. There were no significant differences between the responders and non-responders for age at treatment initiation, disease duration and mean MTX dose. At MTX onset, no significant differences between the two groups in terms of height (P = 0.52), growth rate (P = 0.08), weight (P = 0.74) and BMI (P = 0.9) were found. One year after MTX therapy, mean height (0.2 vs -1.1; P = 0.03), mean growth rate (0.5 vs –2.9 SDS; P = 0.01), mean weight (0.4 vs -2.3 SDS; P = 0.01) and mean BMI (0.6 vs -1.9; P = 0.04) were significantly higher in the responder group than in non responders, respectively. At the latest follow-up, this increase was significantly maintained for growth rate (P = 0.001) and height (P = 0.002) in the responder group. In the multivariate analysis, patients who required &gt;10 mg/m2/week of MTX, systemic JIA and patients with reliance on steroids had a significantly lower growth velocity after the onset of MTX (P &lt; 001, P = 0.02, P = 0.02 respectively).

Conclusion

In our study, the increase in growth parameters in pre-pubertal children with JIA was associated with a better control of the disease activity under MTX therapy.

P017 Complications of Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by onset before the age of 16. This term encompasses several disease categories, each of which has distinct methods of presentation, clinical signs, and prognosis. The study aimed to determine JIA complications in 51 patients.

Methods

A cross-sectional study including patients diagnosed with JIA according to ILAR criteria was conducted for 26 years [1995– 2021]. Epidemiological, clinical, therapeutic, and evolutive aspects were noted.

Results

Twenty-nine males and 22 females were included. The mean age of the disease onset was 7.6 years [1,5–16]. The mean age of patients at the time of the study was 23.29 years [9–45]. Polyarticular and seronegative form was the most frequent (34.5%). Other subtypes diagnosed were systemic (25%), enthesitis-related arthritis (21.2%), oligoarticular (12.5%), and seropositive polyarticular (5.8%).

Standard X-Ray imaging showed articular damage in 50% of the cases. Hip arthritis was observed in 32% and surgery was needed in 16.9%. One patient presented with atlantoaxial subluxation. Growth retardation was noted in 28.6%. Cardiac manifestations were seen in 3 patients (pericarditis = 2, myocarditis = 1), uveitis in 3 cases, renal manifestation (extra membranous glomerulonephritis) in one patient with polyarticular form. One patient was diagnosed with multiple sclerosis.

Small doses of corticosteroids were prescribed in 71.7%. Methotrexate was prescribed in 70.5% (interrupted for adverse effects in 3 patients), sulfasalazine in 30.6%, hydroxychloroquine in 5.7%, leflunomide in 15.4%. bDMARDs were needed in 16 patients: 14 patients received TNF alpha inhibitors, rituximab was prescribed for one patient with a polyarticular form, and tocilizumab in a patient with a systemic form.

A switch of bDMARDs was conducted in 10 patients: for inefficiency in 4 cases and adverse effects in other 4 cases. Three patients developed uveitis under Etanercept, septicemia under Adalimumab, an allergic reaction, and depression under Infliximab. One patient died from a convulsive seizure at the age of 9.

Conclusion

The presence of complications is an additional burden to JIA patients. A multidisciplinary approach is required for the management of these complications.

POS0634 DO BIOLOGICS IMPROVE FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Background:

Fatigue is a significant issue in rheumatoid arthritis (RA) with no accepted evidence-based management guidelines. Several studies suggested that biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) have a direct role on fatigue in RA.

Objectives:

This study aimed to compare fatigue between patients treated with bDMARDs and conventional synthetic Disease Modifying Anti-Rheumatic Drugs (cs DMARDs).

Methods:

We conducted a longitudinal study including patients with RA (ACR/EULAR 2010). Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Demographic data and the following disease-related parameters were collected: pain Visual Analog Scale (VAS), Global Patient Assessment (GPA), tender joint count (TJC), swollen joint count (SJC), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), Health Assessment Questionnaire (HAQ) and DMARDs used. Fatigue was assessed at baseline (T0), at 6 months (T6) and at 12months (T12) using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. A p value inferior to 0.05 was considered significant.

Results:

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

Eighty-three percent of patients used csDMARDs: Methotrexate (n=96), sulphasalazine (n=28), leflunomide (n=21), and hydroxychloroquine (n=12). bDMARDs were prescribed in 17% of patients: Rituximab (n=10), Infliximab (n=9), and Etanercept (n=5).

At baseline, the mean FACIT-F score was 27.1 [0-51]. Moderate fatigue was noted in 57% of cases and severe fatigue in 26% of cases. Patients on csDMARDs had a lower FACIT-F score when compared to patients on bDMARDs (26.89 versus 28.41), but the difference was not statistically significant (p=0.630).

The mean FACIT-F score was 27.41 in bDMARDs patients versus 29.80 in csDMARDs patients (p=0.497) at T6, and 32.35 versus 33.65 respectively at T12 (p=0.695).

The mean delta FACIT-F was 2.18 in bDMARDs patiens versus 2.73 in csDMARDs patients between T6 and T0 (p=0.815), and 3.94 versus 7.2 respectively between T12 and T0 (p=0.807).

When considering all patients, a significant positive correlation was noted between delta FACIT-F and delta DAS28 at T6 (r=0.418, p<0.001) and at T12 (r=0.338, p<0.001).

Conclusion:

RA patients treated with bDMARDs didn’t show significant improvement of fatigue in comparison with those treated with csDMARDs. Further studies are needed to determine if biologics improve fatigue, and whether the improvement results from a direct action on fatigue or indirectly through reduction in disease activity.

Disclosure of Interests:

None declared

AB0614 DENSITOMETRIC VERTEBRAL FRACTURE ASSESSMENT: FACTORS LIMITING GOOD VISIBILITY OF THE VERTEBRA

Background:

The radiograph of the spine is the gold standard for identifying vertebral fractures (VF). Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers that could assess VF. This technique offers the advantage of low irradiation over standard radiography but at the cost of lower image quality.

Objectives:

The aim of this study was to assess factors associated with good vertebra visibility when using VFA.

Methods:

This is a cross-sectional study including patients referred by their physicians for bone mineral density (BMD) measurement. Anthropometric data were recorded. BMD was measured using standard methods over the lumbar spine L1-L4, the total proximal femur. Results were expressed as T-scores using Dual-energy X-ray absorptiometry (DEXA). The screening for VF was performed by VFA. A professional operator analyses VFA scans and assessed the good visibility of the vertebra.

Results:

The study included 100 patients. The mean age was 61.7 ±12.6 years [18-83].The average body mass index (BMI) was 28.9 ± 24.2 kg/m2 [14.2-45.3]. The mean T-score at the vertebral site was -1.5 DS [-4.9-1.5] with a mean mass of 0.95g/cm2 [0.58-1.371]. Osteoporosis was found in 27.7 % of patients. A vertebral fracture was diagnosed in 25% of cases. The visualization of the vertebra was impaired in the upper thoracic region in 60% of cases. Poor visibility was observed in 19% of cases in the mid-thoracic spine and only in 2% of cases in the lumbar spine. No statistically significant correlation was found between good vertebral visibility and age (p=0.2), weight (p=0.5), or BMI (p=0.7). However, good visibility of the vertebra was associated with a lower height (1.7 m vs 1.5 m, p=0.03). A better vertebrae visualization was correlated neither to the BMD of the right hip (0.84 vs 0.87, p=0.4) nor to the left hip (0.85 vs 0.89, p= 0.3). Similarly, the absence of vertebral osteoporosis was not correlated with a better vertebral visualization (p=0.6).

Conclusion:

Visibility of the vertebra on VFA does not appear to be altered by the BMD and vertebral osteoporosis, suggesting safe use in the elderly. However, precautions may be taken when interpreting VFA in patients with high heights.

Disclosure of Interests:

None declared.

AB0184 SCREENING FOR DEPRESSION IN A GROUP OF TUNISIAN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Depression is thought to be common comorbidity in patients with rheumatoid arthritis (RA), which is one of the most frequent chronic inflammatory diseases.

Objectives:

This study aimed to screen for depression in RA patients, and study its relation to social and clinical parameters, as well as disease activity.

Methods:

Single-center cross-sectional study, involving patients with RA, according to ACR/EULAR criteria 2010, using the original Beck Depression Inventory (BDI) as a screening tool for depression: measures of 0–9 indicated that a patient was not depressed, 10–18 indicated mild to moderate depression, 19–29 indicated moderate to severe depression and 30–63 indicated severe depression.

Results:

Sixty-five patients were included (57 F / 8 M). The average age was 55 years [23-73]. The mean duration of the disease was 11.75 years [1-25]. Half of the patients had precarious socioeconomic conditions and no social security. Forty-two patients were unemployed. Seventeen percent of them experienced grief by losing a close family member. Both rheumatoid factor and anti-citrullinated peptides antibodies were positive in 83.1 % of cases. RA was erosive in 78.5% of cases, and deformed in 21.5 % of cases. Almost half of the patients (52.3 %) were followed for at least another chronic disease. Forty-eight percent of patients were on Methotrexate with an average weekly dose of 15.3 mg/week [10-22.5], 10% on Leflunomide, 10% on Sulfasalazine, and 45% on biotherapy. The analysis of BDI scores showed that 64.6 % of patients suffered from depression: mild to moderate in 35.4 % of cases, moderate to severe in 21.5% of cases and severe in 7.7% of cases. Depression was significantly associated with precarious socioeconomic conditions (p=0.018). A correlation between the BDI score and the Disease Activity Score (DAS28) as well as the Health Assessment Questionnaire was noted (p = 0.045 and p = 0.02, respectively). There were no statistically significant associations with the other studied data.

Conclusion:

Depression was frequent among RA patients. Our study suggests that better control of the disease may reduce the incidence of depression within this group of patients.

References:

[1]Beck, A.T., Ward, C., & Mendelson, M. (1961). “Beck Depression Inventory (BDI)”. Archives of General Psychiatry, 4, 561-571.

Disclosure of Interests:

None declared

POS1491-HPR MENTAL HEALTH OUTCOMES AMONG HEALTH CARE WORKERS DURING THE CORONAVIRUS-19 PANDEMIC

Background:

The coronavirus-19 (COVID-19) pandemic is having negative effects on societies’ mental health, particularly health care workers who are exposed to tremendous psychological stress.

Objectives:

To assess the magnitude of mental health outcomes among health care workers treating patients exposed to COVID-19.

Methods:

This cross-sectional study collected demographic data and mental health measurements from health workers in different hospitals using an online questionnaire. Participants were also asked to complete the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Insomnia Severity Index (ISI), and the 7-item Generalized Anxiety Disorder scale (GAD-7). The total scores of these measurement tools were interpreted as follows: PHQ-9 normal (0-4), mild (5-9), moderate (10-14), and severe (15-21) depression; ISI normal (0-7), mild (8-14), moderate (15-21), and severe (22-28) insomnia; GAD-7 normal (0-4), mild (5-9), moderate (10-14), and severe (15-21) anxiety.

Results:

A total of 155 health care workers with a mean age of 31.3 ± 25 years [26-45] and a sex-ratio of 0.3 completed the online questionnaire. All participants were directly engaged in diagnosing, treating, or caring for patients with or suspected to have COVID-19. Participants were divided into two groups: 79% medical (61% doctors in training and 18% hospital doctors) and 21% paramedical staff. Twenty-two participants (14.2%) had a chronic disease and 21(13.5%) had a history of depression. Nineteen (12.2%) of the participants were infected with COVID-19, 4 of whom contracted the infection in the hospital (50% during October 2020). A statement to the department of occupational medicine was made in 70% of cases. Ninety-one percent of the participants were fit for treating patients with COVID-19. The mean number of nightshifts in the COVID unit per month was 5.3. The mean number of hours of work in the COVID unit was 5 hours per day, 36 hours per week, and 62 hours per month. An increase in workload compared to the pre-epidemic was noted in 62.9% of cases. Thirteen percent of participants experienced the same anxiety level as the first time of taking care of COVID patients while 65% were rather at ease compared to the first time. Forty-seven percent of participants felt the need for psychological support and 16.7% of whom had consulted a psychiatrist. Participants were diagnosed with depression (9 cases), anxiety (13 cases), and burn-out (3 cases). The prescribed treatment was: antidepressants (5 cases), anxiolytic (10 cases), and psychotherapy (12 cases). Mild depression was detected in 13% of cases, moderate depression in 4% of cases, and severe depression in 2% of cases. Mild insomnia was detected in 41% of cases, moderate insomnia in 14% of cases, and severe insomnia in 9% of cases. As for anxiety, 33% of participants suffered from mild anxiety, 14% moderate anxiety, and 5% severe anxiety.

Conclusion:

Participants reported experiencing psychological burden and a high rate of anxiety, depression, and insomnia. It is important to protect health care workers and to promote mental well-being to survive this pandemic.

Disclosure of Interests:

None declared

AB0188 DO PATIENT-REPORTED OUTCOMES IN RHEUMATOID ARTHRITIS REFLECT DISEASE ACTIVITY?

Background:

Patient-reported outcomes (PROs) reflect the patient’s perspective and are used in rheumatoid arthritis (RA) routine clinical practice. However, PROs may be associated with other aspects of health, such as psychological distress or comorbidities, which leads to situations of discordance with objective RA assessments.

Objectives:

The aim of this study was to determine whether PROs were associated with objective assessment of disease activity.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data were collected. The following PROs were assessed: number of nocturnal awakenings, morning stiffness duration, estimation of spontaneous pain and fatigue by Visual Analog Scale (VAS), and global patient assessment (GPA). In addition, patients rated their current satisfaction with their disease state according to the Austrian school mark system (PATSAT: 1=excellent, 2=good, 3=average, 4=moderate (fair), 5=unsatisfactory). Disease activity was assessed using the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28 ESR) and C reactive protein (DAS28 CRP). We used Cohen’s kappa (κ) to determine the agreement between PATSAT and DAS28 ESR. The κ result was interpreted as follows: values ≤ 0 as indicating no agreement and 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement. A p-value inferior to 0.05 was considered significant.

Results:

We included 54 patients (45 women and nine men) with a mean age of 55±11 years old [23-69]. The mean disease duration was 9.9±5.9 years [0-20]. The mean number of nocturnal awakenings was 1.1 [0-4] and the mean morning stiffness duration was 25.1 minutes [0-120]. The mean GPA was 5.3±2.2 cm [0-10]. The mean pain VAS was 5.4±2.2 cm [0-10] and the mean fatigue VAS was 4±2.5 cm [0-8]. None of the patients described his disease state as ‘excellent’. It was considered ‘good’ in 23.1% of cases, ‘average’ in 36.5% of cases, and ‘moderate’ to ‘unsatisfactory’ in 40.4% of cases.

The mean ESR and CRP were 46.3±29.3 mm [5-120] and 15.8 mg/l [0.6-100] respectively. The mean DAS28 ESR was 4.68±1.35 [1.50-7.16] and the mean DAS28 CRP was 3.9±1.1 [1.02-6.05].

A significant positive correlation was noted between both DAS28 ESR and DAS28 CRP and, number of nocturnal awakenings (r=0.385, p=0.013 and r=0.448, p=0.002), morning stiffness duration (r=0.495, p=0.001 and r=0.617, p<0.001), GPA (r=0.485, p<0.001 and r=0.530, p<0.001), and pain VAS (r=0.594, p<0.001 and r=0.598, p<0.001). No correlation was found between the two scores and fatigue VAS.

No significant agreement was noted between PATSAT and DAS28 ESR (κ=0.077, p=0.478).

Conclusion:

PROs showed moderate to strong correlation with disease activity scores. The timely and effective use of PROs could encourage physicians to focus more on the impact of RA on patients and how patients are feeling. This in turn would facilitate shared decision making between patients and physicians.

Disclosure of Interests:

None declared

AB0770 A RARE CASE OF SYNOVIAL METASTASIS REVEALED BY KNEE PAIN

Background:

Intra-articular masses are not frequently encountered in clinical practice. However, the differential diagnosis can be broad. Synovial metastasis is a rare presentation that carries a poor prognosis with a poor survival rate.

Objectives:

Here by a case of synovial metastasis of the knee joint in a patient diagnosed with an adenocarcinoma of the lung.

Methods:

A 60-year-old man with no remarkable past medical history presented to our department of rheumatology with right knee pain. He described a dull ache and swelling in his right knee with a dragging sensation, waking him up at night on a regular basis. The symptoms lasted from 6 months and were partially improved by analgesics and anti-inflammatory drugs. On examination, temperature was normal. The knee was edematous, erythematous, and warm with a range of motion of <90°. Laboratory investigations showed high acute phase reactants, the erythrocyte sedimentation rate was 75 mm. A plain radiograph of the left knee demonstrated a lytic lesion of the upper tibia. A magnetic resonance imaging of the right knee showed diffuse enlargement of the joint space due to a tissue infiltration within the synovium. These structures demonstrated heterogeneously increased T2 signal and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyper enhancing synovium. At that time, differential considerations included severe inflammatory arthritis and synovial chondromatosis rather than unusual metastasis.

Results:

Biopsy concluded to synovial metastasis from primary adenocarcinoma. Further investigations were necessary. Chest tomography showed a tumor process of left lower lobe associated with mediastinal lymphadenopathy. The patient was treated with palliative external radiotherapy to the right knee. The evolution was marked by the appearance of multiple tracheobronchial fistulas. The patient died 3 months later due to the progression of the disease.

Conclusion:

We report a rare case of synovial metastasis concomitant to a lung adenocarcinoma. It is important to make a rapid diagnosis as early recognition of malignant infiltration into joints ensure appropriate multidisciplinary management decisions.

Disclosure of Interests:

None declared

AB0672 PSYCHOLOGIC STATE OF PATIENTS WITH RHEUMATIC DISEASES AFTER THE OUTBREAK OF SARS-COV2

Background:

The ongoing Coronavirus-19 disease epidemic is a public health emergency of international concern which could pose a challenge to psychological resilience. This is mainly the case of patients with rheumatic diseases (RD).

Objectives:

The aim of this study was to establish the prevalence of psychiatric symptoms in patients with RD and to identify factors associated with psychological stress.

Methods:

A cross-sectional study was conducted among patients with RD. They were invited to respond to a survey designed to assess their psychological response after the outbreak of the SARS-COV2 pandemic. Mental health status after the Covid-19 was evaluated using the Depression and Anxiety Scale (DASS-21). The total depression subscale score was divided into normal (0–9), mild depression (10–12), moderate depression (13–20), severe depression (21–27), and extremely severe depression (28–42). The total anxiety subscale score was divided into normal (0–6), mild anxiety (7–9), moderate anxiety (10–14), severe anxiety (15–19), and extremely severe anxiety (20–42).The Impact of Event Scale-Revised (IES-R) is a 22-item self-administered questionnaire that assesses the post-traumatic state (PTS). A cut-off point of 33 provided the best diagnostic accuracy for PTS. The level of significance was fixed at 0.05.

Results:

Sixty patients were included (42 with rheumatoid arthritis and 18 with spondylarthritis) with a mean age of 51.3 ± 13.1 years [18-75]. The majority of patients were women (63.3%), married (81.7%), with a household size of 3–5 people (67.9%). The mean disease duration was 11.9 ±5.6 [1-23] years.

According to DASS depression score almost half of the patients (47%) suffered from depression, which was classified as severe in 10% of cases. The mean DASS anxiety subscale was 12.6 ± 8.2 [1-35]. The level of anxiety was mild in 23% of cases, moderate in 25% of cases, and severe in 23.3% of cases. The mean ILES-R score was 20.4 ± 10.2 [20-38]. Women experienced more PTS than men (26.3% vs 22.7%) without reaching a statistically significant correlation (p=0.9). Patients with higher education had lower IES-R, depression, and anxiety subscale scores as compared to those who were illiterate without a statistically significant correlation (p=0.5, p=0.2, p=0.4 respectively). A positive correlation was found between anxiety score and IES-R (p=0.00). Other sociodemographic variables including disease duration, parental status, marital status, and household size were not associated with IES-R and DASS subscale scores (p>0.05).

Conclusion:

Our study showed that many of our patients with RD experienced anxiety, depression, and PTS after the outbreak of Covid-19. Professional status as well as other sociodemographic data was not associated with psychological stress.

Disclosure of Interests:

None declared

POS0159-HPR IMPACT OF SLEEP DISTURBANCES ON ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Sleep disturbances have been reported in various rheumatic diseases especially in the elderly. It may be caused by pain and depressive mood. However, reports on the impact of sleep problems in rheumatoid arthritis (RA) activity and functional status were limited.

Objectives:

To assess sleep quality in elderly patients with RA and its impact on disease activity and functional status.

Methods:

This cross-sectional study included 70 RA patients aged ≥ 65 years fulfilling the ACR/EULAR criteria. Sociodemographic data were collected. RA activity was assessed with the Disease Activity Score (DAS28) and functional status with the Health Assessment Questionnaire (HAQ). Sleep quality was assessed using Arabic translated versions of two indexes: the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). An ISI score of [8-14], [15-21], and [22-28] determined respectively mild, moderate, and severe insomnia. A PSQI score > 5 determined poor sleep quality. ANOVA test was used to assess the relationship between DAS28 erythrocyte sedimentation rate (ESR), HAQ, and sleep quality indexes.

Results:

This study included 52 females and 18 males with a mean age of 68.3 ± 25 years [65-81]. Seventy percent of patients were married, 27% were widowed and 2% were divorced. Seventy-one percent of patients were illiterate, 18% had primary education and 11% had secondary education. Eighteen percent of patients were employed whereas 34.7% were retired. A history of depression was noted in 16.5% of patients. The mean duration of RA was 17.4 ± 5.2 years. Eighty-five percent of patients were on conventional synthetic DMARD whereas 15% were treated with biologic treatment. The mean patient’s global assessment of disease activity was 5.2 ± 1.3. The mean tender joint count and mean swollen joint count were 8 ±1.5 and 5 ±1 respectively. The mean DAS28 ESR was 4.7 ±0.9. The mean HAQ was 2.4 ± 0.45. Poor sleep quality was detected in 84% of cases according to the PSQI score. Mild insomnia was detected in 46% of cases, moderate insomnia in 34% of cases, and severe insomnia in 12% of cases. RA activity was higher in patients with poor sleep quality: the mean DAS28 ESR was 5.2 in patients with severe insomnia, 4.82 in moderate insomnia, and 4.13 in mild insomnia; p= 0.00 respectively. The mean ESR was 31.5 mm in patients with severe insomnia, 22.1 mm in moderate insomnia, and 10.6 mm in mild insomnia; p= 0.01 respectively. Furthermore, the higher the PSQI was, the higher DAS28 ESR is (p =0.01). However, no association was found between poor sleep quality and joint count, swollen joint count, CRP, and HAQ.

Conclusion:

Disease activity was a major contributor to poor sleep quality in elderly patients with RA. Functional status however wasn’t associated with insomnia. Physicians should include sleep in the clinical assessment of RA patients to improve their quality of life.

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

Conclusion:

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

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

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

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

G: Group

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

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

Conclusion:

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

References:

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

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

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

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

Results:

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

Conclusion:

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

References:

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

Disclosure of Interests:

None declared

AB0174 FATIGUE IN RHEUMATOID ARTHRITIS: A CASE-CONTROL STUDY

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

Conclusion:

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

Disclosure of Interests:

None declared

AB0590 ARTHRITIS OF THE KNEE AND BALANCE DISORDER

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

Conclusion:

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

References:

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

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

Disclosure of Interests:

None declared.

AB0173 FACTORS ASSOCIATED WITH FATIGUE AND PERSISTENT FATIGUE IN RHEUMATOID ARTHRITIS

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared

AB0592 ASSESSMENT OF KNOWLEDGE OF THE APPLICATION OF TOPICAL ANALGESICS

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

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

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

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

Conclusion:

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

References:

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

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

Disclosure of Interests:

None declared.

AB0597 COMPLIANCE WITH CLINICAL PRACTICE GUIDELINES IN KNEE OSTEOARTHRITIS

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

Conclusion:

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

Disclosure of Interests:

None declared

POS0577 EVALUATION OF COPING STRATEGIES IN RHEUMATOID ARTHRITIS PATIENTS

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

Disclosure of Interests:

None declared

AB0615 ASSESSMENT OF THE IMPACT OF OBESITY ON BONE LOSS

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

Disclosure of Interests:

None declared.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests:

None declared.

Sexual dysfunction and its determinants in women with rheumatoid arthritis

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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