Factors associated with poor prognosis of hip arthritis in juvenile idiopathic arthritis: Data from the JIR cohort

OBJECTIVES

Hip involvement remains a predictor of severe juvenile idiopathic arthritis (JIA) course and carries a high risk of disability. This study aims to determine the factors of poor prognosis of hip involvement in patients with JIA and to assess the treatment response.

METHODS

This is a multicenter observational cohort study. Patients were selected from the JIR Cohort database. Hip involvement was defined as clinically suspected and confirmed by an imaging tool. Follow-up data were collected during 5 years.

RESULTS

Among the 2223 patients with JIA, 341(15%) patients had hip arthritis. Male gender, enthesitis-related arthritis, and North African origin were factors associated with hip arthritis. Hip inflammation was associated with disease activity parameters during the first year, particularly Physician Global Assessment, joint count, and inflammatory marks. Structural hip progression was associated with early onset of the disease, a longer time to diagnosis, geographic origin, and JIA subtypes. Anti-TNF therapy was found to be the only treatment able to effectively reduce structural damage progression.

CONCLUSION

The early onset diagnostic delay, origin, and systemic subtype of JIA predict a poor prognosis of hip arthritis in children with JIA. The use of anti-TNF was associated with a better structural prognosis.

The concept of telemedicine in pediatric rheumatology in Tunisia: Parents' perceptions

INTRODUCTION

With the COVID-19 pandemic, health care systems are facing challenges in delivering proper patient care. Children and adolescents with juvenile idiopathic arthritis require specialized and comprehensive attention. In this context, telemedicine is an alternative that has the potential to improve access to healthcare in addition to cost savings. The objective of our study was to evaluate parents' willingness for telemedicine and factors helping to adopt this alternative in the era of COVID-19.

METHODS

We undertook a cross-sectional study via structured phone interviews of parents' JIA patients as well as those with no established diagnoses. We evaluated their point of view and willingness to adhere to TM.

RESULTS

The study included 40 parents. The main reasons for favoring TM were avoiding hospitals during the pandemic (32.5%), time saving (27.5%) as well as avoiding school absenteeism (27.5%). The main reasons for preferring a live consultation were the fear of a possible discrepancy between physical and distant evaluation (47.5%) and the fear of the trivialization of the disease (38.5%). There was no association between preference for TM and a family history of COVID-19 (p = 0.704) as well as electronic devices afforded (p = 0.263). However, patients who lived away from hospital, not familiar with the concept of TM and with higher income adhered less to TM.

CONCLUSION

Unlike the literature data, our study showed the low prevalence of parents willing to accept TM as a model of care. This imply an urgent need for parent and patient education to promote TM especially in pediatric rheumatology.

10 Impact of the month of birth on the development of juvenile idiopathic arthritis among Tunisian children

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory disease influenced by genetic as well as environmental factors. Prior studies from Israel and USA suggested that JIA had a seasonality of birth, with birth peaking in winter and especially in January.

Objectives

The aim of the study was to evaluate the impact of month of birth and season, and the onset of JIA in Tunisian children.

Methods

We conducted a case-control study including 27 children with JIA compared with a homogeneous control group of 27 children hospitalized in a pediatric orthopedic unit for traumatic reasons and healthy for any chronic inflammatory rheumatism. Statistical differences between groups were also analyzed by non-parametrical tests.

Results

Fifty-four patients (25 females and 29 males) were enrolled. The mean age was 11.04 ± 5.58 years and the mean duration of the diseases was 5.29 ± 3,18 years. The frequency of each JIA subset was at follows: polyarticular rheumatoid factor positive (n = 2), polyarticular rheumatoid factor negative (n = 5), psoriatic arthritis (n = 1), enthesitis-related arthritis (n = 11) and oligoarthritis (n = 8). Although the majority of children with JIA were born in November (22.2%) and December (18.5%), there was no significant difference in month of birth distribution between the cases and the controls. Likewise, there was no significant correlation between season of birth and the onset of the disease (p = 0,6).

Conclusion

This study didn’t show any correlation between season and month birth, and the onset of JIA. Our result may be explained by the weather in Tunisia which is relatively warm with little variation in temperature between seasons compared with the country where they found a significant correlation. It also may be due to the limited number of our cases.

22 Monitoring of juvenile idiopathic arthritis: don’t miss the foot deformities!

Background

Foot deformities seem to be frequent in children with Juvenile Idiopathic Arthritis (JIA) [1,2]. These deformities can deeply affect the child’s activity and alter his quality of life.

Objectives

To study the association between disease activity and foot deformities in JIA patients.

Methods

We conducted a cross-sectional study including patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria for JIA. For each patient, we collected the following data: age, disease duration, tender joint count (TJC), swollen joint count (SJC), Patient Global Assessment (PGA), Visual Analogic Scale (VAS), and therapeutic management. Disease activity was assessed using the Juvenile Arthritis Disease Activity score (JADAS). Foot deformities were assessed using an optical podoscope. C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) levels were measured. Statistical analysis was performed using SPSS software.

Results

We included 35 patients. Forty-three percent of the patients were boys (n = 15). The mean age was 12.2 ± 3.61 years. The mean disease duration was 4.1 ± 3.29 years. The mean PGA and the mean VAS were 3.4 ± 3.02 and 3.37 ± 2.92, respectively. The mean TJC and the mean SJC were 1.48 ± 1.69 and 0.61 ± 0.77, respectively. The mean CRP and ESR were 7.51 ± 11.85 mg/l and 18.88 ± 15.53 mm, respectively. Twenty-four patients were under non-steroidal anti-inflammatory drugs (69%), 12 patients were under methotrexate (34%), and 5 patients were under TNFα inhibitor (14%).

The mean JADAS was 7.58 ± 6.3. Seventeen percent of the patients had the inactive disease (n = 6). Foot deformities were found in 80% of the patients (n = 28). They were flatfoot in 40% (n = 14) and pes cavus in 46% (n = 16). These deformities were bilateral in 18 cases (51%). Hallux valgus was present in 14% of the cases (n = 5). Foot deformities were associated to a higher PGA (4.04 ± 3.01 vs 0.86 ± 1.2, p< 10^–3), VAS (3.93 ± 2.94 vs 1.14 ± 1.46, p = 0.022), CRP level (8.84 ± 13.1 vs 2.79 ± 2.5 mg/l, p = 0.039), and higher JADAS (9.12 ± 6.25 vs 2.08 ± 1.93, p< 10^–3).

Conclusion

Our study showed that foot deformities are common in JIA. Interestingly, these deformities are associated with a higher CRP level and a higher disease activity. These results suggest that an early screening of foot deformities is advisable in patients with active disease.

References

1. Truckenbrodt H, Häfner R, von Altenbockum C. Functional joint analysis of the foot in juvenile chronic arthritis. Clin Exp Rheumatol. 1994; 12 Suppl 10: S91-96.

2. Gschwend N, Ivosevic-Radovanovic D. [The child’s foot in juvenile polyarthritis (cP)]. Orthopade. 1986; 15(3):212–9.

21 Disease activity and body mass index in juvenile idiopathic arthritis: is the truth revealed?

Background

Objective

Methods

Results

Conclusion

19 Maternal and early childhood exposures in relation to juvenile idiopathic arthritis

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. JIA likely has a complex aetiology, with multiple genetic and environmental factors contributing to its development. Existing data on associations between maternal and early childhood exposures and JIA is rare. Previous studies showed potential role for prematurity, number of siblings and infections.

Objectives

The aim of our study is to assess maternal and early childhood exposures in patients with JIA.

Methods

Mothers of children with JIA followed in rheumatology department were asked about maternity related data as well as the course of perinatal period of the child with JIA based on the International League of Associations for Rheumatology (ILAR) criteria. Exposure information from birth included: Maternal factors (age when they had the first child, age when they had the child with JIA, plurality (singleton, twin/multiple gestation), number of prior fetal losses, number of prior births; delivery method (vaginal, cesarean section)) and also information about birth weight (low (&lt;2500 grams), normal (2500– 4000 grams), excessive (4000+ grams)); size for- gestational-age and gestational age (preterm, normal term, post term) and postpartum complications.

Results

Thirty children (sixteen females and fourteen males) with JIA were included. The most common type of JIA was enthesitis-related in 13 cases, then oligoarthritis in 8 cases, polyarthritis without rheumatoid factor in 4 cases, polyarthritis with positive rheumatoid factor in 2 cases and psoriatic arthritis in 3 cases. The mean age of the mothers was 27.1 years [22–40] when they had their first child and 30.27 years [22–42] when they had their child with JIA. They were nulliparous in 40% of the cases. All of the children were from a singleton pregnancy. Thirty percent of the mothers had at least one prior fetal loss before they had their child with JIA. During their pregnancy with their child with JIA, five mothers had pre-eclampsia and two of them had gestational diabetes. None of them smoked during the pregnancy. Only 2 children had preterm birth. Birth weight was normal (2.500–4.000 grams) in 24 cases, low in 3 cases (&lt;2.500 grams) and above normal (&gt;4000 grams) in 3 cases. Size for gestational age was normal in all cases. Nineteen mothers had vaginal delivery and eleven had cesarean section. Neonatal complications were noted in 7 cases who needed to be admitted to neonatal intensive care unit (1 for hypoglycemia, 1 for jaundice, 2 for infection, 1 for respiratory distress and two because of preterm birth). Maternal complications were noted in four cases: 2 postpartum hemorrhage and 2 postpartum infections.

Conclusion

Our study assessed maternal and early childhood exposures in patients with JIA. Further studies are required to explore associations between these factors and the occurrence of the disease for a better knowledge of etiologies of JIA and for a possible prevention from this pathology.

AB0215 DOES THE PARITY IMPROVE THE RHEUMATOID ARTHRITIS ACTIVITY?

Background

The parity seems to decrease the risk of auto-immune diseases like Rheumatoid arthritis (RA). The risk reduction appeared when the parity number reached two [1]. The activity of RA improved during pregnancy and flares postpartum, but the relationship of parity to RA prognosis is unclear. The impact of childbirth on disease activity is less studied.

Objectives

We aimed to investigate the impact of parity on rheumatoid arthritis activity.

Methods

We conducted a retrospective study including patients fulfilling the American Congress Of Rheumatology / European League Against Rheumatism (ACR EULAR) 2010 criteria.

We collected epidemiological, clinical, biological (C-reactive protein: CRP, erythrocyte sedimentation rate (ESR), immunological status (rheumatoid factor RF and anti-citrullinated protein/peptide antibody ACPA), and disease activity index (The Disease Activity Score 28 DAS 28). We divided our patients into two groups: group (G1): the nulliparous women; group 2 (G2): women who gave birth.

Results

Ninety-two patients were enrolled. There were 14 men and 78 women. The mean age was 59.56 ± 11.7 years. The mean disease duration was 9.32 ± 8.22 years. Among 78 women, we found 50 patients with parity. The main swollen joint was 3.34 ± 3.6 in G2 versus 4.44 ± 4.04 in G1 (p=0.94). The mean painful joints were 6.74 ± 5.12 and 9 ± 9.19 (p=0.28), respectively. However, the inflammatory syndrome is higher among women in G2. The mean CRP level was 15.1 mg/l, and the mean ESR was 37.7 mm. In G1, the RF and ACPA were 131 UI/l and 281 UI/l, respectively compared with 568 UI/L and 315UI/l, respectively in G2.

A significant difference was noted in the DAS28-CRP between the two groups (G2: 4.18 ±1.23 versus G1: 4.49 ± 2.5, p=0.04).

However, no association was found between parity and disease activity using the DAS28-ESR.

Conclusion

Our study showed that parity could have a protective effect on disease activity. It seems to be associated with a lower joint count and a lower rate of RF and ACPA. However, more studies are necessary to conclude these issues.

References

[1]Chen WMY, Subesinghe S, Muller S, Hider SL, Mallen CD, Scott IC. The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. avr 2020;50(2):252‑60.

Disclosure of Interests

None declared

AB0819 Impact of childbirth on the sacroiliac joints in non-radiographic axial Spondyloarthritis

Background

The era of magnetic resonance imaging (MRI) has contributed to a better assessment of patients with early disease stages of axial spondyloarhtis (ax-SpA), to the extent that a new entity has emerged. Indeed, the spectrum of SpA has broaden to include non-radiographic axial spondyloarthritis (nr-axSpA). Childbirth has been found to be associated with bone marrow edema (BME) in the sacroiliac joints (SIJ) [1], yet the extent of these lesions is inadequately described, which complicates the distinction with nr-axSpA.

Objectives

This study aimed to explore the impact of childbirth on MRI findings and BME in nr-axSpA.

Methods

We conducted a cross-sectional study including women diagnosed with nr-axSpA according to the ASAS (Assessment of SpondyloArthritis international Society) criteria. Socio-demographic data as well as childbirth history were recorded. The sacroiliac joints manoeuvers’ examination were also transcribed. Ultrasound of the SIJ as well MRI-SIJ was performed in all the women. The sequence protocol included the following: T1-weighted, T2-weighted and axial STIR and were scored for BMO. We investigated an association between the number of children and MRI abnormalities mainly the presence of BME. The level of significance was fixed for p<0.05.

Results

The study included 30 women. The mean age at diagnosis was 40±9.8 years old [21-59] and the mean age at inclusion was 49±11 years old [26-74]. The median number of children was 2 [0-7]. Half of the patients were multiparous. Doppler ultrasound of the SIJ was found in 59.1% of cases. Overall, 36.7% of the women fulfilled the ASAS definition of a positive MRI. BME was displayed on STIR MRI sequence in 26.5% of cases and was equally present at the right SIJ compared with the left (26.7% vs 23.3%). Gadolinium enhancement was found in 16.7% of cases and subchondral erosions were found in 36.7% of cases. There was no association between the different sacroiliac maneuvers on physical examination and the number of children: distraction test (p=0. 145), compression test (p=0.088), Gaenslen test (p=0.475), and Mennel test (p=0.088). BME was more frequent among multiparous women (33% vs 29%) without reaching a statistically significant difference (p=0.635). There was no association between the number of children and Hyper T1 (p=0.608), T1 gadolinium (p=0.55) as well as sclerosis (p=0.55). Similarly, there was no association between the presence of Doppler signal on ultrasound and multiparity (p=0.5).

Conclusion

Our study showed that MRI-SIJ findings were similar in nr-axSpA women regardless of the number of children, mainly BME. More trials are needed to evaluate the discriminatory capacity of MRI abnormalities and to palliate to the lack of specificities of the ASAS MRI criteria.

References

[1]Germann C, Kroismayr D, Brunner F, Pfirrmann CWA, Sutter R, Zubler V. Influence of pregnancy/childbirth on long-term bone marrow edema and subchondral sclerosis of sacroiliac joints. Skeletal Radiol. 2021;50(8):1617-1628.

Disclosure of Interests

None declared

POS1313 HIP INVOLVEMENT IS A MORE FREQUENT COMPLICATION IN ENTHESITIS-RELATED ARTHRITIS COMPARING TO THE ADULT SPONDYLARTHRITIS

Background

The hip disease develops in 30% to 50% of children with juvenile idiopathic arthritis (JIA) and is associated with poor outcomes and functional impairment. The coxitis in enthesitis-related arthritis (ERA or juvenile-onset spondyloarthritis) patients was frequent but weakly studied.

Objectives

To assess the occurrence of coxitis in patients with ERA and compare it to that of older patients with spondyloarthritis (SpA).

Methods

We conducted a retrospective comparative study including patients with ERA and adult spondyloarthritis patients.

The first group included patients under 16 years old fulfilling the International League of Associations for Rheumatology (ILAR). The second group of patients fulfilled the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria.

We studied the socio-demographic characteristics of both groups, the hip involvement occurrence, and the treatment modalities.

Quality of life was appraised by the Study 36-item Short-Form Health Survey (SF-36) and the Ankylosing spondylitis quality of life test (ASQOL).

Results

Forty ERA (mean age= 25,3 ± 10,15) patients and 134 SpA (mean age=37,96±11,77) patients were enrolled. Seventeen ERA patients (42,5%) had coxitis at recruitment compared to 28 SpA patients (20,9%), p=0,06. More than half of the ERA patients were positive to HLAb27, compared to the SpA group (44,7%) without reaching a significant threshold, p=0,07. The mean delay of coxitis onset in ERA patients was 4,66 ± 8,46 years, and was 5,65 ± 6,85 years in SpA patients, with no significant difference between the two groups (p=0,527). There was no difference between the two groups for the coxitis being unilateral or bilateral (p=0,272 and 0,169 respectively). Regarding the treatment approach, local therapy was proposed to 11 patients in the ERA group and 13 patients in the SpA group (p=0,07), with synoviorthesis being the most common therapy. Total hip replacement was done in 8 ERA patients (of which seven were bilateral) and in 17 SpA patients (of which ten were bilateral), without reaching the significant threshold (p=0,858). There was no significant difference between the two groups on the period when the total hip replacement was done (p=0,925). Quality of life assessed by the ASQOL and the SF-36 was comparable between the two groups (p=0,666 and 0,326; respectively).

Conclusion

Our study shows the high prevalence of hip involvement in the juvenile group of SpA. This complication occurs within the five years of disease outcomes and constitutes a turning point in their lives.

Disclosure of Interests

None declared

AB1255 ASSESSMENT OF SLEEP DISTURBANCES IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Sleep problems are common among children with chronic illnesses such as Juvenile Idiopathic Arthritis (JIA), which is one of the most common rheumatic diseases in childhood. Sleep disturbances collectively refer to impairments in the ability to initiate or maintain sleep. They can be measured by parent or child self-report and by objective measures such as actigraphy and polysomnography.

Objectives

The aim of this study was to assess sleep disorders in children with JIA.

Methods

Parents of children suffering from JIA (according to the International League of Associations for Rheumatology (ILAR)), followed in rheumatology department were asked to complete a specific specialized scale for children (HIBOU) [1] to screen sleep disorders. This scale assesses five aspects of sleep: irregular schedule and daytime drowsiness, insomnia, moves in sleep, nose obstruction and ultra-vigilance. Parents were asked to answer 8 questions rated from 1 to 3 according to the frequency of the problem, 1: rarely, 2: 3 to 4 times a week and 3 if 5 to 7 times a week. If the sum is ≤ 9, only sleep hygiene is recommended. If the sum is between 10 and 15 the child requires regular supervision. If the sum is between 16 and 24, the child needs to be referred to a specialist. General demographic and clinical information (family history of chronic inflammatory disease, child’s current age, diagnosis and type of JIA, duration of disease progression and activity of the disease) were also collected.

Results

Twenty-four children with a mean age of 12 years [4-16] were included in the study. The gender ratio was 1. The mean duration of the disease was 4 years with extremes from three months to thirteen years. The frequency of each JIA subset was as follows: polyarticular with rheumatoid factor (n= 2), polyarticular without rheumatoid factor (n=5), psoriatic arthritis (n= 1), enthesitis-related arthritis (n=10) and oligoarthritis (n= 6). Irregular sleep schedule and daytime drowsiness were reported at least 3 times a week by 58.3% of the children. Insomnia and inability to initiate sleep were reported in 29.3% of the children at least 3 times a week. Parents reported exaggerated moves during sleep in 50% of the cases and airway obstruction or snoring in 58.3% more than 3 times a week. Difficulties to maintain a good night of sleep more than three times a week were reported in 25% of cases. To sum up, 29.2% of the children had a score above 15 and needed to be referred to a specialist and 58.3% of them need a regular supervision of their sleep and may need to be referred to a specialist. Only three children had a score under 9 and don’t have concerning sleep disorders according to this scale.

Conclusion

This study showed that sleep disorders are a common challenge in children and adolescents with JIA which could have a huge impact on their physical and psychosocial health-related quality of life. This study highlights the need for assessment of sleep disorders in JIA patients.

References

[1]Benhaberou-Brun D. HIBOU: pour évaluer les troubles du sommeil [HIBOU: evaluating sleep disorders in children]. Perspect Infirm. 2011;8(6):35-37.

Disclosure of Interests

None declared

AB0820 Remission criteria in non-radiographic axial spondyloarthritis: don’t miss subclinical inflammation

Background

With the advent of the treat-to-target strategy (T2T), clinical remission has become the main objective to achieve in patients with rheumatic diseases. Contrary to rheumatoid arthritis, the T2T strategy is less codified in axial spondyloarthritis, even more in non-radiographic SpA (nr-axSpA) [1]. More importantly, T2T based on imaging remission and guidance for tapering medication has not been extensively studied.

Objectives

The objective of this study was to investigate the prevalence of bone marrow edema in the sacroiliac joint of nr-axSpA patients in remission.

Methods

We undertook a cross-sectional study including nr-axSpA patients according to the ASAS criteria, treated with NSAIDs. Socio demographic data as well disease characteristics were recorded. Disease activity parameters were also collected including the duration of morning stiffness, the number night awakening, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). MRI-SIJ was performed for all the patients. All the images were screened for bone marrow edema with the corresponding sequence (short tau inversion). To define remission, we used in addition to BASDAI<4, more stringent criteria: BASDAI<4 and CRP<6 mg/l and ESR<20 mm/h and EGM<4 [2]. The level of significance was fixed for p<0.05.

Results

The study included 43 nr-axSpA patients. There was a female predominance with a sex ratio of 0.43. The mean age of the patients was 42±12 years [20-71] and the mean disease duration was 17±9.7 years [4-38]. The mean ESR and CRP were 2.2 mg/L [2-65] and 6.4mm/h [1-47], respectively. A higher level of acute phase reactants was found in 40.5% of cases (ESR: 35.7%, CRP: 11.9%). Forty percent of the patients had high CRP or ESR despite BASDAI<4. According to BADSAI<4, of the 15 patients in remission, BME was displayed in 43.5% of the cases. According to the used criteria, 25.6% of the patients were in remission, of which 45.4% exhibited BME in the sacroiliac joint. There was no statistically significant association between disease activity according to the used definition and the presence of BME (p=0.473). Nr-axSpa patients in remission without BME had more durable morning stiffness and articular involvement without reaching a statistically significant difference (p=0.361, p=0.08 respectively). Similarly, we did not find an association between this subgroup and sex, age, night awakenings, the presence of HLAB27 (p>0.05).

Conclusion

Our study showed that even when using stringent criteria, subclinical remission evidenced by BME was not achieved in nr-ax SpA. Nevertheless, imaging remains one important parameter to consider in therapeutic decision making. More studies are needed to identify the best criteria for an optimal remission in this population.

References

[1]Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis?. Rheum Dis Clin North Am. 2020;46(2):311-25.

[2]Navarro-Compán V, Plasencia-Rodríguez C, de Miguel E, et al. Anti-TNF discontinuation and tapering strategies in patients with axial spondyloarthritis: a systematic literature review. Rheumatology (Oxford). 2016;55(7):1188-94.

Disclosure of Interests

None declared

AB1262 PERFORMANCE OF JADAS-ESR AND JADAS-CRP IN THE ASSESSMENT OF DISEASE ACTIVITY IN TUNISIAN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

The Juvenile Arthritis Disease Activity Score (JADAS) is a feasible tool which consists of four items: tender (TJC) or swollen joint count (SJC), the physician and the patient’s/parent’s global assessment and the erythrocyte sedimentation rate (ESR). C-reactive protein (CRP) has also been suggested as an alternative inflammatory marker.

Objectives

To compare the performance of JADAS-ESR and JADAS-CRP in the evaluation of JIA activity.

Methods

Twenty nine patients who met the International League of Associations for Rheumatology (ILAR) criteria for JIA were enrolled in the study. Disease activity was assessed by the JADAS-ESR and JADAS-CRP scores at 54 consultations, 29 at baseline and 25 during the last follow-up consultation. Data of JIA subtypes, disease duration and treatment were retrospectively collected from medical records. All data were checked for normality by the Kolmogorov-Smirnov test. The Spearman correlation was used for data analysis and p values less than 0.05 were considered statistically significant.

Results

The mean age of our population was 13.1±4.2 years [4-21] and the sex ratio of males to females was 1.07. The mean disease duration was 4.69±3.26 years [0.3-13]. JIA subtypes were: enthesis-related arthritis (n=12), polyarthritis (n=7), oligoarthritis (n=6), undifferentiated (n=3) and psoriatic arthritis (n=1). At baseline most of our patients (51,73%) were not under treatment, 34.49% were under non-steroidal anti-inflammatory drugs (NSAIDs) and 13.8% under methotrexate (MTX). At the last follow-up consultation 41.38% of the patients were under MTX, 34.49% under NSAIDS and 10.35% under TNF inhibitor (Etanercept). At baseline JADAS-ESR1 was correlated to JADAS-CRP1 (p<0.001, r=0.808) in all AIJ subtypes. JADAS-ESR1 and JADAS-CRP1 were not correlated to ESR1 (p=0.416, p=0.661) nor to CRP1 (p=0.376, p=0.058). Both JADAS-ESR1 and JADAS-CRP1 were correlated to TJC1 (p<0.0001, r=0.643; p=0.015, r=0.502) and only JADAS-ESR1 was correlated to SJC1 (p=0.012, r=0.461). At the last follow-up consultation, correlations were observed between JADAS-ESR2 and JADAS-CRP2 (p<0.001, r=0.992) in all AIJ subtypes. JADAS-ESR2 and JADAS-CRP2 were both correlated to CRP2 (p=0.015, p=0.003) but not to SJC (p=0.175, p=.119), nor to ESR2 (p=0.535, p=0.426).

Conclusion

Our study suggests that both JADAS-ESR and JADAS-CRP correlate closely during the follow-up of JIA. JADAS-CRP could be recommended for assessing disease activity in JIA.

Disclosure of Interests

None declared

AB0768 Influence of continuous non-steroidal anti-inflammatory drugs intake on bone marrow edema in non-radiographic Spondyloarthritis

Background

The concept of non-radiographic axial spondyloarthritis (nr-axSpA) has revolutionized the classical understanding of axSpA. Indeed, it facilitated the classification of patients with axSpA who did not present substantial structural damage as it was only detectable on magnetic resonance imaging of the sacroiliac joints (MRI-SIJ) [1]. Continuous non-steroidal anti-inflammatory (NSAIDs) intake has been reported as a potential factor reducing the sensitivity of MRI-SIJ to detect bone marrow edema (BME).

Objectives

The aim of the study was to investigate the effect of continuous NSAIDs intake on BME in nr-axSpA.

Methods

We undertook a cross-sectional study including nr-SpA according to the ASAS criteria and treated with NSAIDs at baseline. Socio demographic data as well disease characteristics were recorded. Disease activity parameters were also collected including the duration of morning stiffness, night awakenings, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). MRI-SIJ was performed for all the patients. All the images were screened for bone marrow edema with the corresponding sequence (short tau inversion). Patients were grouped according to NSAIDs intake: G1: continuous versus G2 occasional. The level of significance was fixed for p<0.05.

Results

The study included 43 nr-axSpA patients. There was a female predominance with a sex ratio of 0.43. The mean age of the patients was 42±12 years [20-71] and the mean disease duration was 17±9.7 years [4-38]. The mean morning stiffness duration was 47.3±45.6 [15-240] minutes. The mean spinal VAS was 5.9±2.6 [0-10]. Nearly 41% of the patients had an active disease with a mean BASDAI of 4.7± 2.1 [0-8.6]. The prescribed NSAIDs were as follows: Diclofenac (44 %), Indomethacin (8%), Ketoprofen (18%), Meloxicam (3%), Celecoxib (3%), Piroxicam (3%) and Naproxen (21%). Nearly half of the patients were continuously taking NSAIDs (52.6%) versus occasional intake (47.4%). Four patients failed two NSAIDs and were treated with a third one. Both groups were comparable for age (p=0.193), sex (p=0.386), and disease duration (p=0.4). Similarly, there were no statistically significant differences regarding disease activity parameters between both groups: numerical rating scale of pain (p=0.713), ESR (p=0.314), CRP (p=0.644), morning stiffness (p=0.428), night awakening (p=1), as well as BASDAI (p=0.514). Regarding MRI-SIJ findings, hyper signal in STIR sequence was comparable between both groups (G1: 35% vs G2:33%, p=0.914). Moreover, the increased signal with Gadolinium injection on T1-weighted images was similar between both groups (p=0.113).

Conclusion

Our study showed that continuous NSAIDs intake was not associated with significant changes in MRI-SIJ features. This study suggests that a NSAID-free period is not necessary before assessing bone marrow edema on MRI-SIJ.

References

[1]Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis?. Rheum Dis Clin North Am. 2020;46(2):311-25.

Disclosure of Interests

None declared

AB0870 ASSESSMENT OF FRACTURE RISK IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background

Spondyloarthritis (SpA) is a chronic inflammatory disease that predominantly affects the sacroiliac joints and the spine. Patients with SpA have an increased risk of osteoporosis and fracture resulting from a combination of inflammation and immobility. The non-radiographic form for SpA (nr-axSpA) has the same predictors factors of bone fragility however the real fracture risk is unknown in this phenotype.

Objectives

This study aims to investigate BMD and the Fracture Risk Assessment Tool (FRAX) in patients with nr-axSpA.

Methods

We conducted a retrospective study including 40 patients with nr-axSpA, according to the ASAS criteria. For the enrolled patient, we collected the clinical and biological data. We calculated the disease activity using the Bath Ankylosing Spondylitis disease activity (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Functional impairment was assessed by the Ankylosing Spondylitis Functional Index (BASFI). We measured the bone mineral density using the dual-energy X-ray absorptiometry (DXA) in the anteroposterior lumbar, lateral spine, and hip neck. The ten-year probability of major osteoporotic fracture was calculated using the Tunisian version of Fracture Risk Assessment Tool (FRAX).

Results

Twenty-seven women (67.5%) and thirteen men (32.5%) were enrolled. The mean age was 41.5 years (±11.2), and the mean disease duration was 3,1 years (±2.7). The mean BASDAI and ASDAS CRP was 4.7 ± 2.2 and 3.27 ± 1.29, respectively. The mean BASFI was 3.6 ± 2.5. According to World Health Organization (WHO) criteria, 45% of patients displayed osteopenia and 30% osteoporosis. The mean major osteoporotic fracture (MOF) score was 0,09 ± 0,25 [0-1,3]. The MOF was significantly associated with BMD (p=0.000). The variables associated with MOF were a high physician’s global assessment score, a high BASFI, and female gender, but without significant relation. However, no correlation was found between the MOF and the disease duration, the presence of peripheral arthritis or enthesitis, and the ASDAS.

Conclusion

In nr-axSpA, patients with low BMD had a higher calculated 10-year fracture risk. FRAX score is related to functional impairment and gender. Disease activity does not affect the probability of fracture.

Disclosure of Interests

None declared

AB1111 NO INCREASED RISK OF ADVERSE EVENTS OF THE WHO-VALIDATED COVID-19 VACCINES IN PATIENTS WITH RHEUMATIC DISEASES TREATED WITH BIOLOGICS

Background

The COVID-19 pandemic is a major concern for the management of patients with rheumatic diseases (RD). Indeed, an increasing risk of coronavirus infection has been demonstrated in these patients, explained on the one hand by the chronic inflammation and on the other hand by the immuno-modulating treatments used [1]. In this context, vaccination represent an efficient mean to prevent infections and should be included in the management of these patients.

Objectives

The objective of our study was to determine the peculiarity of vaccination against SARS-COV2 in patients with RD treated with biologic therapies.

Methods

We conducted a cross-sectional study during August 2021, including patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA). Sociodemographic data as well as disease characteristics were recorded. Patients were asked to answer a self-questionnaire about SARS-COV2 vaccination: modalities, time between doses, type of vaccine, adverse events, and time to biologic injection. We compared these results between the two groups: group 1 patients on biologics and patients on conventional disease-modifying antirheumatic drugs (DMARDs). A significance level was set for p<0.05.

Results

The study included 102 patients with RD: RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 years [19-77]. There was a female predominance (71 women and 31 men) with a gender ratio of 0.4. The mean duration of disease progression was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7 mg [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. SARS-COV2 infection was found in 27.3% of cases, of which 19% had a severe form. Sixty percent of patients received the SARS-COV2 vaccine, and 25% of them received only the first dose. The mean time between the two injections was 27 ± 7.6 days [23-67 days]. The most common type of vaccine was Pfizer (54.4%), Moderna (5.5%), followed by AstraZeneca (20%), Sinovac (16.4%), Johnson (1.8%) and Sputnik (1.8%). Three patients deferred their biotherapy injection by one week. Only one patient discontinued methotrexate therapy for one month. Sixteen patients reported adverse events such as injection site pain (62.5%), disease flare (12.5%) and fatigue and fever (25%). Patients receiving biologics were not at greater risk of SARS-COV2 infection (p=0.076) or hospitalization (p=0.131) compared to patients receiving conventional therapy. Similarly, patients on conventional therapy did not report more adverse events (p=0.678). The vaccination rate was significantly higher in patients on biologics compared to patients on CsDMARD: 72% versus 43%, p=0.004.

Conclusion

Our work demonstrated that patients treated with biologics adhered to vaccination and did not have more SARS-COV2 infections or adverse events compared to patients on conventional treatment.

References

[1]Akiyama S, Hamdeh S, Micic D, Sakuraba A. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. 2020;80:384-391.

Disclosure of Interests

None declared

AB1259 THE NEUTROPHIL-TO-LYMPHOCYTE AND THE PLATELET-TO-LYMPHOCYTE RATIOS AS INFLAMMATORY MARKERS IN JUVENILE IDIOPATHIC ARTHRITIS

Background

The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have recently emerged as potential indicators of systemic inflammation in chronic rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, and spondyloarthritis.

Objectives

To investigate the value of NLR and PLR as inflammatory markers in juvenile idiopathic arthritis (JIA) and to explore possible associations with disease activity parameters.

Methods

We enrolled 29 patients with JIA according to International League of Associations for Rheumatology (ILAR) criteria. Tender joint count (TJC), swollen joint count (SJC) and laboratory tests were retrospectively collected from medical records. Disease activity was also assessed by the Juvenile Arthritis Disease Activity Score (JADAS). All data were checked for normality by the Kolmogorov-Smirnov test. The Spearman correlation was used for data analysis and p values less than 0.05 were considered statistically significant.

Results

A total of 54 consultations (29 at baseline and 25 at the last follow-up consultations) of 29 patients were included in our study. The mean age was 13.1±4.2 years [4-21] and the sex ratio of males to females was 1.07. JIA subtypes were: enthesis-related arthritis (n=12), polyarthritis (n=7), oligoarthritis (n=6), undifferentiated (n=3) and psoriatic arthritis (n=1). At baseline 51,73% of the patients were not under treatment, 34.49% were under non-steroidal anti-inflammatory drugs (NSAIDs) and 13.8% under methotrexate (MTX). At the last follow-up consultation 41.38% of the patients were under MTX, 34.49% under NSAIDS and 10.35% under Etanercept. At baseline, NLR1 was positively correlated with TJC1 (p=0.022, r=0.424) and SJC1 (p=0.014, r=0.453) but not with C-reactive protein CRP1 (p=0.512) neither erythrocyte sedimentation rate ESR1 (0.096) nor disease activity scores JADAS-CRP1 (p=0.063) and JADAS-ESR1 (p=0.091). PLR1 was positively correlated with SJC1 (p=0.004, r=0.521) and both disease activity scores JADAS-CRP1 (p=0.026, r=0.462) and JADAS-ESR1 (p=0.052, r=0.364). At the follow-up consultations only PLR2 was positively correlated to CRP2 (p=0.045, r=0.404). No correlation was noted between NLR2 and PLR2 and JADAS-CRP2 (p=0.281, p=0.063) and JADAS-ESR2 (p=0.324, p=0.082).

Conclusion

Our study suggests that NLR and PLR may be used as assessment tools of disease activity in patients with JIA. Further studies with larger sample sizes are needed to confirm these results and to explore the value of these ratios in the follow-up and the prognosis of JIA.

Disclosure of Interests

None declared

AB0285 MTX REDUCED THE CARDIOVASCULAR RISK IN RHEUMATIC DISEASES

Background

The relationship between cardiovascular risk (CVR) and inflammatory rheumatic diseases (IRD) remains certain [1].

The aggressive suppression of systemic inflammation by the CsDMARDs or biologics may lower this risk.

Objectives

The purpose of this study was to assess the protective role of the different treatments in rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Methods

We carried out 107 patients followed up for IRD between March and December 2020. We collected the socio-demographic data of patients, the clinical and biological characteristics of the disease. Prescribed treatments were specified.

CVR was assessed by measuring, in centimeters, the Intima-media Thickness (IMT) at the level of the left (LCC) and right (RCC) common carotid arteries and by calculating the Framingham risk score (FRS) for each patient. Individuals with IMT≥0.9 mm or an FRS≥20% were considered as those with high CVR (HCVR).

Results

Of the 107 surveyed patients, 56% had RA (n=47) and 44% had SpA (n=60). Among them, 55% were male. The mean age was 43.9±14.2 years. The mean disease duration was 117.3±89 months. The mean BASDAI was 4.98 ±2.7. The mean DAS28 was 4.13±1.5. Seventy percent of patients had active disease. Conventional DMARDs were prescribed in 54.7% of cases: Methotrexate (95% in RA versus 5% in SpA) and Sulfasalazine (13% in RA versus 30% in SpA), NSAIDs in 57.3% of patients (4.5% in RA versus 96.6% in SpA), corticosteroids (CT) in 25% (47.5% in RA versus 8.5% in SpA), and biotherapy in 9% of cases (12.8% in RA versus 6.7% in SpA).

The mean FRS was 5.98 ± 6.6. The mean IMT was 0.58±0.15. About 60% of patients were considered with HCVR.

NSAIDs were associated with an increase in IMT in the LCC (p<0.001) and in the RCC (p<0.001). MTX had a significant protective effect on IMT in LCC (p=0.001).

However, there was no association between CT use and IMT. Regarding FCS, no significant association was found based on MTX (p=0.09), NSAIDs (p=0.11), CT (p=0.45) nor biologic use (p= 0.74).

Conclusion

In our study, patients taking MTX had a lower IMT than those not taking this molecule. NSAIDs were associated with an increase in IMT. However, we didn’t observe any effect of CT and biologic treatment on CVR in our population.

References

[1]Cho SK, Kim D, Won S, Lee J, Park B, Jang EJ, Bae SC, Sung YK. Impact of anti-rheumatic treatment on cardiovascular risk in Asian patients with rheumatoid arthritis. Semin Arthritis Rheum. 2018;47(4):501-506.

Disclosure of Interests

None declared

AB1254 CHALLENGES FACED BY FAMILIES OF CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatism of childhood. Diagnostic and therapeutic approaches are difficult for families to sustain with significant psychological and social effect.

Objectives

The aim of this study is to understand the different challenges faced by families with children suffering from JIA.

Methods

Parents of children with JIA (according to the International League of Associations for Rheumatology (ILAR)) followed in rheumatology department were asked to complete a survey in order to screen the impact of their children’s disease on their family life. Open-ended questions and directed questions were included. General demographic and clinical information (family history of chronic inflammatory disease, child’s current age, diagnosis and type of JIA and, duration of disease progression) were also collected.

Results

The study included 24 children with a gender-ratio of 1. The mean age was 12.4 years old [4-16]. The mean duration disease was 4 years with extremes varying from 3 months to 13 years. The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 2), polyarticular without rheumatoid factor (n=5), psoriatic arthritis (n= 1), enthesitis-related arthritis (n=10) and oligoarthritis (n= 6). Twenty-four parents completed the survey. The mother was the one who answered the questions in 83% of the cases. Other family members with a chronic rheumatic disease were reported in 40% of the families.

Parents noted negative impact on their work in 50% of cases (40% missing time from work, 10% changing work schedule) and, significant parental stress, anxiety, and fatigue in 75% of the cases. In 33% of the cases, parents had difficulty getting the required medical care and attention for their child’s illness because of financial issues and 37.5% of them were feeling anxiety regarding diagnosis uncertainty. Parents reported worry about their child’s daily functioning and future in 75% of the cases. They noted psychological impact on the child itself in 58% of the cases and child missing school in 41% of the cases. The most common resources parents used for information were health care professionals in 54.2 % of the cases and 45.8% of them got additional information from online research.

Conclusion

Parents of children with JIA share common challenges due to their child’s illness including a substantial impact on their work and personal wellness in addition to the psychosocial impact of the disease on the child. Support groups or educational sessions may be needed to provide guidance for these families to cope with disease.

Disclosure of Interests

None declared

AB1248 CONTRIBUTION OF IMAGING IN THE DIAGNOSIS OF ATRAUMATIC HIP

Background

Joint pain of the hip in children and adolescents is one of the most frequent symptoms seen by pediatricians, orthopedists, and pediatric rheumatologists, with an annual incidence of 148.1/100 000 [1]. The identification of an etiology for atraumatic hip pain is challenging. Even though imaging findings are often various and nonspecific, they are necessary for an accurate diagnosis.

Objectives

The main goal of this study is to investigate the contribution of the different imaging techniques in the diagnosis of the hip main in children.

Methods

We conducted a retrospective study including children and adolescents with atraumatic hip pain recruited from the Kassab institute of orthopedics. Transcribed data included age, sex, and the etiology of the hip disease. We also recorded different imaging techniques performed for the diagnosis: plain radiography, ultrasound (US), Computed tomography (CT) as well as magnetic resonance imaging (MRI).

Results

The study included 81 patients. There was a male predominance (59.3% boys versus 40.7% girls) with a sex ratio of 1.45. The mean age at diagnosis was 9.9 years [1-16]. The mean disease duration was eight months [0.1-156]. Hip disorders were distributed as follows: Legg-Calvé-Perthes disease (n=3), epiphysiolysis of the femoral head (n=30), transient synovitis of the hip (n=7), septic hip (n=10), tumor (n=4), hip dislocation (n=8), hip dysplasia (n=4), juvenile idiopathic arthritis with coxitis (n=15). The hip X-ray was abnormal in 75.6% of cases. The hip US was performed in 34.2% of the patients and showed abnormalities in most of the cases (88.5%). US findings were as follows: joint effusion (n=26), synovial thickening (n=18), synovitis (n=12), and a positive power Doppler signal (n=7). Seven patients underwent pelvic CT scans. The main findings were joint effusion (n=2), synovial thickening (n=1), and hip dysplasia (n=4). MRI of the hip was carried out in 23 children and was contributive in 91.3% of the cases. The main findings were as follows: joint effusion (n=12), synovitis (n=10), bone marrow edema (n=8), synovial thickening (n=7), nidus (n=3) and tumoral process (n=1).

Conclusion

Our study showed that hip X-ray and US are the first-line imaging modalities in an atraumatic hip diagnosis. However, in other cases, further investigations may be needed to make an early diagnosis and avoid adverse sequelae.

References

[1]Yagdiran A, Zarghooni K, Semler JO, Eysel P. Hip Pain in Children. Dtsch Arztebl Int. 2020;117(5):72-82.

Disclosure of Interests

None declared

AB1405 THE USEFULNESS OF TELEMEDICINE IN RHEUMATOLOGY: POINTS OF VIEW OF PRACTITIONERS AND PATIENTS

Background

The advent of COVID-19 has allowed a rapid expansion of telemedicine (TM) and its implementation in various specialties. Despite this extensive use of TM, its role in rheumatology is conflicting and much remains unknown about TM’s acceptability and efficiency in rheumatology [1].

Objectives

Our study aimed to evaluate rheumatologists’ and patients’ willingness for TM and factors helping to adopt this alternative.

Methods

We conducted a cross-sectional study including patients attending our rheumatology department as well as rheumatologists. Patients were contacted by phone and rheumatologists were invited to answer a questionnaire via Google Form. We evaluated their points of view and suitability for TM by inquiring about their experience with tele-rheumatology, information technology supports, personal barriers to telemedicine, and reasons for adopting this alternative. Moreover, additional questions probed the clinician’s perception of the appropriate clinical context for TM application as well as the corresponding legislation.

Results

Overall, 135 responses were collected including 60 rheumatologists and 75 patients. The distribution of diagnosis was as follows: rheumatoid arthritis (RA) (n=15), spondyloarthritis (SpA) (n=20), juvenile idiopathic arthritis (n=23), and osteoarthritis (n=17). Of the rheumatologists, 76.2 % were aged between 30 and 50 years old, 79.3% reported working at an academic center, and the majority were physician-level practitioners (71.2%), working for more than 5 years (61%). Afforded electronic devices were as follows: laptop (87.9%), smartphone (70.7%), afforded headset microphone (24.1%), camera (29.3%) for doctors. Forty-six percent of the rheumatologists estimate that they have a good internet connexion, 62.7% had an appropriate place for teleconsultation. Nearly, 40.7% of the rheumatologists were familiar with the concept of TM but only 39% reported experience with TM. Willingness to accept this model of care for rheumatologists and patients was found in 78% and 37.3% respectively. According to the doctors, the benefits of TM encompassed tele-training (61.7%), remote medical monitoring (61.7%) especially during the COVID-19 (70.2%), benefits for patients (74.5%), reduced inequalities in access to healthcare (46.8%), and improved quality of care (29.8%). The main barriers to TM were the lack of clear legislation (47.8%) and financial compensation (17.4%). Clinicians and patients identified common barriers to effective tele-rheumatology as the inability to perform a physical exam (91.3% vs 33.3%), the fear of trivializing the disease (34.8% vs 36%), and the lack of resources and infrastructures (43.5% vs 29.3%). The majority of the doctors (86.2%) expressed their willingness to attend training workshops. Reported areas to apply TM according to the doctors were mainly osteoarthritis (76.3%) and rheumatic diseases (64.4%), but also pediatric rheumatology (28.8%) and undiagnosed new patients (3.4%). Regarding legislation, most of practitioners estimated that it should be selective with specific authorizations (42.4%) or relaxed with the possibility of derogation (32.2%). Twenty-two percent of them reported that legislation should be strict with the possibility of sanctions, whereas a minority (3.4%) opted for a free practice without regulation at all. Factors associated with adherence to TM were age<40 years (p=0.036) for doctors and familiarity with the concept (p=0.006) and electronic devices afforded (p=0.000) for the patients.

Conclusion

Findings from this study showed the reluctance of the patients to adhere to TM compared to doctors. Concerns and risks may lessen for both sides, once remote consultations are applied. Nevertheless, patient education is required for the success of TM application.

References

[1]Sloan M, Lever E, Harwood R, et al. Telemedicine in rheumatology: A mixed methods study exploring acceptability, preferences and experiences among patients and clinicians [published online ahead of print, 2021 Oct 26]. Rheumatology (Oxford). 2021;keab796.

Disclosure of Interests

None declared

AB1249 IMPACT OF OVERWEIGHT AND OBESITY ON HIP INVOLVEMENT IN JUVENILE IDIOPATHIC ARTHRITIS

Background

The prevalence of obesity among children is on the rise, becoming a worldwide epidemic. The overweight is also associated with mechanical stress in the weight-bearing joint especially in the hip joint. Previous studies showed that increased Body mass index was a predicting factor of a poor outcomes [1].

Objectives

In this regard, we proposed to evaluate the effect of obesity on hip involvement in JIA patients.

Methods

We conducted a cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR)). Transcribed data included age, sex and the characteristics of the disease (subtype of JIA, disease duration). Data on hip involvement was also collected. Weight and height of each patient was recorded. The body mass index (BMI) was calculated (Kg/m2). We compared these parameters between two groups: G1: presence of coxitis and G2: absence of coxitis.

Results

The study included 62 patients with a male perdominance: sex ratio was 2.3. The mean age of onset of the disease was 11.4 years [3-16].The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n=2), polyarticular without rheumatoid factor (n=4), systemic (n= 1), enthesitis-related arthritis (n=44), oligoarthritis (n=8), psoriatic arthritis (n=3). Hip involvement was reported in 71 % of cases and was bilateral in 81% of patients. The mean weight (Kg) and height (meter) was similar between the two groups (57.4 in G1 vs 53.6 in G2, p=0.486) and (1.61 in G1 vs 1.58 in G2, p=0.483) respectively. The prevalence of overweight patients was higher in G1 than G2 without reaching a statistically significant correlation (23% vs 12.5%, p=0.518). Similarly, there was no statistically significant correlation between the body mass index (Kg/m2) and coxitis (22.2 vs 21, p=0.45). Moreover, a higher BMI was not associated with a limited range of motion as well as hip replacement (p=0.7, p=0.1 respectively).

Conclusion

Our study showed that BMI did not impact hip involvement in juvenile idiopathic arthritis patients. As obesity confers an additional health risk, addressing this co-morbidity should be a health priority in these patients.

References

[1]Makay B, Gücenmez ÖA, Ünsal E. Inactive Disease in Enthesitis-related Arthritis: Association of Increased Body Mass Index. J Rheumatol. 2016;43(5):937-43.

Disclosure of Interests

None declared

AB1128 MAINTENANCE THERAPY FOR PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19

Background

The Covid-19 pandemic has been raging for more than a year in a pandemic mode. Since then, many questions have been raised regarding the management of patients with rheumatic diseases (RD). In this context, the maintenance therapy of conventional, biologic and targeted synthetic disease-modifying antirheumatic drugs (Cs DMARDs, bDMARDs and tsDMARDs respectively) during the Covid-19 infection remains a subject of debate given their immunosuppressive effects as well as their potential generation of lung fibrosis. While the EULAR 2020 guidelines emphasize that discontinuation or maintenance should be discussed on a case-by-case basis, the ACR guidelines advocate discontinuation of all therapies except for the anti-interleukin-6 [1,2].

Objectives

The objective of our work was to report our real-life experience of therapeutic maintenance during the covid-19 pandemic.

Methods

We conducted a cross-sectional study of patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA) recruited from the rheumatology department of the Kassab Institute of Orthopedics. All the patients were asked to complete a questionnaire about their disease management in the era of the Covid-19. The questionnaire included sociodemographic data, treatment modalities, as well as data related to the infection with the Covid-19 (severe forms defined by the need for oxygen therapy or hospitalization), and changes in treatment during the infection.

Results

The study included 102 patients with RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 [19-77] years. There was a female predominance with a sex ratio of 0.4. The mean duration of the disease was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7±4.5 mg/L [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. A Covid-19 infection was occurred at least once in 25.5% of cases, of which 19.2% had a severe form (hospitalization (15.4%), oxygen therapy (19.2%)). No deaths were observed. The treatments received during the covid-19 infection were: corticosteroids (n=5), heparin therapy (n=6) and antibiotic therapy (n=10). No patient tapered treatment dosage of DMARDs but discontinuation was reported by 4 patients with a mean time between discontinuation and resumption of 2.1 ± 2 months [0.5-5 months]. The cessation of the treatment was dictated by the treating physician in 2 cases and involved csDMARD in 3 cases (Methotrexate (n=2), Leflunomide (n=1)) and biologics in only one patient. There were no cases of clinical pulmonary worsening upon resumption of the treatments. We found no statistically significant association between severe forms of the infection and the type of RD (p=0.925), as well as the presence of comorbidities (p=0.825). Similarly, the presence of severe forms was not associated with the use of long-term NSAIDs (p=0.29), corticosteroids (p=0.85), or biological treatment (p=0.7). However, maintenance therapy was significantly associated with a lower risk of severe forms (p=0.013).

Conclusion

Our work showed that the maintenance of conventional treatment during Covid-19 infection was associated with a lower risk of severe forms. Our results, along with those of other studies in the literature, support the maintenance of antirheumatic treatments.

References

[1]Landewé RB, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;79(7):851-8.

[2]Roongta R, Ghosh A. Managing rheumatoid arthritis during COVID-19. Clin Rheumatol. 2020 Nov;39(11):3237-44.

Disclosure of Interests

None declared

Impact of lean and fat mass on disease activity and function in spondyloarthritis

BACKGROUND AND AIMS

Changes in body mass composition such as reduced lean and fat mass can occur in a patient with rheumatic diseases. However, data about body composition in spondyloarthritis (SpA) showed conflicting results. The aim of the present study was to assess by DXA the distribution of lean and fat mass in SpA patients compared to healthy controls and to investigate the association between body mass composition and disease characteristics.

METHODS

We conducted a cross-sectional case-control study including 50 SpA patients and 50 controls. Sociodemographic data as well as disease characteristics were assessed. Body composition measurements, biochemical and inflammatory serum markers were evaluated. Radiographic data (Bath Ankylosing Radiologic Index and the modified Stroke Ankylosing Spondylitis Spine Score was also recorded.

RESULTS

No statistically significant correlation was found between the two groups regarding bone mineral density, body mass distribution. However, a lower weight was observed in the study group compared to the control group (p=0.043). Male gender and younger age were associated with a higher lean mass (p=0.05). C-reactive protein (CRP) level was positively correlated with lean mass (r=0.38, p=0.023). Similarly, BASFI was higher in patients with lower fat mass (r=-0.42, p=0.024). A longer duration of NSAIDs intake was associated with a lower lean mass and a higher fat mass. However, no correlations were found between body mass composition and BASRI mSASSS scores as well as bone mineral density and calcium intake.

CONCLUSION

Our findings suggest that younger age, male gender, and axial phenotype were associated with higher lean mass.

Which Metrological Index-the BASMI or EDASMI-is Best Correlated With Disease-Related Parameters in Spondylarthritis Patients?

OBJECTIVE

To compare the Edmonton Ankylosing Spondylitis Metrology Index (EDASMI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) to determine which of the two is best correlated with disease-related parameters in axial spondyloarthritis (axSpA) patients.

METHODS

A cross-sectional study was made of 86 patients with radiographic axSpA. Sociodemographic data, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire were applied. Spinal mobility was assessed by two indices: the BASMI and the EDASMI. Structural damage of the spine was also evaluated by two indices: the Bath Ankylosing Spondylitis Radiology Index (BASRI) and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS).

RESULTS

Eighty-six patients with an average age of 43.21 ± 11.43 years (20-79) were included. Impaired spinal mobility, which corresponds to higher BASMI scores, was correlated with prolonged disease duration (p < 0.01, r = 0.310), higher ASDAS-CRP (p < 0.001, r = 0.386), severe functional disability on the BASFI (p < 0.01, r = 0.505) and poorer quality of life according to the ASQoL (p < 0.01, r = 0.369). However, the EDASMI score did not correlate with any disease parameter. The BASMI was correlated with the total BASRI (p < 0.01, r = 0.634) and mSASSS (p < 0.01, r = 0.388). Unlike the BASMI, the EDASMI was neither correlated with the BASRI (p = 0.520, r = 0.245) nor the mSASSS (p = 0.252, r = -0.120).

CONCLUSION

Our results indicate that among the studied metrological indices, the BASMI is more contributory since it is correlated with clinical disease parameters and structural damage, unlike the EDASMI.

Case report of Osteopoikilosis in patient with psoriatic arthritis

Osteopoikilosis (OPK) is one of the rare genetic musculoskeletal, non-inflammatory disorders that we should increase awareness toward. We report a case of a patient diagnosed with psoriatic arthritis with incidental imaging findings of lesions suggestive of osteopoikilosis.

Factors associated with the inflammatory process in pain in ankylosing spondylitis

Introduction

sleep disorders, closely related to any chronic pain process, are frequent among patients with rheumatic diseases, mainly ankylosing spondylitis (AS). Our study aimed to determine the association between sleep disturbances and the inflammatory process in pain in AS patients compared with lower back pain (LBP) patients. We have additionally examined factors associated with sleep disorders among AS patients.

Methods

we conducted a cross-sectional study among AS patients. Sociodemographic data, patient reported outcomes and disease characteristics were recorded. Sleep was assessed using the medical outcomes study sleep scale measure (MOS-SS). For psychological assessment, Beck anxiety (BAI) and depression index (BDI) was used. A multivariate logistic regression was performed to identify factors associated with sleep disorders.

Results

the study included 50 patients with AS and 40 patients with low back pain. The most common affected domains among AS patients were inadequacy, sleep disturbance, and daily somnolence. The MOS-SS index was significantly higher in the AS group than in the control group (p<0.001). Sleep disorder was associated with age, female gender, analphabetism, patient-reported outcomes (all p<0.05), but was not associated with profession, comorbidities and smoking habits. In multivariate analysis, factors associated with sleep disruption were the duration of morning stiffness (MS), disease activity, bath ankylosing spondylitis metrology index (BASMI), ASQol, as well as anxiety and depression (odds ratio: 5.4(CI 95% 1.6-18.3), 9.9 (CI95%1.1-86); 6 (CI95%1.1-32); 13 (CI 95% 1.4-143.8); 15.7 (CI 95% 2.6-94.3); 14 (CI 95% 2-105.7) respectively, p<0.05 for each).

Conclusion

our study highlighted the importance of sleep disorders among patients with AS with a predilection for inadequacy, sleep disturbance, and daily somnolence. Factors associated with sleep disruption were high disease activity, a longer duration of MS, an altered function and quality of life as well as anxiety and depression.

Perception de la télémédecine par les consultants en rhumatologie à l’ère de la COVID-19

Introduction

Avec l’avènement de la pandémie de COVID-19, le système de santé a été confronté à des difficultés pour fournir des soins appropriés aux patients suivis au long cours pour des pathologies autres que le COVID-19. Ces derniers, du fait de la chronicité de leurs maladies, nécessitent un suivi régulier et rapproché [1]. Quoique la télémédecine n’est pas encore officiellement mise en œuvre en Tunisie, cette alternative peut avoir le potentiel d’améliorer l’accès aux soins en plus de réduire les dépenses de santé. L’objectif de notre étude était d’évaluer la perception de la télémédecine par les patients suivis en rhumatologie et d’étudier les facteurs favorisant l’adoption de cette alternative à l’ère du COVID-19.

Patients et méthodes

Nous avons mené une enquête transversale structurée par téléphone auprès des patients suivis au service de rhumatologie de l’institut Kassab d’orthopédie, pour un rhumatisme inflammatoire chronique ou pour une pathologie dégénérative. Les données sociodémographiques et les caractéristiques de leur maladie ont été recueillies. Nous avons évalué leur point de vue et leur aptitude à la télémédecine.

Résultats

L’étude a inclus 75 patients. Il y avait une prédominance féminine avec un sex-ratio de 0,4. La répartition des pathologies rhumatismales était comme suit: polyarthrite rhumatoïde (PR) (20 %), spondyloarthrite (SpA) (26,6 %), arthrite juvénile idiopathique (30,7 %), et pathologie dégénérative (22,7 %). La durée d’évolution de la maladie était en moyenne de 9,8 ± 7,5 [1–29] ans. Près de la moitié des patients (46,7 %) avaient un revenu mensuel inférieur à 500 dinars et 44 % d’entre eux avaient un revenu mensuel entre 500 et 1000 dinars (151 et 303 euros). La durée moyenne du trajet pour se rendre à l’hôpital était de moins de 2 heures dans 61,3 % des cas, entre 2 et 5 heures dans 28 % des cas et plus de 5 heures dans 10,7 % des cas. Les appareils électroniques disponibles étaient les suivants: smartphone (18,7 %), internet (16 %), téléphone portable simple (24 %), et l’association des trois (41,3 %). Seuls 14 patients connaissaient le concept de télémédecine et 37,3 % d’entre eux accepteraient ce modèle de soins. Le moyen de télécommunication le plus apte à être adopté selon les patients était les appels vidéo (64 %) comparé aux appels téléphoniques (36 %). Les principales raisons de préférer la télémédecine étaient comme suit: éviter les hôpitaux pendant la pandémie (28 %), faire des économies (25,3 %), gagner du temps (26,7 %) et éviter l’absentéisme (14,7 %). Les principales raisons de préférer la consultation en direct étaient la crainte d’une éventuelle discordance entre l’évaluation physique et l’évaluation à distance (33,3 %), la crainte de la banalisation de la maladie (36 %), les inquiétudes quant à maîtrise de la technologie (21,3 %) et enfin, la crainte de perdre la connectivité (29,3 %). Il n’y avait pas d’association entre la préférence pour la télémédecine et le motif de consultation (p = 0,87), un revenu plus élevé (p = 0,84), la durée du trajet vers l’hôpital (p = 0,07), la profession (p = 0,54), ainsi que des antécédents familiaux de COVID-19 (p = 0,54). Les patients au courant du concept de télémédecine et disposant de ressources électronique adhéraient plus à la télémédecine (p = 0,006, p = 0,000 respectivement).

Conclusion

Contrairement aux données de la littérature, notre étude a montré la faible prévalence des patients prêts à accepter la télémédecine comme modèle de soins. En effet, en Tunisie, le concept de télétravail en général n’était pas d’usage courant avant la pandémie, d’où la nécessité de sensibiliser les patients d’avantage afin de promouvoir cette alternative.

P029 Assessment of diagnosis delay during enthesitis related arthritis

Background

Enthesitis related arthritis (ERA) is a distinct subgroup of juvenile arthritis characterized by male predominance and adolescent onset. Though, ERA patients still experience long diagnosis delays. This may lead to articular damage and functional disability. The aim of this study was to quantify the lag time between ERA symptoms onset and diagnosis and to evaluate its impact on disease activity, functional disability and structural damage.

Methods

A retrospective monocentric study was carried out on ERA patients. Diagnosis delay was collected from patients’ medical files. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional disability and structural damage were evaluated by Bath Ankylosing Spondylitis Fonctional Index (BASFI) and Bath Ankylosing Spondylitis Radiology Index (BASRI) respectively. Data were analyzed using the SPSS statistical package. A p-value &lt; 0.05 was considered significant.

Results

Thirty-four patients with a mean age of 23.8 ± 7.5 years were included. Male to female sex ratio was 3.85. Mean age at disease onset was 12 ± 2.6 years. Median disease duration was 108 months [12–408]. Median ERA diagnosis delay was 10 months [3–108]. Median ESR and CRP were 35 mm/h [8–90] and 20 mg/l [1–70] respectively. Median BASDAI score was 4.7 [1–9.7]. Median BASFI and BASRI scores were 4.6 [1.9–10] and 10 [2–16] respectively. Coxitis was found in 38.2% of cases.

On statistical analysis, significant positive correlation was found between ERA diagnosis delay and ESR (P = 0.03, r = 0.69) and CRP (P = 0.05, r = 0.456) respectively.

No link was noted between ERA diagnosis delay and these parameters: gender (P = 0.58), age at disease onset (P = 0.68), occurrence of coxitis (P = 0.66), BASFI (P = 0.08), BASDAI (P = 0.45) and BASRI (P = 0.12).

Conclusion

ERA patient’s journey was long in our study. Longer delays were associated with higher ESR and CRP levels. Further studies are required to confirm our results.

P037 Does perinatal history and delivery enhance the risk of hip involvement in Juvenile Idiopathic Arthritis patients? A case-control study

Background

Children are vulnerable to congenital and developmental hip disorders. One of the causes of coxitis among children is juvenile idiopathic arthritis (JIA). Existing data on associations between maternal and early childhood exposures highlighted the potential role of prematurity in JIA [1]. The aim of this study was to compare perinatal history in JIA children with coxitis compared with patients with other causes of hip involvement.

Methods

We conducted a cross-sectional study including children with JIA complicated with coxitis and patients with other causes of hip involvement. We recorded sociodemographic data and the hip disorder. The mode of delivery, the values of the neonatal birth weight as well as the delivery method (vaginal, cesarean (C) section) were retrieved from medical records. We divided the patients into two groups: G1: JIA patients with coxitis and G2: patients with other causes of hip involvement. We compared delivery mode, as well as perinatal outcomes between the two groups.

Results

The study included 81 patients. There was a male predominance (59.3% males vs 40.7% females) with a sex-ratio of 1.45. The mean age of diagnosis was 9.9 years [1–16]. The mean disease duration was 9 months [0.1–156]. Hip disorders were distributed as follows: Legg-Calvé-Perthes disease (n = 3), epiphysiolysis of the femur head (n = 30), transient synovitis of the hip n = 7, septic hip (n = 10), tumor (n = 4), hip dislocation (n = 8), hip dysplasia (n = 4), juvenile idiopathic arthritis with coxitis (n = 15). The mean birth weight of the children was 3.4 kg [1.3–9]. About half of the patients had a natural delivery (55.6%) and most of them a face presentation (71.6%). A twin pregnancy was reported only in 2.5% of cases. Childbirth complications were reported in 7.4% of cases: umbilical cord prolapse (n = 1), Meconium aspiration syndrome (n = 1), failure to descend (n = 1), acute fetal distress (n = 3). Most of them had a normal growth and psychomotor development (96% and 97% respectively). There was no statistical difference between the two groups regarding delivery mode and fetal presentation before birth (P = 0.07, P = 0.48 respectively). Similarly, weight at birth was similar between JIA children and patients with other hip involvement (P = 0.52).

Conclusion

Our study showed that maternal and perinatal history did not differ between JIA patients with coxitis and patients with other causes of hip involvement.

P033 Impact of breastfeeding on Juvenile Idiopathic Arthritis outcomes

Background

Juvenile idiopathic arthritis (JIA) is the most common, chronic rheumatic disease of childhood. The aetiology is still unclear. Over the past few years, several studies have investigated the association between JIA and environmental exposures such as infections and parental smoking. However, data concerning the influence of past breastfeeding on the presentation and the severity of JIA remain scarce and still a matter of debate (1, 2).The aim of this study was to determine the influence of breastfeeding history on the pattern and severity of JIA.

Methods

A cross-sectional monocentric study was carried out on JIA patients according to International League of Associations for Rheumatology (ILAR). Demographic, clinical and biological data were collected from medical records. Breastfeeding data were obtained by interviewing mothers. Patients were divided into two groups: group 1 (G1) stands for JIA patients breastfed over 6 months and group 2 (G2) stands for JIA non-breastfed patients or patients breastfed &lt;6 months. Data were analyzed using the SPSS statistical package. A p-value &lt; 0.05 was considered significant.

Results

Twenty-nine patients (10 male and 19 female) were enrolled. Mean age at disease onset was 9.1 ± 3.4 years [2–15]. Median diagnosis delay from symptoms onset was 3.5 ± 21. 1 SD months [1–72]. Median disease duration was 36 ± 79 SD months [7–336]. JIA subtypes were in decreasing order of frequency: enthesitisenthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular RF- (n = 4), Polyarticular RF + (n = 2), systemic (n = 1) and psoriatic arthritis (n = 1).

Inflammatory markers were raised in 48.3% (n = 14) of cases. Median ESR (raised in 41.3% of the cases) and CRP (raised in 34.4% of the cases) were 17 ± 25.1 SD mm/h [3–98] and 3 ± 18 SD mg/l [0–56].

Among patients with enthesitis-related arthritis, median BASDAI and BASFI scores were 1.8 ± 1.6 SD [0.3–6.3] and 2.5 ± 1.7 SD [0–6] respectively.

Only 16 (55.2%) patients had bone densitometry. Osteoporosis and osteopenia were found in 10.3% and 13.8% of cases, respectively. Coxitis was found in 65.5% of patients (n = 19).

Overall, 82.8% of children (n = 24) were breastfed. Breastfeeding was exclusive in 55.2% of cases (n = 16). Median breastfeeding duration was 12 ± 10.3 SD months [1.5–48]. Over two-thirds (n = 19) of patients were breastfed for &gt;6 months.

The statistical study revealed that G1 had significantly lesser occurrence of coxitis than G2 (57.9% vs 80%; P = 0.032). Age at disease onset (P = 0.26), diagnosis delay (P = 0.9), raised inflammatory markers (P = 0.76) and the frequency of osteoporosis (P = 0.87) were comparable between the two groups. No correlation was noted between breastfeeding duration and the following parameters: age at disease onset, ESR rate, CRP rate, BASDAI and BASFI.

Conclusions

In this study, JIA patients breastfed over 6 months had fewer coxitis occurrence. Further investigations with larger sample sizes are still required to assess the benefits of breastfeeding on JIA outcomes.

P023 Impact of Juvenile Idiopathic Arthritis on schooling and family life

Background

Juvenile Idiopathic Arthritis (JIA) and its related symptoms have been associated with interference in the daily life of children and adolescents with JIA including their friendships, their school attendance and sometimes their family life. The aim of the study was to describe the impact of JIA on schooling, social and family life from the point of view of children.

Methods

We interviewed 23 children and adolescents, diagnosed with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR).

Results

The mean age of our group was 16 years, with a sex ratio of 3. Eight percent of the children were in elementary school, 21.7% in high school and 8.7% in university. Eighty-seven per cent reported school absenteeism due to JIA (pain, being hospitalized,) with a mean of 8 missed school days. Forty-three per cent failed in their schooling at some point. Thirty percent thought it was related to the consequences of their disease. Only 47.8% found the school staff to be helpful and supportive. Seventy eight percent felt understood and supported by their family in dealing with the different aspects of JIA. Twenty-six per cent felt more spoiled than their other siblings, creating tension sometimes. Fifty two percent felt different and not accepted by their peers because of the JIA.

Conclusions

Children with JIA are already suffering from the physical aspect of their disease. Initiating an open discussion with them might reduce the burden these children are carrying often in silence, and improve long-term outcomes in terms of schooling, social and, family life.

P009 Osteoporosis is a frequent complication in enthesitis related arthritis patients

Background

Enthesitis related arthritis (ERA) represents a clinical entity of juvenile idiopathic arthritis. This chronic rheumatic disease may lead to early bone mass loss and increase risk fracture. The aims of this study were to evaluate the prevalence of clinical osteoporosis in patients with ERA and to identify what factors are associated with increased occurrence of osteoporosis.

Methods

We reviewed the medical records of patients with confirmed ERA. We analyzed their demographic data and the clinical characteristics. Dual-energy X-ray absorptiometry (DEXA) was used to determine bone status. Osteoporosis was defined as Z score &lt;-2.5DS. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Data were analyzed using the SPSS statistical package. A P-value &lt; 0.05 was considered significant.

Results

Thirty-three patients (27 male and 7 female) with a mean age at of 23.8 ± 7.5 years were enrolled. The mean age at disease onset was 12 ± 2.6 years. Median disease duration was 108 months [12–408]. The median ESR and CRP levels were 35 mm/h [8–90] and 20 mg/l [1–70] respectively. Median BASDAI score was 4.7 [1–9.7]. At bone densitometry, osteoporosis and osteopenia were found in 44.1% and 23.5% cases respectively. None of the patients had a history of osteoporotic fractures. Long term corticosteroid therapy and sedentarily were noted in 18.2% and 47.1% of patients respectively. On statistical analysis, osteoporosis was associated with these parameters: age at ERA onset (P = 0.035), disease duration (P = 0.04), CRP (P = 0.009), BASDAI score (P = 0.05) and sedentarily (P = 0.031). Neither corticosteroid therapy (P = 0.68) nor high ESR level (P = 0.73) were associated with osteoporosis.

Conclusion

In this study, osteoporosis was a common extra articular feature during ERA. As adult spondyloarthritis, disease activity, duration and sedentarily seem to be associated with the bone loss.

P022 Genetic background predicts the extra-articular involvement in patients with enthesitis related arthritis

Background

Enthesitis-related arthritis (ERA) represents 20% of all juvenile idiopathic arthritis subtype. Among the genetic risk factors for the development of ERA, HLA-B27 has been implicated as a major contributor. The frequency of HLA-B27 varies among population. HLA-B 27 status in ERA may influence the clinical phenotype and prognosis of the disease. The main objective of this study is to determine whether genetic background including HLA B27 and familial history of spondylarthritits (SpA) may influence the clinical features of ERA patients.

Methods

We conducted a retrospective study including patients with ERA, all fulfilling the International League of Associations for Rheumatology (ILAR) criteria.

For all patients, we collected the following data: Age, family history of rheumatic inflammatory diseases, inflammatory bowel diseases (IBD), the presence of HLA-B27 antigen, the inflammatory biomarkers: Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP), the disease activity assessed by morning stiffness, night awakenings, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the current treatment. We assessed, as well, the functional impact using the Bath Ankylosing Spondylitis Functional Index (BASFI) the Lequesne index.

The population was divided into two groups: a group including patients positive to HLA-B27 antigen and/or with family history of rheumatic inflammatory diseases, psoriasis or inflammatorybowel diseases. The second group was defined as control group with patients negative to HLA-B27 antigen and without any family history of the diseases above.

Results

We included 40 ERA patients, mean age of onset 12,43 ± 3,003 years (6–16). The majority of them were male (n = 34). Twenty-eight patients had a genetic background. Among them, 7,5% of patients had a positive family history, 42,5% were positive to HLA-B27 antigen and 20% of them met both criteria.

As shown in table 1, clinical manifestations were similar between the 2 groups. Enthesitis was more frequent in patients with HLAB27 without a significant difference. Regarding the disease activity, the number of night awakenings and the morning stiffness duration were comparable in the two groups. Six patients had a BASDAI score &gt; 4 with no difference between the two groups. Extra-articular manifestations were present in 15 patients. Among them 14 had a genetic background, reaching the significance threshold with P = 0,013. We counted 8 cases of uveitis, one case of IBD, 5 cases of lung disease and 1 case of cardiac involvement.

Inflammatory markers were higher in the group with familial history of SpA and/or positive HLAB27. Indeed, the mean ESR value was 42,73 vs 29.9, P = 0,01.

There were no correlations between BASFI score and a positive genetic background (P = 0,283). Only one patient was put on biologics. He has no family history and is negative to HLA-B27 antigen.

Conclusion

The frequency of HLAB27 was in line with the literature data. The genetic background did not influence the disease activity or the functional impairment in our population. However, a positive correlation was found between a positive familial history of SpA, HLAB27, and the presence of extra-articular manifestations as well as with a higher ESR value.

P038 Let’s look at coxitis features in enthesitis-related arthritis population

Background

Enthesitis-related arthritis (ERA) is a defined juvenile idiopathic arthritis subtypes, which presents with enthesitis, arthritis and axial skeleton involvement. ∼20–50% of JIA patients have hip involvement within 1–6 years of diagnosis onset [1]. The frequency of coxitis in ERA category is not recognized. The aim of this study was to assess coxitis features and its management in ERA population.

Methods

A retrospective study including children with ERA according to the International League of Associations for Rheumatology (ILAR). Data recorded included sociodemographic features, disease characteristics (disease duration, extra-articular manifestations, and presence of HLAB27) as well as treatment modalities. Regarding coxitis, we collected radiographs, ultrasound (US) and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema).

Results

The study included 51 patients with ERA. There was a male predominance (78.4%). The mean age of onset of the disease was 12.2 years [6–16]. The mean current age was 24.3 years old [9–59]. A family history of spondyloarthritis was found in 26.8% of cases. A positive HLAB27 was reported in 85.7% of cases. The distribution of extra-articular manifestations (37.5%) was as follows: ocular (n = 8), cardiovascular (n = 2), gastrointestinal (n = 1), pulmonary (n = 4). A peripheral onset was found in 39% and a peripheral and axial onset was reported in 42% of patients. Hip involvement was found in 78.4% of the patients and revealed the disease in 43% of cases. The mean delay between disease onset and coxitis was 4.5 years [0–34]. Coxitis was bilateral and destructive in 82.5% and 51% of cases respectively. The most limited range of motion was the internal rotation (68%), followed by hip flexion (48%) and the external rotation (43.2%). In patients with normal hip radiography (n = 8), US or MRI depicted early changes in 75% of cases. Hip replacement was noted in ten patients and was bilateral in 70% of cases. Regarding treatment modalities, NSAIDs and csDMARD (MTX n = 14, SLZ n = 8, biologics n = 2) were prescribed in 76.4% and 52% respectively. Most of the patients had physical therapy (88%) and 23.5% of them had intra-articular corticoid injection. Twenty-six percent of the patients had hip replacement.

Conclusion

Our study showed a high prevalence of coxitis among ERA patients. There is a need to further optimize therapeutic strategies for such patients.

P057 Uveitis in enthesitis-related arthritis: what are the predictive factors?

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Uveitis is its most common extra-articular manifestation [1]. It is a potentially sight-threatening condition with a considerable risk of morbidity. This study aimed to describe the prevalence and characteristics of JIA-related uveitis in enthesitis-related arthritis (ERA) patients.

Methods

We conducted a retrospective study including 40 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR). All selected patients presented with ERA. A screening of uveitis was conducted in all patients. Clinical, radiologic and, biologic features of JIA were collected. We evaluated the association between these features and the presence of uveitis.

Results

The mean age of our patients was 24 years, with a sex ratio of 3. The mean age at the onset of JIA was 11 years. Upon screening, fifteen percent of the patients had active uveitis. Nine percent of the patients presented with an acute onset of JIA. Forty-six percent had initial spinal symptoms, while 26% presented with peripheral onset. Upon examination, 4% of the patients presented with monoarthritis, 20.4% with oligoarthritis and 34.8% with polyarthritis. Thirteen percent had enthesitis. Fifty-seven percent of the patients had coxitis. Sixty-eight percent had sacroiliitis. The mean CRP and ESR levels were respectively 16 mg/l and 34. Human leucocyte antigen (HLA) B27 screening came back positive in 11% of the cases. The mean BASDAI and BASFI levels were both at 4.7. The mean MASES was 0.44.

Twenty percent of the patients received NSAIDs. Eleven percent received methotrexate, 18% salazopyrine and, 5.6% biologics.

A significant association was established between the presence of uveitis and a polyarticular onset of JIA (P = 0.036). However, no significant associations were established with the sex of patients (P = 0.457), age of onset (P = 0.828), activity of the disease as evaluated by BASDAI (P = 0.40) and MASES (P = 0.87), inflammatory markers (CRP P = 0.946, and ESR P = 0.662), the use of NSAIDS (P = 1), methotrexate (P = 0.318), salazopyrine (P = 0.170) and biologics (P = 1).

Conclusion

In conclusion, uveitis associated with JIA is a serious and sight-threatening disease.

Several factors associated with a more severe disease development have been identified [2–4]. Our study showed a significant association between the polyarticular onset of JIA and the occurrence of uveitis. Also, our study showed no significant association with male gender and HLA-B27 in children, unlike previous studies of spondyloarthritis conducted in adults [5–6].

We conclude that the screening of uveitis should be performed in all JIA patients, especially those presenting initially with polyarthritis.

P077 Ultrasound features of a traumatic hip pain in paediatric population

Background

Atraumatic hip pain in children is a serious condition that may require urgent investigations. Conventional radiographs are often normal in early stage of the diseases. However, further imaging techniques such as hip ultrasonography (US) are needed. The main objective of this study is to describe Hip ultrasound findings in patients with atraumatic hip pain.

Methods

We conduct a retrospective monocentric study. Children with atraumatic hip pain and undergoing joint ultrasound were included. Sociodemographic, clinical and biological characteristics were collected. The data were analyzed using the SPSS statistical package. Results:

Thirty patients (21 boys and 9 girls) were enrolled. The male to female sex ratio was 2.3. Mean age at disease onset was 9.1 ± 4.6 [1.3–16]. Median diagnosis delay from symptoms onset was 1.2 months [0.2–48]. Chief complaints were as following: 80% of inflammatory hip pain (n = 24), 20% of mechanical hip pain (n = 6) 76.7% of limping (n = 23), 23.3% of functional impotence (n = 7) and 23.3% of fever (n = 7). Physical examination noted a pain on passive joint mobilization and restriction of hip movement in 90% (n = 27) and 54% (n = 18) of cases respectively. A biologic inflammatory syndrome was found in 66.6% of cases (n = 20). Median ESR and CRP were 30 mm/h [2–101] and 4.5 mg/l [1–38] respectively. Hip X-ray was abnormal in 46.6% (n = 14) of cases. All patients had hip ultrasound. US findings were as following: 80% (n = 24) of joint effusion, 50% (n = 15) of synovial thickening, 36.7% (n = 11) of synovitis and 23.3% (n = 7) of positive power Doppler signal. Hip Ultrasound was normal in 13.3% (n = 4) of cases. Causes of hip pain were in decreasing order of frequency: septic arthritis (n = 10), juvenile idiopathic arthritis (n = 10), transient synovitis (n = 7), osteoid osteoma (n = 2) and osteosarcoma (n = 1).

Conclusion

Hip Ultrasonography is a noninvasive and useful screening technique for the management of atraumatic hip pain in children. Though, imaging features are often various and nonspecific. Radiologists should be more familiar with sonographic anatomy of infant hip.

P031 Adherence with Methotrexate in Tunisian Juvenile Idiopathic Arthritis Patients

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in the pediatric population. Methotrexate (MTX) has been considered as the cornerstone of treatment of poly and oligoarticular subtypes of JIA. However, this treatment is supposed to be for long term, which may involve an obstacle for adherence. The aims of the study were to evaluate adherence of Tunisian JIA patients to MTX and to identify factors associated with high adherence to MTX.

Methods

A cross-sectional study including patients with confirmed JIA diagnosis, according to the International League of Associations for Rheumatology (ILAR) criteria, was performed. Demographic data as well as disease characteristics were obtained from medical records. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. Adherence was measured, for patients under MTX for &gt;3 months, using the 5-item Compliance Questionnaire Rheumatology (CQR5) (1). Patients were divided into two groups: group 1: High adherence (HA) for patients having a CQR5 ≥ 80% and group 2: low adherence (LA) for patients having CQR5 &lt; 80%. A p inferior to 0.05 was considered statistically significant.

Results

The study included 29 patients (10 males and 19 females) with a mean age at disease onset of 9.1 ± 3.4 years. The mean disease duration was 61 ± 79 months [7–336]. JIA subtypes were in decreasing order of frequency as follows: enthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular without rheumatoid factor (n = 4), Polyarticular with rheumatoid factor (n = 2), systemic (n = 1) and, psoriatic arthritis (n = 1).

A biologic inflammatory syndrome was found in 48.3% (n = 14) of cases. The mean ESR and CRP were 20 mm/h ± 11.3 [3–98] and 5 ± 17.8 mg/l [0–56] respectively. Nineteen (65.5%) patients had coxitis. Overall, 55.17% of patients (n = 16) were treated with MTX with a mean weekly dose of 9.2 ± 3.2 mg [5–15]. MTX was orally administrated in all patients. NSAIDs and prednisone were prescribed in 51.7% (n = 15) and 17.2% (n = 5) of cases respectively. The MTX was associated with biological DMARDs in five patients (17.2%). It was about Etanercept in 4 patients and Tocilizumab in 1 patient. Mean CQR5 score was 70.8% ± 18 [25–100]. Only seven patients (43.8%) showed high adherence to MTX. The statistical study revealed no difference between HA and LA in term of gender (P = 0.84), age at disease onset (P = 0.39), disease duration (P = 0.9), prednisone use (P = 0.22), the occurrence of coxitis (P = 0.2), ESR (P = 0.83) and CRP (P = 0.033) rates.

Conclusion

In this study, less than one half of JIA patients were highly adherent to MTX according to CQR5. Low adherence should be considered before declaring MTX treatment failure.

P011 Radiological pattern in juvenile onset Spondylarthritis differ from the adult onset spondylarthritis

Background

Spondylarthritis (SpA) is a chronic inflammatory disease of the axial spine that may be affect the peripheral joints. SpA occurs predominantly in adulthood: Adult onset Ankylosing Spondylitis (AoAS). However, it can occur earlier in childhood (≤16 years old), also termed as juvenile onset Ankylosing Spondylitis (JoAS). In the second group, delay in diagnosis may lead to further structural damage. The aim of our study was to compare the differences in radiographic features between JoAS and AoAS.

Methods

We conducted a retrospective study in our department of rheumatology of Kassab Institute of orthopedics, including patients diagnosed with SpA according to the ASAS criteria (≥17 years at symptom onset) or to the ILAR criteria (≤16 years at symptom onset). Were not included AS patients whose disease onset was ≥ 45 years. Sociodemographic as well as disease characteristics were recorded. The lateral cervical and lumbar spine radiographs were used to assess structural damage by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and The Bath Ankylosing Radiologic Index (BASRI). The total score of mSASSS and BASRI vary between 0–72 and 0–16 respectively with higher scores indicating evolved structural damage. Radiographic features were then compared between AoAS and JoAS. The level of significance was fixed for a P &lt; 0.05.

Results

Of 140 AS patients, 40 had JoAS and 100 had AoAS. The average age at disease onset was 12.4 ± 3 [8–16] and 25.4 ± 10.1 [17–42] respectively (P &lt; 0.001). The disease duration was 10.6 years [1–44]. The average current age was 25.3 ± 10.2 [9–59] and 32.5 ± 7.5 [18–46] (P &lt; 0.001). The JoAS group showed a more frequent onset with peripheral joint involvement than the AoAS group (80% vs 50%,P = 0.001). Similarly, hip involvement was more frequent among JoAS patients (57.7% vs 25%, P = 0.000). There was no significant differences between the two groups regarding the mean mSASSS score, the total BASRI score and the BASRI score for the sacroiliac joints (P = 0.9, P = 0.49, P = 0.06 respectively). Similarly, there was no differences in the mean spine BASRI score between the two groups, although there was a trend of higher scores among AoAS patients (3.2 vs 3.9, P = 0.15 respectively). On the contrary, JoAS patients had a significantly higher BASRI score for the hip than AoAS patients (2.4 vs 1.3, P = 0.000).

Conclusion

Our study showed that JoAS patients are more likely to suffer from early hip damage than AoAS patients. The spine BASRI was similar between the two groups despite the shorter disease duration in the juvenile group. This highlights the need for screening for hip involvement and for a closer monitoring in this subset of children.

P020 The male gender predicts the hip involvement among JIA patients

Background

Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of chronic arthritides that affect children aged 16 years and under. Regardless of the clinical presentation, hip involvement ranges between 20% to50% of cases [1]. The aim of the present study was to examine the role of gender and disease onset in coxitis involvement.

Methods

We conducted a cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR)). Transcribed data included age, sex and the characteristics of the disease (subtype of JIA, disease duration). Regarding coxitis, we collected radiographs, ultrasound (US) and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema).

We divided patients into two groups: G1: presence of coxitis and G2: absence of coxitis.

Results

The study included 62 patients with a male perdominance: sex ratio was 2.3. The mean age of onset of the disease was 11.4 years [3–16]. The frequency of each JIA subset was as follows: polyarticular with rheumatoid factor (n = 2), polyarticular without rheumatoid factor (n = 4), systemic (n = 1), enthesitis-related arthritis (n = 44), oligoarthritis (n = 8), psoriatic arthritis (n = 3). A Hip involvement was reported in 71% of cases and was bilateral in 81% of patients. Coxitis was not correlated with the disease duration (P = 0.7). A positive correlation was found between the age of onset of the disease and the presence of coxitis (12.2 vs 9.6, P = 0.005). However, hip involvement was higher among males without significant difference (76.7% vs 58%, P = 0.132).

Conclusion

Unlike the literature data, our study showed a high frequency of hip involvement in Tunisian children with JIA. We found an association between the male gender and coxitis involvement without significant difference. However, coxitis was more frequent in later onset of the disease.

P069 Assessment of diagnostic delay for hip disorders in the pediatric population

Background

Hip disorders are highly common among pediatric patients. The diagnosis is based primarily on the clinical findings, the context and the personal and family history of the child. It is in most cases steered by the biological and imaging findings. The latter are usually derived from radiographs, ultrasound imaging and, in some cases, MRI. The main purpose of this study is to evaluate assess the diagnostic delay for hip disorders in the pediatric population.

Methods

We conducted a retrospective study including pediatric patients from the rheumatology and the orthopedics department, who consulted or were referred to orthopeadics for a suspected hip disorder.

For all patients, we collected the following data: age, clinical findings, imaging findings, the number of consultations in general medicine or emergency medicine and the number of consultations in orthopedics department before the diagnosis is made, the final retained diagnosis and, ultimately, the diagnostic delay since onset of symptoms and first consultation.

Results

We included 81 children (48 boys and 33 girls) with a mean age of 9.9 years old [1.5–16]. Sixty-two patients were symptomatic at admission. The pain was located in the hip in 55.5% of patients (n = 45), in the groin in 7.4% of patients (n = 6) and in the knee in 12.34% of patients (n = 10). One child reported unilateral buttock pain. The other reasons for consultation were limping in 3.7% of cases (n = 3), deformity of the lower limb in 1.23% of cases (n = 1), a crying baby in 1.23% of cases (n = 1) and swelling of the knee in 1.23% of cases (n = 1). On clinical examination, 58 patients had a limitation of the hip motion. Twenty-nine percent of the children had a biological inflammatory syndrome at admission. In total, over one hundred and seventy-one imaging examinations were performed in order to adjust the diagnosis; among them, 7 CT pelvic scan and 23 MRI.

The different retained diagnoses of hip involvement are summarized in Table 1.

The mean number of consultations in general medicine or emergency medicine before the diagnosis is made was 0,58 ranging from 0 to 2. The mean diagnostic delay since the onset of symptoms was 9,12 months ranging from 3 days to 13 years. The mean diagnostic delay since the first medical check -up was 3,5 months ranging from 0 to 10 years.

Conclusion

Our study showed that the patient lost an average of 9 months from symptom onset to retaining the final diagnosis. The hip being a prognosis joint, this delay could alter the child's future functional abilities.

P015 Imaging findings in cervical spine in patients with Juvenile Idiopathic Arthritis in Tunisia

Background

Juvenile Idiopathic Arthritis (JIA) is a chronic disease characterized by prolonged synovial inflammation that may cause structural joint damage. However, little is known about cervical spine involvement in JIA. The main objective of this study is to describe radiological findings of the cervical spine in patients with JIA.

Methods

We conduct a retrospective monocentric study. All JIA patients were included (ILAR criteria). Sociodemographic, JIA subtype, and clinical characteristics were collected. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis-related enthesitis form. Cervical spine radiographs including anteroposterior and lateral with flexion views were analyzed. A p-value &lt; 0.05 was considered significant.

Results

We included 25 patients (16 girls and 9 boys) diagnosed with JIA with a mean age at disease onset of 9.9 ± 3.9 [3–16]. The median disease duration was 36 months (IQR 25–75%; 30–84). The JIA subtypes were in decreasing order of frequency: Enthesitis-related Arthritis (n = 9), Oligoarticular (n = 6), Polyarticular RF- (n = 4), Polyarticular RF + (n = 2), Systemic (n = 2), Psoriatic Arthritis (n = 1), and Undifferentiated (n = 1).

Median ESR and CRP were 17 mm/h [2–98] and 15.4 mg/l [0–56] respectively. The Median BASDAI score was 2.8 [1–6.3]. Median JADAS10 score was 5.3 [0–20]. Four patients (16%) were on long-term corticosteroid therapy.

Five patients (20 %) have a cervical spine involvement with the following subtypes: Polyarticular (n = 2), enthesitisenthesitis-related arthritis (n = 2), and systemic (n = 1). Clinical manifestations were neck pain (n = 3) and limited range of motion (n = 4). Neurological examination noted brisk deep tendon reflexes (n = 6), positive Babinski reflex (n = 1) and positive Hoffmann reflex (n = 2). No patient had a neurological deficit.

The conventional radiographs of the cervical spine showed: loss of cervical lordosis (n = 2), diastasis C1-C2 (n = 3), erosion of the odontoid process (n = 1), and anterior ankylosis (n = 3). Subsequent cervical spine MRI confirmed these findings and showed pannus at the craniocervical junction in one case and block vertebra of C6-C7 in another case. Atlanto-axial subluxation was anteroposterior in 3 patients and rotatory in one.

Conclusion

Cervical spine involvement is frequent and underestimated in JIA, and its radiological features are various. Hence, regular radiographic monitoring of the cervical spine is required to prevent the development of this complication.

P018 Functional impairment in enthesitis related arthritis patients

Background

Enthesitis related arthritis (ERA) is a subgroup of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis and predominately lower limb arthritis and can affect sacroiliac joint and spine. Recent studies showed that ERA is associated with worse physical status and poorer quality of life (1). The main objective of this study was to compare the aspects of functional status in patients (ERA) and patients with spondyloarthritis (SpA).

Methods

A retrospective monocentric study was carried out on patients with ERA (ILAR criteria) or SpA (ASAS Criteria). Demographic data and clinical characteristics were obtained from medical records. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein rate (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impairment was evaluated by Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of life Questionnaire (ASQoL). Global well-being was assessed by Bath Ankylosing Spondylitis Global Index (BASGI). Population was divided into two groups: group 1 (G1) stands for ERA patients and group 2 (G2) stands for SpA patients. P &lt; 0.05 was considered statistically significant.

Results

A total of 174 patients (40 ERA and 134 SpA) were enrolled. Mean age at disease onset was 12.4 ± 3 years in G1 and 27.8 ± 8 years in G2. Male to female sex ratio was 5.6 in G1 and 3.7 in G2.

Morning stiffness (&gt;60 min) was reported by 37.5% of G1 and 49.3%. G1 patients had longer morning stiffness than G2 (61 [0–90] min vs 30 [0–240] min; P = 0.58). Multiple nocturnal awakenings were reported by 45% of G1 patients and 58.2% of G2 patients. Median BASDAI score was 4.9 [1–44] in G1 and 4.5 in G2 [0–10] (P = 0.48). Median BASGI score was 6 [1.5–9.5] in G1 and 6 [0–10] in G2 (P = 0.58). Median ESR was 35 mm/h [8–90] in G1 and 35 mm/h [2–125] in G2. Median CRP was 18.2 mg/l [1–70] in G1 and 13 mg/l [3–180] in G2. The assessment of functional status revealed that G1 patients had higher BASFI scores than G2 patients (5.2 vs 4.5). The association between G1 and BASFI was statistically significant (P = 0.05). Median ASQoL was 12 [2–17] in G1 and 9 [0–18] in G2. No link was noted between G1 and ASQoL score (P = 0.152).

Conclusion

Our study showed that ERA was associated with higher BASFI scores in comparison with SpA. Treat-to target strategies are mandatory in order to optimize the functional status of children with ERA.

P027 Assessment of physical activity in Juvenile Idiopathic Arthritis

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood, grouping together different diseases characterized by arthritis of unknown origin with onset before age of 16 years. JIA may cause functional impairment and a limited exercise capacity thus a reduced time engaged in physical activity. The aim of the study was to describe participation in physical activity among children with JIA.

Methods

We conducted a descriptive retrospective study including 23 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology ILAR. Demographic data were collected. All patients answered a questionnaire referring to physical activity.

Results

The mean age of our patients was 16 years old with a sex ratio of 3. The education level was distributed as follows: 8,7% were in elementary school and 21,7% were in high school. Only 4,3% of the children were participating in high loading sports. Twenty-one per cent of the children reported spending &gt;3 h per week in physical activity during leisure time. Participation in compulsory school-educational physical activity was reported in 43,5% of the children and 26,1% reported full participation. Full exemption from school sports was reported in 46.5% of cases and it was mostly associated with functional limitations.

Exercise therapy was prescribed in 26.1% of patients and it was mainly swimming. The impact of physical activity on symptoms was divided into 43,5% of the children who reported an aggravation, 8,7% who reported an improvement and 34,8% who didn't report any change.

Conclusion

Physical activity in childhood is important to acquire knowledge and behavioral skills in order to maintain an active lifestyle. A special attention to children with JIA is required in order to promote their full potential of social interaction and improve long-term outcome.

P035 Hip involvement in Tunisian Juvenile Idiopathic Arthritis patients

Background

Juvenile idiopathic arthritis (JIA) is characterized by a widely variable clinical course and outcome. If uncontrolled, joint damage may occur. In this context, coxitis is a feared complication. The aim of our study was to determine the prevalence and patterns of hip involvement in Tunisian JIA patients.

Methods

A retrospective study including children with JIA according to the International League of Associations for Rheumatology (ILAR)) was conducted between 2012and 2021. Sociodemographic data as well as disease characteristics were collected. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Hip involvement was assessed clinical exam and imaging (standard radiograph, ultrasound or magnetic resonance imaging (MRI)). We compared these parameters between the two groups: G1: presence of coxitis and G2: absence of coxitis.

Results

The study included 40 patients with a male predominance: sex ratio was 1.6. The mean age was 11.1 years-old [3–16]. The mean age at onset of the disease was 18.1 years old [8–30]. The distribution of the different subsets was as follows: polyarticular with rheumatoid factor (n = 1), polyarticular without rheumatoid factor (n = 2), enthesitis-related arthritis (n = 29), oligoarthritis (n = 7), psoriatic arthritis (n = 1). Extra-articular manifestations were found in 21.2% of cases: ocular (n = 4), pulmonary (n = 2) and cardiovascular (n = 1). The mean ESR and CRP was 30.9 mm/h [2–90] and 15.8 mg/l [1–70] respectively. A high ESR or CRP were found in 67% of cases. Hip involvement concerned 70% of the patients and was bilateral in 67.9% of them. Hip radiographs were normal in 50% of cases. Ultrasound was performed in 9 patients and revealed a positive Doppler synovitis (n = 2), a negative Doppler synovitis (n = 7) and joint effusion (n = 2). MRI was performed in 20% of cases and revealed synovitis (67%) and joint effusion (33%). Overall, 79.3% of patients had medical treatment combining NSAIDs and rehabilitation, 39% of the patients had had local infiltration with Hexatrione and only two patients had hip replacement. Hip involvement was not correlated with age at onset (P = 0.2), subtype (P = 0.8), sex (P = 0.7), extraarticular manifestations (P = 0.4). Similarly, there was no correlation between the presence of coxitis and ESR (P = 0.07) as well as CRP (P = 0.5).

Conclusion

Our study showed that hip involvement is frequent among Tunisian patients with JIA. Although not correlated with disease characteristics, hip involvement should be assessed frequently and carefully.

[Musculoskeletal hand disorders in musicians]

Music is often associated with joy, pleasure and leisure. However, like any other profession, it has its constraints and risks.The purpose of this update is to present a non-exhaustive inventory of musculoskeletal hand disorders most frequently associated with music practice.All music instruments are concerned. The difference lies in damage location as well as in the frequency of specific pathologies according to the used instrument. The most feared disorder by musicians is focal dystonia, which is characterized by a painless and repetitive coordination disorder. It only appears in the realization of specific professional movements. The overuse syndrome and the nerve entrapment syndrome constitute other dreaded disorders. Specific and multidisciplinary care is often necessary.

Sustainable positive effects of Ramadan intermittent fasting in rheumatoid arthritis

The short-term positive effects of intermittent fasting during the month of Ramadan on rheumatic inflammatory diseases have been previously evaluated. The objective of this study was to assess the sustainability of these effects on rheumatoid arthritis (RA) activity. This prospective study included 35 patients with RA, who observed fasting during Ramadan 2019. The disease activity was assessed and compared between three time points: T1 (6 months before the beginning of Ramadan), T2 (during the month between the 7th day of fasting and the 7th day after Ramadan), and T3 (averagely 3.4 months after fasting). The disease activity score 28 (DAS28) was used to evaluate the disease activity. After a significant decrease of all disease activity parameters between T1 and T2, a gradual increase of clinical and biological outcomes was seen between T2 and T3. Except for CRP, which was significantly higher at T3 (p = 0.02), the changes of the other disease activity parameters were not statistically significant. By reference to baseline data (T1), the decrease of ESR, DAS28 CRP, and DAS28 ESR induced after Ramadan fast was maintained until T3, with statistically significant differences. We can therefore conclude that this study has been conducted at the beginning of the fading-out of the effects of Ramadan fast, and that the duration of 3 months may be the recommended interval between fasting periods to maintain the positive effects of intermittent fasting on RA activity. Key Points • Intermittent fasting can induce a rapid improvement of rheumatoid arthritis activity. • The positive effects of this model of fasting can last up to 3 months. • The recommended interval between fasting periods may be estimated at 3 months.

AB0693 NON-STEROIDAL ANTI-INFLAMMATORY DRUGS DURING CORONAVIRUS 19 PANDEMIC: WHAT DO TUNISIAN RHEUMATOLOGISTS THINK?

Background:

Concerns over the safety of non-steroidal anti-inflammatory drugs (NSAIDs) use during severe acute respiratory syndrome associated with coronavirus 19 disease (covid-19) have raised. NSAIDs are one of the most commonly prescribed and used pain medications for acute and chronic rheumatic diseases such as spondyloarthritis (SpA) and osteoarthritis.

Objectives:

This study aimed to assess the impact of covid-19 pandemic on NSAIDs prescription.

Methods:

A cross-sectional web survey was disseminated to all Tunisian rheumatologists through a mailing system and social media. The French version was accessible on Google form. It included close-ended questions about the prescription of NSAIDs during covid-19 pandemic. Participation was anonymous. Data collection and analysis was performed between January the first and January 30, 2021.

Results:

Among one hundred and thirty Tunisian rheumatologists, thirty responded to the online questionnaire. Ninety percent of participants were women. The mean age of rheumatologists was 34 years [25-57]. The duration of practice was inferior to 5 years in 59.3%, between 5 and 10 years in 18.5%, and superior to 10 years in 22.2% of cases. Sixty-three percent of rheumatologists reported that their activity decreased during covid-19 pandemic. NSAIDs prescription was avoided as much as possible in 40.7% of cases.

The participants indicated NSAIDs less frequently in 33.3% of cases, and as much as before the pandemic in one-quarter of cases.

Rheumatologists believed that NSAIDs worsen the respiratory symptoms (67%), delay recovery (55%), and increase mortality (48%), hospitalization in intensive care (44%), and infectious complications (33%).

The participants suggested that the most incriminated NSAIDs were: Ibuprofen (7.4%), indomethacin (7.4%), celecoxib (7.4%), and diclofenac (3.4%). The majority of rheumatologists (74%) believed that all NSAIDs had a similar risk.

For patients with osteoarthritis, rheumatologists replaced NSAIDs with paracetamol and corticoids in 78% and 11% of cases, respectively. If mandatory, reducing NSAIDs doses or duration was an option in 22% and 74% of cases.

For patients with SpA, half of rheumatologists did not change the treatment. However, the participants limited the use of NSAIDs or discontinued the treatment in patients with comorbidities. More than 60% of rheumatologists didn’t know the effect of NSAIDs in the post-covid-19 syndrome.

Conclusion:

Covid-19 pandemic has affected rheumatologists’ practice. Rheumatic disease management during this pandemic may be challenging. More evidence is mandatory to standardize treatment prescription, especially with NSAIDs.

Disclosure of Interests:

None declared

AB0171 ACHILLES ENTHESITIS AND PLANTAR FASCIITIS IN RHEUMATOID ARTHRITIS PATIENTS: IMPACT OF BODY MASS INDEX

Background:

Enthesitis is known as a hallmark of spondyloarthitis. However, the growing use of ultrasonography (US) increased our opportunity to encounter enthesitis in rheumatoid arthritis (RA). The involvement of Achilles tendon and the plantar fascia is not rare in RA patients.

Objectives:

The aims of this study were to determine the prevalence of Achilles enthesitis and plantar fasciitis in RA patients, and to identify association with clinical data.

Methods:

We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic and clinical data were collected. Three groups were defined according to the BMI: normal (BMI<25kg/m2), overweight (BMI≥25kg/m2) and obese (BMI≥30kg/m2). US examination of Achilles tendon and plantar aponeurosis was performed by a blinded radiologist experienced in musculoskeletal US using a Philips HD11 device with a high-frequency linear transducer. Enthesitis was defined as hypoechoic and/or thickened insertion of the tendon close to the bone (within 2 mm from the bony cortex) which exhibits Doppler signal if active and that may show erosions, enthesophytes or calcifications as sign of structural damage. A p-value <0.05 was considered significant.

Results:

Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].

The mean BMI was 27.7±5.4 kg/m2 [18.3-45.8]. Obesity was noted in 22.7 % of patients and overweight in 45.5% of patients. Clinical examination revealed pes planus valgus (PPV) in 55.6% of cases and pes cavus varus (PCV) in 18.5% of cases.

Heel US revealed Achilles enthesitis in 79.6% of cases. The following elementary lesions were noted in the enthesis: thickness (24.1%), hypoechogenicity (37%), erosions (9.3%), enthésophytes (75.9%), and Doppler signal (3.7%). Plantar fasciitis was noted in 81.5% of cases. The following elementary lesions were found in the insertion of plantar aponeurosis: thickness (75.9%), hypoechogenicity (77.8%), erosions (16.7%), enthesophytes (13%), calcifications (1.9%), and Doppler signal (1.9%).

An association was noted between BMI and Achilles enthesitis (p=0.002). This association was not found with plantar fasciitis (p=0.224).

Achilles enthesitis was also associated with PCV (p=0.007) while plantar fasciitis was associated with PPV (p=0.039).

Conclusion:

Achilles enthesitis and plantar fasciitis are common in RA patients. These lesions seem to be associated with BMI and foot deformities rather than the inflammatory process.

Disclosure of Interests:

None declared

AB0186 AT WHAT LEVEL SHOULD WE MEASURE INTIMA-MEDIA THICKNESS IN RHEUMATOID ARTHRITIS?

Background:

Rheumatoid arthritis (RA) is chronic inflammatory rheumatism characterized by an independent cardiovascular (CV) risk. The screening of carotid intima-media thickness (IMT) in the common carotid artery appears to be a marker of atherosclerosis and is used as a specific tool for CV risk assessment.

Objectives:

The main of this study was to determine the most associated US sites with CV risk in RA.

Methods:

The present study is a prospective study conducted on Tunisian RA patients in rheumatology department of Mohamed Kassab University Hospital (March and December 2020). The characteristics of the patients and those of the disease were collected. The measurement of cIMTwas done using high-resolution B-mode carotid US with a Philips machine with the patient in supine position, according to AmericanSociety of Echocardiography guidelines.The carotid bulb below itsbifurcation and the internal and external carotid arteries were evaluated bilaterally with gray scale, spectral and color Doppler ultra-sonography using proprietary software for carotid arterymeasurements.IMT was measured using the two inner layers of the commoncarotid artery and an increased IMT was defined as ≥0.9 mm. The CV risk at 10 years was calculated by the SCORE index.

Results:

Forty-seven patients were collected, of which 78.7% were women. The mean age was 52.5 ±11.06 years. The rheumatoid factor (RF) was positive in 57.8% of cases, and anti-citrullinated peptide antibodies (ACPA) were positive in 62.2% of cases. RA was erosive in 81.6% of cases. Hypertension (hypertension) was present in 14.9% of patients and diabetes in 12.8% of patients. Nine patients were active smokers. The mean IMT in the left common carotid (LCC) was 0.069 ±0.015, in the left internal carotid (LIC) was 0.069 ±0.015, in the left external carotid (LEC) was 0.060 ±0.023. The mean IMT was 0.068 ±0.01 in the right common carotid (RCC), 0.062 ±0.02 in the right internal carotid (RIC), and 0.060 ±0.016 in the right external carotid (REC). The mean SCORE index of CV risk was 2±2.81 [0-11.6]. CV risk was significantly associated with the IMTs for LIC (p=0.029; r=0.374), LEC (p=0.04; r=0.480), and REC (p=0.016; r=0.408). No association was found between the IMT in the LCC (p=0,361; r=0,162), neither in the RCC (p=0,438; r=0,140) nor the RIC (p=0,670; r=0,077).

Conclusion:

In our study, IMT is strongly associated with score index, especially in carotid bifurcation. However, IMT measured in common carotid does not reflect a cardiovascular risk at 10-years.

References:

[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and Experimental Rheumatology 2018; 36: Clinical E.xperimental.

[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2017.

[3]Martin I. Wah-Suarez and al, Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis. 2018;1–7.

Disclosure of Interests:

None declared