Magnetic therapy in acute and subacute non-specific back pain: Results of an open multicenter study

Magnetic therapy (MT) is a non-drug method that improves the effectiveness of treatment of musculoskeletal pain, including:acute non-specific back pain (NBP). Objective of our study was to evaluate the results of complex treatment of patients with acute/subacute NBP at home using MT. The study group consisted of 339 patients with severe acute/subacute NBP. All patients received nonsteroidal anti-inflammatory drugs (NSAIDs). 166 patients (Group 1) received a course of MT (ALMAG+ device), 173 patients or a control group (Group 2) who did not receive MT. The dynamics of pain was significantly higher in group 1 than in group 2. So, the intensity of pain during movement (NRS) decreased from 7 [5;8] and 7 [5;8] to 0 [0;13] and 2 [1;3] after 1 month. (p<0.001). Significant differences between Groups 1 and 2 were observed in the dynamics of pain at rest and at night, overall health assessment (OHA), and sleep function and disorders. The average duration of NSAIDs use in Group 1 was 8.8±3.9, Group 2 – 11.8±5.7 days (p<0.001). The use of MT increases the effectiveness of treatment of acute/subacute NBP and reduces the need for NSAIDs use.

POS1134 THE EFFECT OF ETORICOXIB ON PAIN AND SIGNS OF CENTRAL SENSITIZATION IN PATIENTS WITH OSTEOARTHRITIS

Background

Central sensitization (CS) plays an important role in the development of chronic pain in osteoarthritis (OA).

Objectives

to evaluate the effect of etoricoxib on pain and signs of CS in patients with OA.

Methods

790 patients with OA (knee or hip) were included in an open observational study. Most of them (71.6%) were female, mean age 54.5 ± 13.0 years. All patients received etoricoxib 60 mg/day for 2 weeks. The dynamics of pain was assessed on a numerical rating scale (NRS 0-10), the dynamics of the sign of CS was assessed using the Central Sensitization Inventory (CSI). CSI ≥ 40 was observed in 35.3% of patients.

Results

After 2 weeks of treatment with etoricoxib, the intensity of pain at movement, at rest and at night decreased by 58.8±24.1%, 69.7±32.6% and 70.1±32.8. There was a decrease in CSI values ​​by 33.1±14.5% (p<0.001), as well as a decrease in the number of patients with CSI ≥40: from 35.3% to 10.3% (p<0.001). There were no serious complications during the treatment. The total number of adverse events was 5.9%, mainly dyspepsia and arterial hypertension.

Conclusion

Etoricoxib improved pain in OA patients and reduces the severity of signs of CS, supporting the central mode-of-action of the drug.

Disclosure of Interests

None declared

POS1110 WHAT FACTORS ARE ASSOCIATED WITH THE DEVELOPMENT OF PAIN AFTER TOTAL JOINT REPLACEMENT?

Background

Chronic postoperative pain (CPP) is one of the most common complications of total hip (HJ) and knee (CJ) arthroplasty (TA). The search for the factors that determine this pathology is an urgent scientific and practical task.

Objectives

To determine the factors associated with the development of CPP in patients who underwent TA, CJ or HJ.

Methods

The study group consisted of 124 patients with osteoarthritis of the knee or hip joint, mean age 63.6 + 9.9 years, 63% of women and 37% of men, who in 2019-2020 year done out by TA KJ or HJ. The development of CPP was assessed after 3 and 6 months. telephone survey of patients. This complication was diagnosed in the presence of moderate to severe pain (≥40 mm on a visual analogue scale, VAS), persisting for at least 3 months, causing concern in patients and / or requiring regular use of analgesics. A comparison was made between the groups of patients with CPP and the absence of CPP for a number of factors determined in the preoperative period.

Results

The incidence of CPP was 27.4%. There were no differences in the incidence of CPP in patients who underwent TA CJ and TA HJ: 28.1% and 26.9%, respectively (p = 0.88). The presence of CPP was significantly associated with such preoperative indicators as a higher body mass index (BMI), a higher intensity of pain at rest, higher values of the WOMAC pain index, WOMAC and WOMAC stiffness in general, and the severity of symptoms of neuropathic pain. (PainDetect questionnaire), signs of depression and anxiety (HADS questionnaire). The risk of developing CPP was significantly higher (p <0.05) in patients with BMI> 30 kg / m2 - odds ratio (OR) 2.755 (95% confidence interval, CI 1.053-7.206), for pain at rest ≥40 mm VAS - OR 1.349 (95% CI 0.478-3.803), Pain Detect score ≥13 - OR 3.598 (95% CI 1.048-12.36), depression score HADS ≥8 - OR 2.193 (95% CI 0.745-6.454), number of pain sources ≥ 2 - OR 6.996 (95% CI 2.358-20.756).

Conclusion

The risk of CPP after TA CJ and HJ is higher in patients with overweight, high preoperative pain, signs of neuropathic pain and depression, and in the presence of several sources of musculoskeletal pain (except for the affected joint planned for TA).

Disclosure of Interests

None declared

AB1116 RESULTS OF PRESCRIBING BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS AND JANUS KINASE INHIBITORS FOR RHEUMATOID ARTHRITIS DURING THE COVID-19 PANDEMIC: DATA FROM A TELEPHONE SURVEY OF 254 PATIENTS

Background

Prescribing biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase (JAK) inhibitors during the global pandemic of coronavirus disease 2019 (COVID-19) requires a balanced approach and rigorous monitoring of patients’ condition.

Objectives

To evaluate the effect of bDMARDs and JAK inhibitors on the condition of patients with rheumatoid arthritis (RA), taking into account the outcomes assessed by the patients themselves, as well as the incidence of COVID-19 in these patients.

Methods

A telephone survey was conducted of 254 patients with RA (age 49.8 ± 13.7 years, 83.5% women, RF + 64.4%, DAS28 5.4 ± 1.6), who in the period from January 2020 to June 2021 by decision of the medical commission of the V.A. Nasonova Research institute was first prescribed bDMARDs or JAK inhibitors: rituximab (RTX) - 148 (58.3%), TNF-a inhibitors - 57 (22.4%), JAK inhibitors - 20 (7.9%), IL 6 inhibitors - 17 (6 .7%), abatacept - 12 (4.7%).

Results

At the time of the survey, 204 (80.3%) patients continued to take the prescribed drugs. The main cause discontinuation of treatment was for non-medical reasons. Synthetic DMARDs (mainly methotrexate and leflunomide) were received by 68.0%, glucocorticoids - 45.3%, non-steroidal anti-inflammatory drugs - 44.5% of respondents. Among the patients who took bDMARDs or JAK inhibitors, 68.1% noted the “state of symptoms acceptable to the patient”, the absence of frequent joint pain - 65.3%, increased fatigue - 14.3%. The incidence of COVID-19 and hospitalization associated with this disease didn’t differ between individuals who continued and discontinued the use of bDMARDs or JAK inhibitors: 41.2% and 44.6; 13.7% and 14.0% respectively, p=0.80884. There was no significant difference in the incidence of COVID-19 and hospitalization associated with this disease in patients taking various biologics or JAK inhibitors.

Conclusion

Despite the COVID-19 pandemic, rituximab remains one of the most popular bDMARD. About a third of patients receiving bDMARDs and JAK inhibitors aren’t satisfied with their condition. More than 40% of patients treated with these drugs experienced COVID-19, and 14.0% required hospitalization.

Disclosure of Interests

None declared

AB0970 What is the effect of intra-articular injections of glucocorticoids in real clinical practice?

Background

Intra-articular injections of glucocorticoids (IAI GC) are widely used in the complex therapy of rheumatic diseases (RD). However, there are relatively few modern data on their efficacy and safety in real clinical practice.

Objectives

To evaluate the effectiveness of IAI HA in RD in clinical practice.

Methods

The study group consisted of 290 patients with RD, mainly osteoarthritis (OA) and rheumatoid arthritis (RA) (69.0% of women, age 55.6 ± 12.6 years), who underwent IAI GC in the knee joint. The indications for IAI were determined by the attending physicians. The control consisted of 112 patients with OA (71.4% of women, age 59.3 ± 14.6 years), who underwent a course of IAI of hyaluronic acid (HA). The result of treatment was assessed after 2 weeks, 1 and 3 months. according to a telephone survey.

Results

After 2 weeks, 1 month. and 3 months. after IAI GC, the severity of pain during movement decreased (numerical rating scale, NRS 0-10, Me [25%; 75%]) from 6.0 [4.0; 8.0] to 1.0 [0; 2.0], 2.0 [1.0; 4.0] and 2.5 [1.0; 4.0], respectively (p <0.001). After 3 months. the number of patients with no / mild pain (<4 according to the NRS) was 63.8%, with a complete / almost complete absence of pain (≤1 by the NRS) - 30.3%. The effect of HSI HA was higher in RA than in OA: the dynamics of pain after 3 months. -4.0 [-2.0; -6.0] and -2.0 [-1.0; -5.0], p = 0.003. In OA, the effect of HAI HA and HA did not differ: the dynamics of pain after 3 months. was -2.0 [-1.0; -5.0] and -3.0 [-1.0; -5.0] p = 0.869. There were no serious adverse reactions in IAI.

Conclusion

IAI GC are an effective and fairly safe method of short-term treatment of synovitis in RD.

Disclosure of Interests

None declared

AB0996 The possibility of long-term pain control in patients with osteoarthritis

Background

In some patients with osteoarthritis (OA), moderate or severe joint pain may persist for a long time and functional limitations may increase, which requires long-term administration of nonsteroidal anti-inflammatory drugs (NSAIDs).

Objectives

To evaluate the efficacy and safety of long-term use of NSAIDs in patients with OA in real clinical practice.

Methods

611 patients with OA (knee or hip) were included in an open observational study. 64.5% were female, mean age 58.3±11.0years. All patients received aceclofenac at a dose of 200 mg / day. Pain at movement was determined on a 10-cm visual analog scale (VAS). The number of patients with severe pain (≥6 cm by VAS) and the number of patients with pain reduction ≥50% were evaluated. The assessment was carried out 2 weeks, 3, 6, 9 and 12 months after the start of therapy. Adverse events were noted at each visit.

Results

By 12 months of follow-up, 53.3% of patients had completed the study. The mean pain severity at baseline, after 2 weeks, 3, 6, 9 and 12 months was 6,5±1,2; 4,8±1,4; 3,2±1,4; 2,6±1,4; 2,2±1,1; 1,4±1,1 cm VAS (p<0.05). The number of patients with severe pain decreased from 77.8% to 24,9%, 2,9%, 2,3%, 0,9% and 0%. The number of patients with pain reduction ≥50% was 12,0%, 65,1%, 81,0%, 88,5% and 84.0%. Adverse events were observed in about 30% of patients, mainly mild or moderate dyspepsia (11.1%- 23.3%) and arterial hypertension (7.1% - 10.9%). No serious complications were recorded.

Conclusion

Taking into account the large number of drop-outs from the study (46.7%), approximately half of the patients can have long-term pain control with NSAIDs in real clinical practice. Aceclofenac is effective and well tolerated and can be used for long-term pain control in patients with OA.

Disclosure of Interests

None declared

POS1109 GENETIC MARKERS PREDICT THE DEVELOPMENT OF POSTOPERATIVE PAIN

Background

Postoperative pain (POP) is a serious complication that affects the outcome of total arthroplasty (TA) of the knee (CJ) and hip (HJ) joints in patients with osteoarthritis (OA). The search for the genetic characteristics of POP is an urgent direction in the study of this problem.

Objectives

To determine the relationship between the polymorphisms of the KCNS1, COMT, and OPRM1 genes and the development of postoperative pain in patients with osteoarthritis of the knee joint and hip joint who underwent total arthroplasty.

Methods

The study group consisted of 95 patients with knee osteoarthritis and / or hip joint osteoarthritis (64.6% of women; mean age - 65.4 ± 9.0 years) who underwent TA CJ (47.8%) or TA HJ (52.2 %). The presence of POP was determined when it persisted or appeared after 3 and 6 months. After surgery, pain in the area of the operated joint ≥40 mm by 100 mm visual analogue scale. All patients underwent genotyping of KCNS1 (rs734784), COMT (rs6269, rs4633), and OPRM1 (rs1799971) gene polymorphisms by real-time polymerase chain reaction using original sequence-specific primers and probes labeled with various fluorescent labels. Registration and interpretation of the obtained results were carried out on a DT-96 amplifier (DNA-Technology LLC, Russia).

Results

POP was observed in 32.6% of patients who underwent TA CJ or TA HJ. The incidence of POP after TA CJ and TA HJ was 30.2% and 34.0%, respectively (p = 0.882). There were no differences in the frequencies of genotypes of the studied genes (p>0.05). The presence of the homozygous GG genotype of the KCNS1 gene polymorphism (rs734784) was associated with the presence of POP in accordance with the recessive genetic model (GG vs AA + AG; odds ratio (OR) - 3.96 [95% confidence interval (CI): 1, 51; 10.37]; p = 0.005). The presence in the genotype of the mutant allele T (TT + CT) of the COMT polymorphism (rs4633) reduced the risk of developing POP compared with the carriage of the CC genotype (OR = 0.32 [95% CI: 0.12; 0.83]; p = 0, 02) according to the dominant genetic model. There was no statistically significant correlation between the development of POP and the carriage of various genotypes and alleles of the COMT (rs6269) and OPRM1 (rs1799971) genes.

Conclusion

There is a statistically significant association between the polymorphism of the KCNS1 (rs734784) and COMT (rs4633) genes and the development of chronic POP in patients who underwent TA CJ and TA HJ. Further studies of the genetic predisposition to POP are required using more clinical material.

Disclosure of Interests

None declared

Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians

In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

AB0272 CAN NONSTEROIDAL ANTI-INFLAMMATORY DRUGS CONTROL THE SYMPTOMS OF MODERATE RHEUMATOID ARTHRITIS?

Objectives:

to evaluate the efficacy of long-term pain therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA) with an initially moderate disease activity (DAS 28 <5,1).

Methods:

the study included 404 RA patients, disease duration was more than 1 year, mean DAS 28 3.7±1.6, mean age 58.6±10.0 years, 69% women, 76,7% RF “+”, 81,5% ACPA “+”. 91,2% of the patients received conventional DMARDs (methotrexate), 8,8% - biological agents. All patients received NSAIDs (aceclofenac) to control their symptoms. Тhe follow-up period was 6 months. We evaluated the dynamics of the DAS 28 index, the level of pain and patient global health on a 100- mm visual analog scale (VAS).

Results:

the level of pain (VAS) decreased from 63,1 ± 15,4 to 46,3± 8,3 (p=0,001) by 3 months of follow-up and up to 39,5± 11,2 (p= 0,001) by 6 months of follow-up. The patient global health (VAS) also improved from 58,2 ± 13,4 at baseline to 40,3 ± 11,2 (p=0,001) at 3 months and to 35,5 ± 9,7 (p=0,001) at 6 months of follow up. The mean DAS 28 remained within the moderate disease activity and decreased from 3,7±1,5 to 3,4 ±1,1 (p=0,01) after 3 months, and to 3,1± 0,9 (p=0,01) after 6 months.

Conclusion:

long-term NSAID therapy allows to control the disease activity in patients with moderate RA. This should be taken into account when planning therapy, including deciding whether to “switch” DMARDs and prescribing biological agents.

Disclosure of Interests:

None declared

AB0267 HOW EFFECTIVE IS PAIN MANAGEMENT IN THE PATIENTS’ OPINION? DATA FROM THE COMPAS STUDY

Objectives:

to evaluate the effectiveness and satisfaction of pain management in patients with rheumatic diseases (RD) according to a survey in the COMPAS (Quality of Pain Management according to Patients with Arthritis and Back pain) study.

Methods:

the survey involved 1040 patients with RD (rheumatoid arthritis-40.6%, osteoarthritis -32.1%, spondyloarthritis-10.6%, connective tissue diseases-8.6% of patients). 76.8% were women, the mean age was 55.8±14.0 years. 35.7% of patients continued to work in their specialty, 31.6% had various degrees of disability. The effectiveness of pain therapy was evaluated by the patient in the last month preceding the survey on a 5-point scale, where 1 - no effect and 5-excellent effect. Patients ‘ satisfaction with treatment, possible reasons for the lack of effectiveness of pain therapy and the use of additional treatment tools were also evaluated.

Results:

as therapy for the underlying disease, 40% of patients received conventional disease modifying antirheumatic drugs, 33.1% - glucocorticoids, 7.2% - biological agents and 15.2% - symptomatic slow-acting drugs in osteoarthritis. At the same time, 68% of patients needed additional analgesic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Slightly less than half of the surveyed patients (46.9%) noted a moderate effect of analgesic therapy, 22.7% - a low effect and 5% - no effect, 23.7% rated the effectiveness of therapy as good and only 1.7% - as excellent. At the same time, only 15.6% of patients were completely satisfied with the result of NSAIDs, 64% were partially satisfied with the treatment and 20.4% were completely dissatisfied. As the reason of insufficient effectiveness of NSAIDs, most often (34.3%) patients named fear of adverse events associated with taking drugs, 19.4% - weak drugs, 15.3% - insufficient attention of doctors to complaints, 6.6% - poor diagnosis of the causes of pain. Others found it difficult to answer or were completely satisfied with the treatment. 40% of patients used additional methods, most often chiropractic (12.3%), acupuncture (4.8%), physiotherapy (12.7%) and folk remedies (7.4%).

Conclusion:

A significant proportion of patients with RD don’t have adequate pain control. Only 25.4% of patients rate the result of treatment as good and excellent, and even fewer patients (15.6%) are completely satisfied with the results of therapy. Thus, a personalized approach to analgesic therapy is necessary, taking into account the expectations of patients regarding the results of treatment.

Disclosure of Interests:

None declared

AB0135 A VERY EARLY CLINICAL RESPONSE TO TOFACITINIB IS ASSOCIATED WITH LOW RHEUMATOID ARTHRITIS ACTIVITY AFTER 3 AND 6 MONTHS

Background:

JAK inhibitors block intracellular signaling pathways responsible for the synthesis of cytokines and mediators involved in the development of chronic pain and central sensitization (CS). This determines a very rapid clinical response to JAK inhibitors. However, it is not clear how the significant pain reduction in the first weeks of therapy is associated with the achievement of low rheumatoid arthritis (RA) activity.

Objectives:

to assess the relationship between the early clinical response to tofacitinib and the decrease in RA activity after 3 and 6 months.

Methods:

Study group included 88 patients with RA, their age was 53±11,5, 79.3% of women, 89.8% of RF “+”, DAS28 5.2±1.2, receiving DMARDs (methotrexate 59.5% and leflunomide 19.8%), who were administered with tofacitinib 5 mg 2 times a day due to inefficacy or intolerance of biological DMARDs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration, RA activity using DAS28 after 3 and 6 months.

Results:

The mean pain severity at baseline was 5.3±2.0 according to the visual analogue scale (VAS 0-10), 51.1% of patients had signs of central sensitization (CSI ≥ 40), 15.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.1±1.8 (р<0.05) and CS – CSI from 40.4±13.5 to 36.5±12.5 (р=0.01). After 28 days, the effect was higher: the pain level (VAS) was 2.8±1.6 (p=0.000), PainDETECT decreased from 11.8±5.6 to 6.8±3.1 (p=0.000), CSI – to 31.6±13.9 (p=0.000). DAS28 after 3 and 6 months was 3.7±1.3 and 3.6±1.2. The number of patients with pain decrease of ≥50% after 28 days of therapy was 59.9%. Low RA activity after 3 months. (DAS28 ≤3.2) was achieved in 64.4% of patients. There was a clear correlation between the number of patients with significant pain reduction at 28 days and the number of patients with low RA activity after 3 and 6 months (rS=0.548, p=0.000; rS=0.790, p=0.000). Six patients withdrew from the study due to inefficacy or social reasons. There were no serious adverse reactions.

Conclusion:

The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect and reduce CS signs. An early clinical response to tofacitinib (pain relief) predicts a decrease in RA activity after 3 and 6 months of the therapy.

Limitation: Open-label observatory study.

Disclosure of Interests:

None declared

AB0714 COMPARISON OF THE EFFECT OF SUBACROMIAL ADMINISTRATION OF HYALURONIC ACID AND PLATELET RICH PLASMA IN CASES OF DAMAGE TO THE TENDONS OF THE ROTATORS OF THE SHOULDER IN INDIVIDUALS OF DIFFERENT AGE GROUPS

Background:

Everyone has had shoulder pain at least once in their life. From 70 to 80% of chronic pain in the shoulder joint is associated with subacromial impingement syndrome. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids does not always meet the needs of patients and have a number of adverse reactions. Local administration of PRP and HA preparations is widely used for chronic shoulder pain. However, the question of the effectiveness of these drugs in patients of different ages has been insufficiently studied.

Objectives:

To compare the efficacy of GLA and PRP in patients with chronic shoulder pain by age.

Methods:

The study group included 100 patients, 46% women and 54% men, aged 51.5 ± 15.1, with chronic shoulder pain (≥3 months) caused by damage to the tendons of the muscles of the shoulder rotators. Patients <45 years old accounted for 34%, patients ≥45 years old - 66%. All patients were randomly divided into 2 groups. Patients in group 1 received 2 consecutive subacromial injections of GLK, groups 2 - 3 consecutive subacromial injections of PRP. Pain dynamics were assessed using a 100-mm visual analogue scale (VAS), functional impairments according to ASS (American Shoulder and Elbow Surgeons Assessment) and CS (Constant Score), and a decrease in the need for NSAID use after 6 months. after the course of treatment.

Results:

The dynamics of pain and functional disorders in the treatment of GLC and PRP did not differ. The pain decreased from 57.6 ± 17.8 to 30.2 ± 26.3 and 56.0 ± 14.6 to 31.8 ± 26.3 (p = 0.768), ASS from 54.7 ± 15.1 to 77.3 ± 22.5 and 54.8 ± 13.8 to 74.6 ± 22.4 (p = 0.552), CS from 47.8 ± 16.9 to 65.6 ± 19.3 and 59.2 ± 14.4 to 66.9 ± 17.4 (p = 0.245). In general, with the treatment of GLA and PRP, the dynamics of pain and functional disorders was significantly better in patients <45 years old than in patients ≥45 years old. So, pain according to VAS after 6 months. was 22.4 ± 26.3 and 35.5 ± 26.2 (p = 0.022), ASS 83.3 ± 20.9 and 72.1 ± 22.6 (p = 0.017), CS 76.2 ± 16, 1 and 63.2 ± 18.2 (p = 0.001). There was no need to take NSAIDs in 82.4% and 65.2% of patients (p = 0.103). No serious adverse reactions have been reported with the treatment of GLC and PRP.

Conclusion:

The efficacy of GLA and PRP in chronic shoulder pain caused by damage to the tendons of the muscles of the rotator of the shoulder does not differ. The clinical response to both drugs was significantly higher in those under 45 years of age.

Disclosure of Interests:

None declared

AB0165 CENTRAL SENSITIZATION IN RHEUMATOID ARTHRITIS

Background:

Central Sensitization (CS) is a proposed physiological phenomenon in which dysregulation in the central nervous system causes neuronal dysregulation and hyperexcitability, resulting in hypersensitivity to both noxious and non-noxious stimuli. The term Central Sensitivity Syndrome (CSS) describes a group of medically indistinct (or nonspecific) disorders, such as fibromyalgia (FM) (1, 2).

The prevalence of FM has been estimated at 2-7% in general population, but 10-30% patients with several rheumatic diseases fulfill the FM criteria, which suggests that they have not only nociceptive pain, but signs of CS or nocyplastic pain. (3)

Objectives:

to identify the signs of central sensitization (CS) in patients with rheumatoid arthritis (RA) with the central sensitization inventory (CSI).

Methods:

We examined 43 RA patients (mean age 45.5 [29.0; 53.0] years) with chronic pain. The patients underwent rheumatological examinations; CS was diagnosed using the CSI(4).; inflammation severity (DAS28 index), pain intensity (VAS), affective disorders (HADS), and quality of life (EQ-5D) were assessed.

Results:

We recruited 36 women and 7 men, mostly with moderate and high disease activity according to the DAS28 index.

Using the CSI subclinical CS was found in 9 patients (20.9%), mild in 7 (16.3%), moderate in 8 (18.6%), severe in 16 (37.2%), and extremely severe sensitization in 3 (6.7%). Thus, 62.5% of patients with RA had had clinically significant CS (CS>40 points according to the CSI questionnaire).

Patients with the presence of CS were characterized by more severe anxiety (10.0 [7.0; 11.0] vs 5.0 [3.0; 6.0], p=0.001) and lower quality of life (0.52 [-0.02; 0.52] vs 0.52 [0.52; 0.69], p= 0.02).

The CSI tests not only pain but also other diseases associated with CS. Comorbid disorders associated with CS were found in patients with RA: 34.9% had cognitive impairment, 39.5% had signs of depression.

Conclusion:

Central sensitization was detected in 62.5% of patients with RA using the CSI questionnaire. CS is associated with anxiety and depression and negatively affects the patients’ quality of life. Chronic pain in RA can be of a mixed nature: nociceptive and neoplastic, which must be taken into account in the selection of personalized therapy.

References:

[1]Wolfe F. Fibromyalgianess. Arthritis Rheum. 2009; 61: 715-6.

[2]Martins Rocha T, Pimenta S, Bernardo A, et al. Determinants of non-nociceptive pain in Rheumatoid Arthritis. Acta Reumatol Port. 2018 Oct-Dec;43(4):291-303.

[3]Halioglu S, Carlioglu A., Akdeniz D., Karaaslan Y., Kosar A. Fibromyalgia in patients user rheumatic patients with several rheumatic diseases: prevalence and relationship with disease activity. Reumatol. Int. 2014 Sep; 34(90:1275-80 doi:10.1007/s00296-014-2972.

Disclosure of Interests:

None declared

AB0963 HOW OFTEN DO DOCTORS TREAT PATIENTS WITH LOCAL DAMAGE TO THE PERIARTICULAR SOFT TISSUES IN REAL CLINICAL PRACTICE?

Background:

Damage of the periarticular soft tissues (DPST) - tendinitis, entesitis, bursitis, etc. are one of the most common reasons for patients to contact rheumatologists and orthopedic surgeons.

Objectives:

To evaluate the frequency and localization of DPST in real clinical practice, as well as the effectiveness of therapy for this pathology in the acute period.

Methods:

68 outpatient orthopaedic surgeons evaluated the frequency of initial patient recourse due to DPST within one month. The study did not include patients with systemic rheumatic diseases such as spondyloarthritis. The localization of DPST and the dynamics of clinical manifestations were evaluated in 1227 patients (women 42.5%, cf. age 51.3±15.5 years). Non-steroidal anti-inflammatory drugs (NSAIDs), mainly meloxicam, were used as a first-line treatment for DPST. The results of treatment were evaluated after 10-14 days with repeated visits of patients.

Results:

7766 cases of primary outpatient treatment by orthopedic surgeons were evaluated. DPST was the cause of treatment in 1227 (15.8%) patients. This was the third highest incidence after acute injuries (37.2%) and knee osteoarthritis (20.6%).

In patients with DPST, the most common lesions were in the knee area (knee entesopathy, prepatellar bursitis, pes anserinus area tendinitis/bursitis) - 21.2%, the foot (plantar fasciitis) - 16.9%, the shoulder (tendinitis of the rotator cuff) – 16.4%, and the elbow (lateral and medial epicondylitis) - 15.3%. After treatment, there was a significant decrease in the severity of pain during movement – from 6.58±1.61 to 2.48±1.60 points on the numerical rating scale (p<0.001), a decrease in the intensity of pain at rest, at night and during palpation, as well as the severity of functional disorders. The need for local injection of glucocorticoids occurred in 22.1% of patients. Significant improvement was observed in all DPST localities, with 68.1% of patients rating the treatment result as “good” and “excellent”. Adverse reactions were observed in 15.0% of patients, and no serious complications were reported.

Conclusion:

DPST is the third most frequent reason of recourse to a doctor after acute injuries and osteoarthritis of large joints in the practice of outpatient orthopedic surgeons. The use of NSAIDs in the maximum therapeutic dose for 10-14 days allows for significant improvement in DPST of different localization.

Disclosure of Interests:

None declared

AB0868 EFFICACY AND SAFETY OF PULSED ELECTROMAGNETIC FIELDS IN THE TREATMENT OF OSTEOARTHRITIS: RESULTS OF A MULTICENTER BLIND PLACEBO-CONTROLLED STUDY

Background:

Pulsed electromagnetic fields (PEMF) is a well – known method of non-pharmacological treatment that is widely used in knee osteoarthritis (KOA).

Objectives:

To evaluate the effectiveness and safety of PEMF in KOA.

Methods:

The study group consisted of 231 KOA patients, 77.9% of women, age 61.9±12.2 years, BMI 30.6±5.8 kg / m2, average disease duration 5.0 [2.0;10.0] years. Patients were randomly assigned to two groups. Group 1 patients received PEMF for 14 days using a device that creates a low-frequency pulsed magnetic field, group 2-a false PEMF (a device that completely simulates a working device, but does not create a magnetic field). We evaluated the dynamics of the WOMAC index, the severity of pain at rest and when moving on a 100-mm visual analog scale (VAS), the need for non-steroidal anti-inflammatory drugs (NSAIDs), and the evaluation of the patient’s treatment result (on a 5-point scale).

Results:

Statistically significant reduction in pain, stiffness, and improved function was observed in both true PEMF and false PEMF. Thus, the WOMAC pain in Group 1 decreased from 231 [180; 290] to 110 [60; 166.3], p<0.001; in Group 2 from 212.4 [145; 260] to 143 [76.5; 200], p<0.001, the severity of pain in rest (VAS) decreased in Group 1 from 47 [27.8; 60] to 20 [10; 30], p<0.001; in Group 2 from 40 [20; 57.5] to 20 [7.5; 40], p<0.001. After therapy, the need for NSAIDs also decreased: in Group 1 NSAIDs were canceled or reduced in 33.1% of patients, in Group 2 - in 16.8% (p=0.006). For all indicators, the dynamics were statistically more significant in Group 1 than in Group 2. The result of treatment as “good” and “excellent” was evaluated by 58.5% of patients in Group 1 and 39.8% of patients in Group 2, p<0.001. No serious adverse reactions were observed when using true and false PEMF. Two patients who received false PEMF therapy was interrupted due to increased joint pain.

Conclusion:

PEMF with short-term use provides a significant improvement in the condition of KOA patients. PEMF is well tolerated and does not cause serious complications.

Disclosure of Interests:

None declared

THU0206 А VERY EARLY (7-28 DAYS) RESPONSE ON JAK INHIBITOR TOFACITINIB IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: EFFECT ON PAIN AND CENTRAL SENSITIZATION

Background:

The presence of central sensitization (CS) significantly burdens the course of rheumatoid arthritis (RA). JAK inhibitors block intracellular signal pathways including the ones responsible for synthesis of mediators and cytokines causing pain and CS. The application of JAK inhibitors is supposed to relieve pain and reduce CS severity promptly.

Objectives:

To evaluate JAK inhibitor effect on pain and signs of CS in patients with active RA 7 and 28 days after the start of therapy.

Methods:

Study group included 39 patients with RA, their age was 50.9±11.1, 79.5% of women, 89.7% of RF “+”, DAS28 5.8±0.6, receiving DMARDs (methotrexate 82.0% and leflunomide 18.0%), who were administered with tofacitinib 5 mg 2 times a day due to inefficiency or intolerance of genetically engineered biological drugs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration.

Results:

Patients initially experienced a severe pain – 5.72±2.21 according to the visual analogue scale (VAS), 53.8% had signs of central sensitization (CSI ≥ 40), 17.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.37±2.2 (р=0.01), pain decrease of 29.4±17.9% (BPI), NCP – PainDETECT from 12.9±5.5 to 10.6±5.6 (р=0.047) and CS – CSI from 43.1±12.8 to 35.9±11.2 (р=0.01). The effect had increased after 28 days: pain level (VAS) was 2.84±1.57 (р=0.000), pain decrease of 43.6±29.6% (BPI), PainDETECT 29.8±12.4 (р=0.000), CSI 26.4±13.9 (р=0.000).

During this period there were no serious adverse reactions.

Conclusion:

The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect, also due to impact on CS and NCP.

Source: National Registry patients with RA

Disclosure of Interests: :

Andrey Karateev: None declared, Ekaterina Filatova: None declared, Elena Pogozheva: None declared, Vera Amirdzhanova: None declared, Evgeny Nasonov: None declared, Alexander Lila: None declared, V Mazurov: None declared, N Lapkina: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Tatiana Salnikova: None declared, Ruzana Samigullina: None declared, Diana Chakieva: None declared, Irina Marusenko: None declared, Olga Semagina: None declared, Marina Semchenkova: None declared

SAT0079 FEATURES OF CLINICAL MANIFESTATIONS IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS IN THE PRESENCE OF SIGNS OF CENTRAL SENSITIZATION

Background:

The presence of central sensitization (CS) is observed in 25-30% of patients with rheumatoid arthritis (RA). CS is associated with more severe pain, depression, and anxiety.

Objectives:

To evaluate the effect of CS on activity indicators and clinical manifestations in patients with active RA.

Methods:

The study group consisted of 60 patients with medium or high RA activity (DAS28 ≥3.2), 75% female, age 54.5±17.8 years, 82.1% RF “+”, 75% ACPA “+”. DN4 and PainDETECT questionnaires were used to identify CS signs. Signs of CS were detected in 43% of patients. Clinical parameters and indicators of disease activity in patients with RA CS “+” and CS “- “were compared.

Results:

Groups of patients with RA CS “+” and CS “-” did not differ in age - 55.5 [48.0; 67.5] and 54.0 [40.0; 62.0], p=0.26, body mass index - 24.54 [22.6; 26.78] and 25.04 [21.34; 29.665] kg/m2, p=0.64, duration of illness: 6.5 [2.5; 13.0] and 10.0 [5.0; 16.5] years, p=0.13, level of C-reactive protein: 7.2 [1.0; 23.4] and 8.1 [3.6; 24.3], p=0.53.

SC “+” patients had a higher level of pain on a visual analog scale, VAS (patient score) - 70.0 [60.0; 80.0] and 60.0 [40.0; 70.0], P=0.01; DAS28 - 5.33 [3.38; 6.42] and 4.5 [3.645; 5.4], p=0.04; EQ-5D - 0.52 [0.02; 0.52] and 0.59 [0.52; 0.71], p=0.01; anxiety level (Hads-T) - 8.0 [7.0; 10.0] and 4.5 [2.5; 6.0], p=0.001 and depression (Hads-D) - 7.5 [6.0; 10.5] and 5.0 [2.5; 7.5], p=0.02. The groups did not differ significantly in the values of SDAI, CDAI, and HAQ, as well as in the assessment of health by the doctor (VAS) - 60.0 [50.0; 70.0] and 60.0 [50.0; 60.0], p=0.42.

Conclusion:

The presence of SC is associated with more intense pain, anxiety, depression, and DAS28 activity. This should be taken into account when planning therapy, including deciding whether to “switch” DMARDs and prescribing antidepressants and anticonvulsants.

Disclosure of Interests:

None declared