Assessment Tools for Pulmonary Involvement in Patients with Ankylosing Spondylitis: Is Diaphragmatic Ultrasonography Correlated to Spirometry?

Objective

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease that can lead to spinal ankylosis and consequently, restrictive pulmonary dysfunction. Thus, the present study aimed to assess the accuracy of diaphragm ultrasound compared to spirometry in the screening of restrictive pulmonary disorders in radiographic SpA patients.

Methods

We conducted a cross-sectional study of 50 patients with radiographic SpA, over six months. Sociodemographic data, clinical characteristics of the disease, as well as biological, radiological, and therapeutic data, were collected. Spirometry and diaphragm ultrasound were performed.

Results

The mean age of the study participants (N= 50) was 42.7±11 years [range: 25-66] with male predominance (N= 41). Spirometry showed a restrictive disorder in 32% of cases. The mean chest expansion (CE) value was 3.9±1.81cm [range: 1-9] with a median of 4 cm. A pathological value (<5cm) was observed in 72% of cases. A significant positive correlation was found between the right inspiratory diaphragmatic thickness and forced vital capacity (FVC) (r= 0.36; p = 0.02) and the supine FVC (r=0.29; p = 0.04). The left inspiratory diaphragmatic thickness was correlated with the percentage of the FVC decrease (r= 0.35; p = 0.01) defined as the percentage of difference between FVC and supine FVC. The right expiratory diaphragmatic thickness was associated with the FVC (r=0.32; p = 0.02). A significant positive correlation was found between the CE and the presence of B lines (r=0.32; p = 0.02), but not between the CE and the FVC.

Conclusion

The present study showed that diaphragm ultrasonography is correlated with spirometric findings in radiographic SpA patients. Further studies are required to assess its reliability, specificity, and sensitivity in this pathology.

Factors associated with hip involvement in spondyloarthritis: a retrospective study

BACKGROUND

Hip involvement is a life-changing event during spondyloarthritis (SpA) since it's responsible for significant disability and functional impairment. This study aimed to determine the factors associated with hip involvement in patients with SpA.

METHODS

This was a retrospective study, including patients with axial and/or peripheral SpA divided into two groups: patients without and with hip involvement. Hip involvement was defined as pain or abnormality on clinical examination of the hip and/or on imaging. We collected clinical and laboratory data, activity and functional scores, and radiographic parameters. We conducted a multivariate analysis to identify the associated factors of hip involvement.

RESULTS

We included 165 patients with a mean age of 46.13 ± 13.07 years, 121 patients were male. The mean duration of disease was 10.91 ± 6.94 years. Hip involvement, defined as SpA-related hip pain, joint limitation, and dysfunction and/or imaging involvement (X-ray/MRI), was noted in 60 cases (36.4%). Multivariate analysis indicated that disease duration over 10 years (OR=3.847, 95% confidence interval (CI95%)[1.324-11.178], p=0.013), radiographic sacroiliitis (OR=8.949, CI95%[1.261-63.513], p=0.028), very high disease activity (Ankylosing Spondylitis Disease Activity Score: ASDASCRP≥3,5) (OR=9.364, CI95%[2.552-34.352], p=0.001), higher Bath Ankylosing Spondylitis Functional Index (BASFI) (OR=1.439, CI95%[1.120-1.850], p=0.004) and higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (OR=1.311, CI95%[1.065-1.615], p=0.011) were independently associated with hip involvement in these patients. Regarding extra-articular features, we found that pulmonary involvement and osteoporosis were significantly more frequent in patients with hip involvement, but neither retained significance in multivariate analysis.

CONCLUSION

Disease duration over 10 years, radiographic sacroiliitis, very high disease activity, functional impairment, and limited spine mobility were potential associated factors with hip involvement. Patients with these factors should be closely monitored to detect hip involvement at an early stage.

AB0195 PLATELET TO LYMPHOCYTE RATIO: A BIOMARKER OF STRUCTURAL DAMAGE IN RHEUMATOID ARTHRITIS

Background

A regular monitoring of structural damage in patients with rheumatoid arthritis (RA) is necessary to adjust the treatment. However, the rhythmicity of new radiographs to assess the structural damage is not codified. There is no biomarker able to reflect structural damage.

Objectives

Our study aimed to assess the relationship between the modified Sharp score and the platelet to lymphocyte ratio.

Methods

We performed a cross-sectional study including 53 patients with RA. A cell blood count was performed for each patient, and PLR was calculated. Modified Sharp score and its components (erosion score and joint space narrowing score) were evaluated using the radiograph of hands and feet.

Statistical analysis was performed using SPSS (Statistical Package for Social Sciences).

Results

Of the 53 patients, 39 were female (Sex Ratio: 2.8). The mean age was 53.9 ± 12.7 years. The mean age of the onset of the disease was 43.8±13.5 years. The mean disease duration was 10.1 ± 8.2 years. The mean DAS 28-ESR score was 4.64 ± 1.23.

The mean value of PLR was 161.62 ± 86.59. The mean modified Sharp score was 46.33 ± 37.74. Thirty-two percent of patients had a modified Sharp score greater than 50. The mean scores of joint erosion and joint space narrowing were 12.76 ± 15.05 and 33.57 ± 25.80.

Modified Sharp score was correlated to the PLR (r: 0.501; p <10-3).

Moreover, joint space narrowing score and joint erosion score were correlated to the PLR (r: 0.558; p <10-3 and r: 0.299; p: 0.033, respectively).

Patients with a modified Sharp score ≥ 50 had a higher PLR (203.12 ± 101.71 versus 142.33 ± 74.07).

As shown in Figure 1, the ability of PLR to distinguish patients with a modified Sharp score ≥ 50 was good with an AUC of 0.704 (p= 0.021) with a cut-off of 130.5 (sensitivity=75%, specificity=65.7%).

Figure 1.

ROC curve assessing the ability of PLR to distinguish patients with a modified Sharp score ≥ 50

Conclusion

Our study showed that the modified Sharp score correlated with PLR, which ​​can be useful to distinguish patients with severe structural damage with a cut-off of 130.5. This finding suggests that this ratio is a reliable marker to reflect radiographic joint damage.

Disclosure of Interests

None declared

AB0860 Repercussions of tobacco on spondyloarthritis: the Iceberg effect!

Background

The deleterious effect of smoking is frequently studied in inflammatory diseases such as spondyloarthritis (SA) [1].

Objectives

The objective of our study was to identify the consequences of smoking during AS.

Methods

We conducted a cross sectional study including patients followed for spondyloarthritis meeting the ASAS 2009 criteria. For each patient we collected the following parameters: age, age at onset of the disease, duration of progression, disease activity using BASDAI and ASDAS-CRP scores and structural damage using BASRI and mSASSS scores. We also measured sedimentation rate (ESR) and C-reactive protein (CRP).

Statistical analysis was performed using SPSS software.

Results

We included 140 patients. Seventy-three percent were male (n=102). The mean age was 43 ± 12.9 years. The age of onset of the disease was 34.28 ± 12 years. The mean disease duration was 110 ± 107.8 months.

Sixty patients were smokers (43%) at an average of 20.75 ± 16.09 pack-years.

Mean ESR and CRP were 36.49 ± 27.22 mm and 29 ± 44.27 mg/L, respectively.

The mean BASDAI and ASDAS-CRP were 3.68 ± 1.86 and 2.99 ± 0.98, respectively.

The mean BASRI and mSASSS were 4.12 ± 3 and 10.26 ± 15.41, respectively.

Smokers had significantly higher BASRI and mSASSS scores (BASRI: 5.02 ± 3.32 vs 3.47 ± 2.6; p=0.005 and mSASSS: 14.07 ± 17.56 vs 7.02 ± 12 .62; p=0.03).

In addition, the number of packets year was correlated to mSASSS (r=0.399; p=0.01).

On the other hand, we did not find any association between smoking and the following parameters: ESR, CRP, BASDAI or ASDAS-CRP.

Conclusion

As reported in other studies, ours’ showed that structural damage was correlated with the number of pack-years [2]. Smoking was associated with this structural damage in SA regardless the inflammatory biomarkers and the disease activity. This suggests that control of structural damage in SA requires smoking cessation.

References

[1]Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology. 1 juill 2020;59(7):1472‑81.

[2]Wendling D, Prati C. Spondyloarthritis and smoking: towards a new insight into the disease. Expert Rev Clin Immunol. juin 2013;9(6):511‑6.

Disclosure of Interests

None declared

AB1336 EFFECTS OF MUSLIM PRAYER ON LOWER LIMB ENTHESIS ULTRASOUND

Background

Muslim prayer, also known as salat, includes a series of postures and movements, concomitant with a spiritual meditation and Quran recitations, performed at least 5 times a day by Muslim worshipers [1]. Each prayer includes a specific number of rakaa which consists of a single iteration of movements [2].

Objectives

We aim to assess the effects of the Muslim prayer movements on the lower limb entheses, using ultrasonography (US).

Methods

We performed a cross-sectional study including asymptomatic healthy individuals. Each subject was asked if they performed prayer (G1) or not (G0). People who performed prayer were asked about the age and year when they started praying, number of rakaa performed daily and duration of each rakaa. US of lower limb entheses was performed. We explored the entheses of quadricipital tendon (QT), proximal patellar tendon (PPT), distal patellar tendon (DPT), calcaneal tendon (CT), and plantar aponeurosis (PA) looking for thickening, hypoechogenicity, loss of fibrillar pattern, presence of doppler signal and structure damage lesions (calcifications, cortical irregularity, erosions and enthesophytes). The highest value of enthesis thickness of both sides was considered.

Ultrasonographic enthesitis assessment tools were used: the Spanish Enthesitis Index (SEI) [3] and the Glasgow Ultrasound Enthesitis Scoring System (GUESS) [4]. Data analysis was performed using the IBM SPSS software version 26.

Results

A total number of 370 entheses was evaluated. There were 29 males (78%) and 8 females. The mean age was 44.73±12.7 years. Twenty-five subjects (68%) practice prayer. The mean prayer starting age of 28.58±13.345 years. The mean number of years since prayer was started of 20±16.32 years. The mean daily number of rakaa was 19.16±4.16. The mean total daily prayer duration was 35.28±65.58 minutes.

The mean enthesis thickness was 5.98±0.72 mm (QT), 3.69±0.48 (PPT), 4.1±0.64 (DPT), 4.83±0.62 (CT) and 4.89±0.75 (PA). Structural damage lesions were found in 43.2% of subjects (QT), 8.1% (PPT), 13.5% (DPT), 64.9% (CT) and 21.6% (PA).

Structure damage lesions of CT enthesis were significantly more frequently found in people who performed prayer (G0: 41.6%, G1: 76%, χ2=4.194, p=0.041). Furthermore, they are significantly more likely to have thickened PA enthesis (G0: 50%, G1: 84%, χ2=4.752, p=0.029).

The mean SEI was 17.83 in G0 and 19.56 in G1, p=0.647. The mean GUESS was 18.29 in G0 and 19.34 in G1, p=0.781. A positive correlation was found between total daily duration of prayer and PPT enthesis thickness (r=0.575, p<10-3), DPT enthesis thickness (r=0.362, p=0.028), SEI (r=0.360, p=0.026) and GUESS (r=0.388, p=0.018). Thickness of PPT enthesis was also positively correlated to the number of years since prayer was started (r=0.036, p=0.026).

Conclusion

Our study showed that lower limb enthesis US abnormalities are frequent in asymptomatic and healthy subjects who perform Muslim prayer. This finding suggests that lower limb enthesis US should be carefully interpreted in these subjects.

References

[1]AlAbdulwahab SS, Kachanathu SJ, Oluseye K. Physical Activity Associated with Prayer Regimes Improves Standing Dynamic Balance of Healthy People. J Phys Ther Sci. 2013 Dec;25(12):1565–8.

[2]Kamran G. Physical benefits of (Salah) prayer - Strengthen the faith & fitness. Journal of Novel Physiotherapy and Rehabilitation. 2018 May 29;2(2):043–53.

[3]Alcalde M, Acebes JC, Cruz M, González-Hombrado L, Herrero-Beaumont G, Sánchez-Pernaute O. A Sonographic Enthesitic Index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis. 2007 Aug;66(8):1015–9.

[4]Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002 Oct;61(10):905–10.

Disclosure of Interests

None declared

AB1004 CONTRIBUTION OF DRY REHABILITATION VERSUS BALNEOTHERAPY IN THE CONTROL OF PAIN TRIGGERS IN GONARTHROSIS

Background

Gonarthrosis is a very common condition and a real public health problem [1]. One of the pillars of its management is pain management. In addition to drug treatment, rehabilitation is part of the therapeutic arsenal.

Objectives

The main objective of our work was to compare the contribution of balneotherapy versus dry rehabilitation in the control of pain triggers.

Methods

We carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis (KOA) was made according to the criteria of the ACR [2].

The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a standard rehabilitation program. The second group, called G2, received water gymnastics. Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of KOA was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

Pain was triggered by standing in 92% of cases in G1 versus 98% in G2 with a mean delay of 17.2 min for G1 and 20.1 min for G2. There was no statistically significant difference between the two groups (p=0.452). After rehabilitation, 22% of the patients in G1 and 43% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).

Prolonged sitting in 62% of cases in G1 versus 38% in G2 with a mean delay of 6.2 min for G1 and 52.3 min for G2 awakened pain. There was a statistically significant difference between the two groups (p=0.02). After rehabilitation, 23% of the patients in G1 and 30% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).

Pain was awakened by squatting in 93% of cases in G1 versus 97% of G2. There was no statistically significant difference between the 2 groups (p=0.554). After rehabilitation, 13% of the patients in G1 and 30% in G2 had noted a complete disappearance of pain with a statistically significant difference between the 2 groups (p=0.001).

All patients in G1 and 92% of patients in G2 reported pain when climbing/descending stairs. There was no statistically significant difference between the 2 groups. An improvement in symptomatology was noted in both groups with disappearance of pain in 18% of G1 and 27% of G2.

An adjustment on the parameters by which the 2 groups differed was made without impact on the results obtained.

Conclusion

Rehabilitation has an important role in the control of pain triggers by ensuring, in addition to analgesic means, good muscle balance, joint gain and good proprioception. Balneotherapy has proven to be more effective.

References

[1]Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5-15.

[2]Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-49.

Disclosure of Interests

None declared

AB0842 Foot entheses ultrasound in spondyloarthritis: a case control study

Background

Foot entheses involvement is a common manifestation of spondyloarthritis (SpA). It can be responsible for functional impairment. The superiority of ultrasound (US) examination in foot entheses damages detection has been reported [1].

Objectives

We aimed to compare the US findings of foot entheses between SpA patients and asymptomatic healthy control subjects.

Methods

We conducted a cross-sectional study including 37 SpA patients (G1) fulfilling ASAS criteria for Axial SpA and 37 healthy subjects (G0) matched by age and gender. Demographic and clinical characteristics were collected. A blind US of foot entheses was performed by Mindray DC-70 equipment with a 6-16 MHz linear probe. Calcaneal enthesis (CT) and plantar fascia (PF) were examined bilaterally. A total of 296 entheses were assessed.

In G1, disease activity was evaluated using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS).

Statistical Package for Social Sciences (SPSS) was used for analysis.

Results

The study included 58 men and 16 women. The mean age was 44.6 ± 12.3 years. In G1, the mean disease duration was 108.2±94 months. The average BASDAI was 4.5±2.2. The average ASDASCRP was 3.2±1.3. In G1, clinical examination showed tenderness at the posterior insertion of the CT or inferior insertion of PF in 16.2% of patients.

However, US lesions of the CT were found in 97% of cases in G1 and 67.6% in G0, p:0.001. US lesions are presented in Table 1.

Table 1.

Elementary US lesions in SpA and healthy control groups

EnthesisG1 (n (%))G0 (n (%))pCalcaneal tendonThickness15 (40.5)6 (16.2)0.02Erosion9 (24.3)1 (2.7)0.007Enthesophyte29 (78.4)20 (54)0.03Calcification14 (37.8)10 (27)0.32Bursitis4 (10.8)3 (8.1)1PD signal10 (27)00.001Plantar fasciaThickness30 (81.1)27 (73)0.4Erosion11 (30)1 (3)0.002Enthesophyte12 (32.4)2 (5.4)0.003Calcification18 (48.6)6 (16.2)0.003PD signal11 (30)0<0.001

G0: control group, G1: Spondyloarthritis group, PD: power doppler

Calcaneal tendon thickness was noted in 40.5% in G1 and 16.2% in G2 (p=0.02). Hypo-echogenicity and loss of normal fibrillar structure were more frequent in G1 (86.5% versus 29.7%, p<0.001). Structural damage lesions were found in 89.6 % in G0 (n= 33) and 64.9% in G1 (n=24), p=0.01. In the PF, US structural damage lesions were significantly more frequent in the SpA patients (70% versus 21.6%, p<0.001).

Vascularity at power Doppler was significantly more frequent in G1 (p=0.001 in CT and p<0.001 in PF).

In G1, the disease activity was higher in patients with structural damage lesions of the CT (ASDAS CRP: 3.2 versus 1.9; p=0.01). However, there was no associations between vascularity at power Doppler and high disease activity (p=0.47).

Conclusion

Our study showed that the US lesions of the heel entheses were frequent in SpA patients compared to healthy control. Moreover, US can reveal enthesitis even in asymptomatic patients.

The disease activity was higher in patients with US structural damage lesions of the CT.

References

[1]De Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009; 68(2):169-74.

Disclosure of Interests

None declared

AB1499 PAIN MANAGEMENT IN KNEE OSTEOARTHRITIS: BALNEOTHERAPY VERSUS CLASSIC REHABILITATION

Background

Knee osteoarthritis presents a heavy financial burden due to disability and supported care. Gonalgia is the main symptom leading patients to consult. For some clinicians, this is a warning signal that correlates with the extent of joint degradation [1]. The management of pain in knee osteoarthritis is multidisciplinary comprising pharmacological and non-pharmacological means including classical rehabilitation and aquatic gymnastics.

The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis.

Objectives

The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis.

Methods

Prospective, evaluative and comparative study about 120 patients with knee osteoarthritis carried out over 15 months (September 2016- December 2017) in the Department of Physical Medicine and Functional Rehabilitation.

The patients were divided into two groups of 60. The first group (G1) benefited from a classic rehabilitation program, the second group (G2) benefited from aquatic gymnastics.

The 2 programs were carried out at the rate of three sessions per week for two months. The study was based on the assessment of pain by the following scales: VAS pain and the Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC) questionnaire for the lower limbs (pain section).

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

The pain was mechanical in 89 % of cases. Positional nocturnal pain was noted in 72% of cases. Hydarthrosis was associated in 46% of cases. A daily intake of palliative I analgesics was noted in 56 % of patients.

The mean pain VAS at rest of 33.4±18 in G1 vs 27.3±23.2 in G2 (p=0.13). On exertion, it was 72.3±19 in G1 vs 83.3±20 in G2 (p = 0.72).

After the rehabilitation treatment, an improvement in the two groups was objectified, which was significantly more marked in G2:

Resting VAS improved by 57 % for G1 and by 84% for G2 (p = 0.015). Exercise VAS improved 20% in G1 and 43% in G2 (p <0.001).

The mean WOMAC pain score was 14.3 in G1 and 10.3 in G2 (p = 0.006).

There was an improvement in the WOMAC pain score of 24% in G1 and 58% in G2 (p <0.001).

Conclusion

Functional rehabilitation in the water or in the dry has a marked effect on pain in gonarthrosis patients. The aquatic environment can also bring many benefits on pain by lightening the weight of the body and the analgesic effect of the heat.

References

[1]Trouvin A-P, Perrot S. Douleur dans l’arthrose : comprendre les mécanismes pour améliorer la prise en charge. Revue du Rhumatisme. 2018 Jun;85(4):324–30.

Disclosure of Interests

None declared

AB0790 Effects of physical activity on disease activity and clinical enthesitis scores in patients with spondyloarthritis

Background

Regular physical activity (PA) highly recommended for patients with inflammatory diseases [1]. It was shown to significantly improve disease activity [1]. However, data regarding the effects of physical activity on disease activity and clinical enthesitis scores in patients with SA are scarce.

Objectives

We aim to assess the effects of performing PA on disease activity and clinical enthesitis scores in patients with SA.

Methods

We performed a cross-sectional study including patients with axial spondyloarthritis. Each patient was asked if he performed regular physical activity. Clinical disease activity scores were calculated: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score using C-Reactive Protein (ASDAS-CRP). Clinical enthesitis scores were calculated: Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) [2], Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) [3] and Leeds Enthesitis Index (LEI) [4].

Results

Thirty-seven patients were included: 29 males and 8 females. The mean age was 44.51±12.08 years. The mean disease duration of 9±7.8 years. Regular PA was reported by 51% patients (19). Aerobic exercise was performed by 48.6% of patients (walking: 27%, jogging: 8.1%, football: 5.4%, biking: 2.7%, handball: 2.7% and fitness exercise: 2.7%). Anaerobic exercise was performed by only one patient (2.7%) and consists of weightlifting.

The mean weekly duration of PA was of 4.32±3.4 hours. Means BASDAI, ASDAS-CRP, and ASDAS-ESR were of 4.74±2.2, 3.02±1.2 and 3.26±1.3, respectively. Mean MASES was of 2.95±2.86, LEI of 1.51±1.72 and SPARCC of 2.97±3.42. Patients who performed regular PA had significantly lower disease activity evaluated with BASDAI (3.53 vs 5.45, p=0.007), ASDAS-CRP (2.64 vs 3.44, p=0.045) and ASDAS-ESR (2.84 vs 3.7, p=0.44).

Clinical enthesitis scores were also significantly lower in physically active patients (MASES: 1.74 vs 4.22, p=0.007, LEI: 0.95 vs 2.11, p=0.038, SPARCC: 1.79 vs 4.22, p=0.029).

However, no significative difference was found between the two groups regarding CRP (16.11 mg/L vs 39.67 mg/L, p=0.107).

No correlation was found between the weekly number of hours of PA and the evaluated scores.

Conclusion

Physical activity was associated with lower disease activity scores and lower clinical enthesitis score. This highlights the importance of physical activity as a non-pharmacologic treatment in SA for the management of disease activity and entheseal involvement.

References

[1]Osthoff A-KR, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases. 2018 Sep 1;77(9):1251–60.

[2]Heuft-Dorenbosch L, Spoorenberg A, Tubergen A van, Landewé R, Tempel H van der, Mielants H, et al. Assessment of enthesitis in ankylosing spondylitis. Annals of the Rheumatic Diseases. 2003 Feb 1;62(2):127–32.

[3]Maksymowych WP, Mallon C, Morrow S, Shojania K, Olszynski WP, Wong RL, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Annals of the Rheumatic Diseases. 2009 Jun 1;68(6):948–53.

[4]Gladman DD, Inman RD, Cook RJ, Maksymowych WP, Braun J, Davis JC, et al. International spondyloarthritis interobserver reliability exercise--the INSPIRE study: II. Assessment of peripheral joints, enthesitis, and dactylitis. The Journal of Rheumatology. 2007 Aug 1;34(8):1740–5.

Disclosure of Interests

None declared

AB0792 Hip involvement in spondyloarthritis: analysis of associated factors

Background

Hip involvement occurs in about one-third of patients with spondyloarthritis (SA) [1]. It can be responsible for significant disability and functional impairment.

Objectives

This study aimed to assess the associated factors with hip involvement in SA.

Methods

We conducted a cross-sectional study, including 165 patients with SA diagnosed according to Assessment of SpondyloArthritis international Society (ASAS) criteria over a period from 2017 to 2021. Demographic, clinical, biological and radiographic data were collected. We compared following parameters assessed at the time of diagnosis of coxitis: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Bath Ankylosing Spondylitis Radiology Index (BASRI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

We used logistic regression analysis to identify factors associated with hip involvement in SA.

Results

A total of 165 Patients were enrolled (121 men and 44 women), the mean age was 46.13 ± 13.07 years. The mean age of disease onset was 35.01 ± 12.55 years. The average diagnostic delay was 37.54 ± 50.51 months. The average disease duration was 10.91 ± 6.94 years.

Eighty seven percent of patients had axial spondyloarthritis, 72% had extra-articular manifestations.

Mean ESR and CRP values were 37.49 ± 28.1 mm and 30.14 ± 43.55 mg/L, respectively. Mean BASDAI and ASDAS-CRP values were 4 ± 1.8 and 3.09 ± 1.13, respectively.

Hip involvement was noted in 60 patients (36.4%). It was bilateral in 75% of cases (n=45). A total number of affected hips was 105.

Following parameters were significantly higher in patients with hip involvement: age over 40 years old (73.3 vs 56.3%, p=0.030), symptoms duration over 10 years (60% vs 40.2%, p=0.015), elevated CRP (87.9% vs 73.7%, p=0.036), radiographic sacroiliitis (95% vs 82.7%, p=0.023), frequency of pulmonary involvement (25.0% vs 11.4%, p:0.023), frequency of osteoporosis (20.0% vs 8.6%, p:0.034), BASMI (3.71 vs 1.65, p<0.001), BASRI spine (5.97 vs 2.91, p<0.001), and mSASSS (16.24 vs 5.80, p:0.001). However, no association was found between HLA-B27 and hip involvement (50% vs 28.6%, p=0.099).

A multivariable logistic regression model showed that age over 40 years (OR=2.688 [1.020 - 7.083], p=0.045), radiographic sacroiliitis (OR=5.656 [1.007 - 31.769], p=0.049), and very high disease activity (ASDAS-CRP≥3.5) (OR=5.328 [1.774 - 16.002], p=0.003) were independently associated with hip involvement in SA.

Conclusion

Our study showed that age, symptoms duration, radiographic sacroiliitis, extra-articular manifestations, axial structural damage, elevated CRP, and very high disease activity were associated with hip involvement. These finding suggest that the control of disease activity and inflammation may prevent the onset of hip involvement. There are controversial findings regarding the association between HLA B27 gene and hip involvement [2].

References

[1]Vander Cruyssen B, Vastesaeger N, Collantes-Estévez E. Hip disease in ankylosing spondylitis. Curr Opin Rheumatol. 2013 Jul;25(4):448-54.

[2]Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, Chou CT. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2011 Jun;40(6):552-8.

Disclosure of Interests

None declared

AB1500 ASSESSMENT OF CLINICAL PARAMETERS AFTER CLASSIC REHABILITATION VERSUS BALNEOTHERAPY IN GONARTHROSIS

Background

Knee osteoarthritis (KOA) is the most common pathology of the lower limb. It is multifactorial and constitutes a real public health problem. Nowadays, in addition to the rehabilitation that is part of the multidisciplinary management of this affection, water gymnastics is increasingly finding its place [1].

Objectives

The main objective of our work was to compare the contribution of aquatic gymnastics compared to classical rehabilitation in patients with knee osteoarthritis through a clinical evaluation.

Methods

This is a prospective, comparative and evaluative study carried out in a department of Physical Medicine and Functional Rehabilitation over a period of 15 months between September 2016 and December 2017, including 60 patients with KOA.

The patients were randomly divided into 2 groups of 60 patients each one. The first(G1) benefited from a classic rehabilitation program. The second(G2) benefited from water gymnastics. Two clinical evaluations were carried out: T1 before the start of rehabilitation and T2 at the end of the eight weeks of treatment.

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

55 patients presented with a misalignment of the lower limbs with a varus knee in 33% of cases (G1 25% and G2 42%). 5 patients in G1 and 7 patients in G2 had a valgus knee. In G1, one patient had recurvatum and two patient had knee flexum with no statistically significant difference between the two groups.

After classic rehabilitation, Zohlen’s sign had disappeared in 6 patients for the right knee and 3 patients for the left knee. However, after water gymnastics, this sign had disappeared in 12 patients for the right knee and in 16 patients for the left knee.

A functional mobility sector (>90◦) was found in all patients with an average of 120◦ in G1 and 126◦ in G2. After rehabilitation, an improvement of 2% in G1 and 5% in G2 was noted with a statistically significant difference between the two groups (p<0.001).

Thirty-sex percent of G1 patients had quadriceps amyotrophy versus 32 % of G2, which disappeared in 5 patients after classic rehabilitation and in 6 patients after hydrotherapy.

48 patients of G1 and 56 patients of G2 presented with quadriceps retraction which disappeared in 21 subjects of G1 after classic rehabilitation and in 45 subjects of G2 after hydrotherapy.

A retraction of the hamstrings was noted in 13 and 18 patients respectively in G1 and G2 with a total improvement in the 2 groups.

Conclusion

Dry rehabilitation has its place in the management of knee osteoarthritis, but rehabilitation in water has better results. The aquatic environment makes it possible, by reducing the weight of the body, to reduce the stresses exerted on the knee joints, allowing better joint mobility with the added effect of heat on the reduction of pain and muscle relaxation.

References

[1]Erika Ferreira Nascimento, Paulo Henrique Altran Veiga, Rogério Azevedo Antunes Pereira, Antônio Nery de Araújo Neto. Analysis of quality of life and function in the elderly with overweight gonarthrosis submitted to aquatic physical therapy. Geriatrics gerontology and aging. 2012;6(1).

Disclosure of Interests

None declared

AB1223 ACTIVE MILITARY ARE AT HIGHER RISK OF CHRONICITY IN LOW BACK PAIN: A CROSS SECTIONAL COMPARATIVE STUDY

Background

The incidence of low back pain (LBP) was 40.5 per 1,000 person-years in active military population and thus was comparable to the general population. Other than pain and disability, chronicity of LBP has a significant impact on work through the high rates of resulting sick leave. The Start Back Tool (SBT) questionnaire is a well-known tool used to detect patients with prognostic factors for persistent and disabling back pain. The risk of chronicity in individuals on active military duty suffering from acute back pain is yet to be explored.

Objectives

The aim of our study was to assess the risk of chronicity in active Tunisian military population compared to non-military controls using the SBT questionnaire.

Methods

Cross sectional study in which we enrolled adult patients suffering from acute back pain, who consulted the outpatient department of rheumatology in the military hospital of Tunis from January 2021 to Mars 2021. All patients had a standardized clinical examination. They completed the SBT questionnaire in the validated Arabic language version. Patients were stratified in two groups, active military group (AMG) and non-military group (NMG). Categorical variables were compared with the χ2 -test. Comparisons of the differences of continuous variables were performed by Student’s T-test.

Results

We included 54 patients in the active military group and 60 patients in the non-military group, epidemiologic characteristics were distributed respectively as followed: mean age was at 43+/-8 versus 53+/-13 years old (p<0.001), sex ratios (F/H) were 0.23 versus 3.62 (p<0.001), 54% versus 73% (p=0.033) of patients were overweight or obese, 4% versus 18% (p=0.014) of patients had type 2 diabetes, 4% versus 13% (p=0.099) of patients had dyslipidaemia while 9% versus 20% (p=0.108) of patients had hypertension.

Active military group patients had significantly higher proportions of high risk SBT scores than non-military patients 50% versus 22% (2.27 risk ratio 95% CI 1.47 to 3.08; p=0.002), with total mean of scores significantly higher in the active military group 5.81 (95% CI 5.33 to 6.29) versus 4.85 (95% CI 4.43 to 5.27), p=0.014.

Active military group patients scored significantly higher on the psychological SBT sub-score with a mean of 3.02 (95% CI 2.8 to 3.24) versus 2.38 (95% CI 2.07 to 2.7) p=0.032, they were more susceptible to express low mood 53% versus 35% (1.51 risk ratio 95%CI 1.13 to 1.89; p=0.044).

There was no significant difference in expressed anxiety 69% versus 55% (p=0.139), catastrophizing thoughts 57% versus 47% (p=0.252) and avoidance beliefs 72% versus 60% (p=0.170) though all of these parameters were more prevalent in the active military group.

Conclusion

Though NMG patients had more classic low back pain risk factors such as age and obesity, this did not prevent the AMG to show higher trends toward chronicity via SBT scores. This is to our knowledge the first study to assess the high risk of persistent disabling back pain using the SBT in a Tunisian military population. The implementation of risk stratification for patients with low back pain in routine military health may improve physical function and time off work, sickness certification rates and reductions in healthcare costs compared to usual non-stratified care.

Disclosure of Interests

None declared

AB1497 THE EFFECT OF AQUATIC REHABILITATION ON QUALITY OF LIFE IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background

In addition to its multiple functional, social and economic consequences, knee osteoarthritis is responsible for a significant deterioration in the quality of life (QOL)[1]. Studies examining the impact of osteoarthritis on quality of life have been made possible through the development of validated measurement questionnaires. The SF-12 score with its aspects (physical, mental and social) is a valid and reliable instrument for the assessment of QOL.

Objectives

The main aim of our study was to make a comparison between the contribution of aquatic rehabilitation and classic rehabilitation in patients with knee osteoarthritis using the SF-12 score.

Methods

We carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis was made according to the criteria of the ACR.

The patients were randomly divided into 2 groups of 60 patients each. The first group called G1 received a classic rehabilitation program. The second group called G2 benefited from aquatic gymnastics. The study was based on the SF-12 quality of life assessment. Two evaluations were made, the first (T1) before the start of rehabilitation and the second (T2) at the end of the eight weeks of care.

Results

The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).

Initially, the mean of SF12-P in G1 patients was 31.2 ± 6.5 compared to 35.4±6.2 in G2 patients. In our patients, the SF12-P score was less than 50 in 100% of cases in G1 and in 98% of cases in G2. There was a statistically significant difference between the 2 groups (p = 0.04).

After classical rehabilitation, the SF12-P had increased on average by 2.3 against 6.1 after aquatic gymnastics with a statistically significant difference between the 2 groups (p = 0.012).

Initially, the mean of SF12-M in G1 patients was 32.5 ± 10.2 and 35.3 ± 8.9 in G2 patients. In our patients, the SF12-M score was less than 50 in 94% of cases in G1 and in 98% of cases in G2. There was no statistically significant difference between the 2 groups (p = 0.652).

After classical rehabilitation, the SF12-M increased on average by 6.9 and 12.1 after aquatic gymnastics with a statistically significant difference between the 2 groups (p = 0.005).

Conclusion

The effectiveness of functional rehabilitation, whether aquatic or dry, has been well demonstrated by the study of quality of life, with better results for balneotherapy. The physical properties of water and heat have a positive short-term impact on quality of life by acting on several parameters, including pain, contractures and anxiety. Further studies evaluating this long-term effectiveness will be required.

References

[1]Gabriel SE, Crowson CS, Campion ME, O’Fallon WM. Indirect and non-medical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol. 1997;24(1):43–8.

Disclosure of Interests

None declared

AB0861 Increased serum interleukin 8 levels in spondyloarthritis

Background

Physipathological mechanisms of spondyloarthritis (SA) are very complex. The role of the interleukin (IL)- 8, which is an angiogenic chemokine, has been suggested [1].

Objectives

We aimed to evaluate the discriminative value of interleukin 8 in SA.

Methods

We conducted a cross-sectional study during two years (2019-2020) including 144 subjects divided into two groups: a group G1 that included 72 patients followed for spondyloarthritis meeting the Assessement of SpondyloArthritis international Society (ASAS) criteria and a group (G2) including 72 healthy controls. The two groups were matched by age and sex.

IL-8 was measured for each participant using chemiluminescence.

We performed a ROC analysis and computed the air under the curve (AUC) at IL-8 to assess the ability of this chemokine to diagnose SA and to distinguish between SA patients from healthy controls. Statistical analysis was performed using SPSS.

Results

We included 57 men and 15 females in each group. The mean age was 44.84 ± 13.42 years. In G1, the mean disease duration was 10.25 ±7.7 years. Axial and peripheral involvements were found in 85% of cases (n=65) and 50% of cases, respectively.

The mean BASDAI and ASDAS-CRP were 3.21 ± 1.87 and 2.92 ±1.55, respectively.

IL-8 was able to distinguish SA patients from healthy controls with a cutoff of 4.5 pg/mL. The AUC was good at 0.855 (p<0.0001). The sensibility and the specificity were 92.8% and 81.6% (Figure 1).

Figure 1.

AUC at IL-8 between SA patients and healthy controls 0.855 (p<0.0001)

Conclusion

Several studies have found that IL-8 was significantly higher in SA patients comparing to controls [2,3]. Our study showed that IL-8 could distinguish SA patients from controls with a cutoff of 4.5 pg/mL. This suggests that IL-8 could play a role in the pathophysiology of SA.

References

[1]König A, Krenn V, Gillitzer R, Glöckner J, Janssen E, Gohlke F, et al. Inflammatory infiltrate and interleukin-8 expression in the synovium of psoriatic arthritis--an immunohistochemical and mRNA analysis. Rheumatol Int. 1997;17(4):159‑68.

[2]Limón-Camacho L, Vargas-Rojas MI, Vázquez-Mellado J, Casasola-Vargas J, Moctezuma JF, Burgos-Vargas R, et al. In vivo peripheral blood proinflammatory T cells in patients with ankylosing spondylitis. J Rheumatol. avr 2012;39(4):830‑5.

[3]Sonel B, Tutkak H, Düzgün N. Serum levels of IL-1beta, TNF-alpha, IL-8, and acute phase proteins in seronegative spondyloarthropathies. Joint Bone Spine. 1 oct 2002;69(5):463‑7.

Disclosure of Interests

None declared

AB1002 CLASSIC VERSUS AQUATIC REHABILITATION IN GONARTHROSIS: WOMAC SCORE

Background

Gonarthrosis is the most frequent and common condition of the lower limb, responsible for gonalgia, stiffness, leading sometimes to major functional impotence. The WOMAC with its three domains (pain, stiffness and function) is a valid index for the evaluation of lower limb osteoarthritis [1].

The management of gonarthrosis is multidisciplinary with rehabilitation as the mainstay.

Currently, aquatic gymnastics is more and more prescribed in the management of this pathology.

Objectives

The objective of our work was to compare the contribution of aquatic rehabilitation to classical one in patients with gonarthrosis through the WOMAC score.

Methods

This is a prospective, comparative study conducted over a period of 15 months, between September 2016 and December 2017, including 120 patients recruited at the Physical Medicine and Functional Rehabilitation Department of The HMPIT, in whom the diagnosis of gonarthrosis was made according to the ACR criteria.

The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a conventional rehabilitation program. The second group, called G2, received aquatic rehabilitation.

Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.

Results

The average age of the general population was 54.85 ± 9.5 years [40- 81 years].

The average age of G1 was 59.07 ± 10.2 years versus 50.63 ± 6.4 years for G2.

Among the 120 patients, 28 were male (23%) and 92 were female(77%) There were 6 males and 54 females in group 1 versus 22 males and 38 females in group 2.

Initially, the average WOMAC pain was 15.1 ± 3.9 in G1 and 12.3 ± 1.22 in G2.

There was a statistically significant difference between the 2 groups (p=0.01). After rehabilitation, there was an improvement in the WOMAC pain score of 17% in G1 and 50% in G2 with a statistically significant difference between the 2 groups (p<0.001).

The average WOMAC score for stiffness was initially 5.1 ± 2 in G1 and 3.2 ± 2 in G2 with no statistically significant difference between the 2 groups (p=0.076).

After rehabilitation, an improvement of this score was noted in both groups, it was 19% in G1 and 50% in G2 with a statistically significant difference between the 2 groups (p<0.001).

The average initial WOMAC function score was 42.32 ±15.7 in G1 and 33 ± 11 in G2 with a statistically significant difference between the 2 groups (p=0.002).

After conventional rehabilitation, this score had improved by 10% and after hydrotherapy, the improvement was 46% with a statistically significant difference between the 2 groups (p<0.001).

Conclusion

These results were aligned with the literature and confirmed the effectiveness of functional treatment whether aquatic or classic with better outcome for aquatic rehabilitation. The best would be to combine the different methods according to the needs of the patient and their functional capacities in order to ensure a better adherence.

References

[1]Guermazi M, Poiraudeau S, Yahia M, Mezganni M, Fermanian J, Elleuch MH, et al. Translation, adaptation and validation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for an Arab population. Osteoarthr Car- tilage. 2004;12(6):459-68.

Disclosure of Interests

None declared

AB1221 START BACK TOOL RISK SCORE: WHAT GUIDANCE TO GIVE IN A MILITARY LOW BACK PAIN POPULATION?

Background

The Keele start back Tool (SBT) is a 9-item self-reported questionnaire validated to identify individuals with non-specific low back pain (LBP) who have prognostic factors for persistent disabling pain. Thus, it is a useful component of stratified care, where patients’ prognostic subgroups are matched with appropriate treatment.

Objectives

The aim of our study was to report the prevalence of SBT-calculated risk for back pain disability in Tunisian military patients.

Methods

It was a cross sectional study. The SBT questionnaire was administered to patients > 18 years presenting with common low back pain in outpatient Military teaching hospital in Tunis, Tunisia (from January to Mars 2021). The normality of data distribution was checked by the Kolmogorov-Smirnov test. Quantitative variables were presented as mean ± standard deviation (SD) or median (interquartile range), as appropriate. The categorical variables were expressed as percentages.

Results

Out of 114 participants; the mean age at diagnosis was 79 +/- 12 years old, sex ratio was equal to 1, the median of symptom duration was 22 (6-36) months, 83 (72.8%) were employed, 54 (47.4%) were on active military duty.

Comorbidities reported in our patients were distributed as followed: 52 (45.6%) cases of overweight, 21 (18.4%) cases of obesity, 17 (14.9%) had hypertension, 13 (11.4%) suffered from type 2 diabetes, 10 (8.8%) had dyslipidemia, 6 (5.3%) cases of hypothyroidism and 3 (2.6%) cases of auto-immune diseases.

Seventy (61.4%) participants reported anxious thoughts, 75 (65.8%) patients expressed avoidance beliefs, 59 (51.8%) patients mentioned catastrophizing thoughts and 50 (43.9%) were dealing with low mood. Mean SBT psychological score was at 2.68 +/-1.5.

Patients reported a mean SBT score of 5.31+/-2.1 with the following risk stratification: 27 (23.7%) scored low-risk, 47 (41.2%) medium risk, and 40 (35.1%) high-risk.

Conclusion

This is the first study to report the prevalence of SBT-designated risk subgroups among Tunisian population. Medium or high-risk scores for back pain disability were more prevalent the surveyed sample. Also, rates of low mood and anxious thoughts indicate a need for future research to explore psychosocial factors in non-specific low back pain.

Disclosure of Interests

None declared

AB0800 Ultrasonography of supraspinatus entheses in axial spondyloarthritis

Background

Several scoring systems have been developed to quantify ultrasound (US) abnormalities of the entheses in patients with spondyloarthritis (SpA). These scores included entheses of the lower limb, triceps tendon, and lateral epicondylar tendon [1] [2].

Studies regarding the involvement of supraspinatus enthesis in patients with SpA are scarce.

Objectives

This study aimed to assess the supraspinatus enthesis in patients with axial SpA using ultrasonography.

Methods

We performed a cross-sectional case-control study including 74 subjects (148 entheses):

• G1: 37 patients with axial radiographic SpA diagnosed according to Assessment of SpondyloArthritis International Society (ASAS) criteria.

• G0: 37 age and sex-matched healthy controls.

All subjects underwent the US by a qualified-US rheumatologist.

The long axis of the supraspinatus was assessed with the patient’s hand placed near the ipsilateral hip and the elbow directed posteriorly.

Following parameters were evaluated at the bone attachment supraspinatus tendon: thickness, echogenicity, loss of normal fibrillar structure, calcifications, enthesophytes, erosions, cortical irregularities, bursitis, and vascularity at power Doppler.

Statistical analysis was performed using SPSS Statistics software version 21.

Results

The mean age was 44.62 + 12.31 years. There were 29 men and 8 women for each group. In G1, the mean disease activity using ASDAS-CRP was 3.03 with levels ranging from 0.10 to 5.66.

The mean thickness of supraspinatus tendon at its bone attachment was 4.54 ± 0.84 mm in G1 versus 4.02 ± 0.57 mm in G0 (p=0.03). Receiver Operator Curve (ROC) analysis showed the cutoff point with the best accuracy in distinguishing patients of controls to be 4.65 mm, with a sensitivity of 45.9% and specificity of 86.5% (air under the curve (AUC) value: 0.666 (p=0.014). Hypo-echogenicity and loss of normal fibrillar structure were noted in 27% (n =10 patients) and 5% (n = 2), respectively, in G1.

Structural damage lesions were found in 3 % in G0 (n= 1) and 51 % in G1 (n=19), p< 0.0001.

In G1, structural damage lesions included: calcifications (38%, n=14), erosions (30%, n = 11), cortical irregularities (16%, n=6), and enthesophytes (8%, n=3).

In G0, structural damage lesions comprised: calcifications (3%, n=1) and cortical irregularities (3%, n=1).

Vascularity at power Doppler was found in 11% in G1 (n= 4) and 0 % in G0.

Subacromial-subdeltoid bursitis was noted in 3% in G1 (n=1) and in 0% in G0.

Conclusion

Our study showed that structural damage lesions of supraspinatus enthesis were frequent in patients with SpA compared to healthy controls. A cutoff of 4.65mm supraspinatus’s thickness was able to discriminate patients with SpA from healthy controls. This finding suggests that supraspinatus enthesis evaluation can be added in entheses US scores.

References

[1]de Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. févr 2009;68(2):169‑74.

[2]Balint PV, Terslev L, Aegerter P, Bruyn GAW, Chary-Valckenaere I, Gandjbakhch F, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. déc 2018;77(12):1730‑5.

Disclosure of Interests

None declared

AB1003 EFFECTIVENESS OF CLASSIC VERSUS AQUATIC REHABILITATION IN GONARTHROSIS: LEQUESNE SCORE

Background

Gonarthrosis is a benign knee condition, but it can become disabling if poorly managed. The evaluation of the functional impact of gonarthrosis is based on Lequesne’s algofunctional index [1], thus judging the effectiveness or failure of the proposed treatment.

Water gymnastics is increasingly prescribed in the management of this pathology.

Objectives

The main aim of our work was to compare the efficacy of aquatic gymnastics with conventional rehabilitation in patients with gonarthrosis using Lequesne’s algofunctional index.

Methods

This is a prospective, comparative study conducted over a period of 15 months, between September 2016 december 2017, including 120 patients recruited at the outpatient clinic of the Physical Medicine and Functional Rehabilitation Department of The HMPIT, in whom the diagnosis of gonarthrosis was made according to the ACR criteria.

The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a conventional rehabilitation program. The second group, called G2, received water gymnastics.

Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.

Results

The mean age of the general population was 54.85 ± 9.501 years [40- 81 years]. The mean age of G1 was 59.07 ± 10.275 years versus 50.63 ± 6.425 years for G2.

Thus, there was a female predominance with a sex ratio M/F of 0.11 in G1 and 0.57 in G2.

Lequesne’s algofunctional index was initially 11.46 ± 3.2 in G1 patients and 8.7 ± 1 in G2 patients with a statistically significant difference between the 2 groups (p<0.001). The discomfort according to the Lequesne algofunctional index was very important and unbearable in 69% of the cases in G1 against 41% of the cases in G2. The Lequesne index was ≥ 10 in 46 patients in G1 (i.e. 77%) versus 32 patients in G2 (i.e. 53%). After conventional rehabilitation, there was a 10% improvement in this index compared with a 28% improvement after water gymnastics with a statistically significant difference between the 2 groups (p<0.001).

Conclusion

The effectiveness of functional treatment whether aquatic or classic was well demonstrated by Lequesne’s algofunctional index, with better result for aquatic rehabilitation. The best would be to combine the two according to the initial functional capacities of the patient to ensure his adherence to the rehabilitation program.

References

[1]Guermazi M, Mezganni M, Yahia M, Poiraudeau S, Fermanian J, Elleuch MH, et al. Translation and construct validity of the Lequesne index for Arab speaking North African patients with osteoarthritis of the knee. Ann Readapt Med Phys. 2004;47(5):195-203.

Disclosure of Interests

None declared

AB0421 ASSESSEMENT OF LIVER STIFFNESS IN RHEUMATOID ARTHRITIS PATIENTS UNDER METHOTREXATE

Background

Methotrexate (MTX) is recommended as a first-line disease-modifying antirheumatic drug for treating rheumatoid arthritis (RA) in monotherapy or combinational therapy. A concern about MTX-related liver fibrosis in patients with rheumatoid arthritis (RA) is still unsolved.

Objectives

The aim of the study cutoff of cumulative dose discriminating patients with normal from those with abnormal liver stiffness.

Methods

We conducted a cross-sectional study including consecutive RA patients diagnosed according 2009 ACR-EULAR criteria. Liver stiffness (LS) was assessed by Fibroscan in the gastroenterology department by an experienced operator.

The LS is measured in kilopascals (kPa). It is normal when < 6.2 kPa. Above this rate it is considered pathological. Substantial liver fibrosis was defined as liver stiffness of greater than 8 kPa.

We collected the following parameters: age, disease duration, disease activity assessed by DAS28, cumulated dose of MTX and duration of this treatment, and the body mass index (BMI). Patients underwent blood testing exploring hepatic function: alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl tansferase (GGT), total bilirubin (TB), albumin (ALB) and prothrombin time (PT).

Statistical analysis was performed using SPSS software.

Results

There were 18 men and 36 women. The mean age was 51.9 + 11.49 [22-83]. The mean BMI was 27.27 + 3.40. The mean disease duration 8.08 + 6.28 years. The mean DAS28CRP was 3.96 + 1.49.

The mean cumulative dose of MTX was 3670 + 3432.61mg and mean MTX duration was 55.75 + 50.89 months. The mean of LS was 4.6 + 1.64 kPa.

The means of the liver blood tests are as follows: AST 20.83 + 8.58 UI/L, ALT 19.60 + 9.39 UI/L, ALP 84.65 + 38.68UI/L, TB 9.50 + 4.79 UI/L, GGT 25.88 + 14.26UI/L, ALB 35.19 + 5.47 g/L, PT 94.60 + 9.02.

Eight patients had abnormal LS values and two patients had advanced liver fibrosis. However, hepatic blood tests (AST, ALT, GGT, TB, ALB, PT) were normal in these patients.

A correlation was found between LS and following parameters: cumulative dose of MTX (r: 0.347, p: 0.013), the methotrexate duration (r: 0.363, p: 0.010) and total bilirubin rate (r:0.390, p: 0.005).

Receiver Operator Curve (ROC) analysis showed the cutoff point of cumulative dose of MTX with the best accuracy in distinguishing patients with normal LS from those with LS higher than 6.2 kPA was 7330 mg, with a sensitivity of 50% and specificity of 91.3% (air under the curve (AUC) value: 0.732 (p=0.03).

Conclusion

Our study showed that LS correlated to both MTX duration and cumulative dose. Patients with a cumulative dose of MTX higher than 7330 mg required a close follow up of liver elastometry and monitoring of hepatic function.

Disclosure of Interests

None declared

AB0784 SPINAL HYDATID CYST DISEASE: WHAT FEATURES IN SURGICAL DEPARTMENTS?

Background:

Cystic echinococcosis (CE) is a zoonosis caused by the larve of Echinococcus granulosus. Cysts can develop in any part of the body, although the liver and lungs are most frequently involved. Bone echinococcosis is one of the rarest forms of the disease, accounting for 0.5 to 4.0% of all echinococcosis. Spinal cysts are disabling causing destruction similar to malignant bone lesions, with high risk of neurological deficit.

Objectives:

To increase awareness of this disease, the clinical data of eight patients with spinal CE were analyzed retrospectively.

Methods:

Clinical data of eight patients with spinal CE were analyzed retrospectively, collected over ten years on the department of orthopedics in the Military hospital of Tunis.

Results:

The mean age of the patients was 49 years. The median disease duration was five years. All patients presented with back pain and paresthesia without neurological deficit. Radicular pain was reported by two patients. The diagnosis of spinal CE was made after the diagnosis of visceral CE in two patients. Former X rays showed nonspecific abnormalities and patients were treated initially by symptomatic treatments based on paracetamol and nonsteroidal antiinflammatory drugs without any improvement. All of the patients needed Magnetic resonance imaging (MRI) to explore chronic back pain with paresthesia, revealing spinal CE. The typical MRI appearance is a multilocular cyst. Six patients had cervical and thoracic spinal cysts, one patient had a lumbar spinal cyst and one patient had cervical, thoracic and lumbar cysts. Further examinations with Computed tomography scans (CTscans) were needed before surgery for better examination bone destruction. All patients underwent surgery. Cysts were removed with spinal fixation. All the patients showed relapses and needed at least three surgical interventions.

Conclusion:

Bone echinococcosis is rare and often misdiagnosed. Radiographic and CT images lack disease-specific characteristics whereas MRI images offers a greater chance of direct diagnosis. Treatment of spinal hydatid disease is entirely surgical with high risk of relapses.

Disclosure of Interests:

None declared

POS1290 CYTOKINE BIOMARKERS IN COMMON LOW BACK PAIN

Background:

Common low back pain (LBP) is a common health problem affecting 50 to 80% of working age adults. It is one of the common and costly health problems in Tunisia. Actually, the role of the immune response and inflammatory cytokines in the pathogenesis of chronic pain has been of growing interest.

Objectives:

The aim of this study was to assess whether pro and anti-inflammatory cytokines could be detected in serum in patients with LBP compared with healthy subjects and whether they could be related to pain severity and to clinical findings.

Methods:

It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology, orthopedics and immunology at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized clinical assessment.

Levels of serum cytokines IL-6, IL-8, IL-1β and TNF- α, were measured using the chimiluminescence technique. Serum concentration of IL-10 was assayed by the enzyme-linked immunosorbent assay technique (ELISA). The normal levels of cytokines were determined in 50 healthy controls.

Results:

The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. LBP duration was 66.4 months. The mean lumbar visual analog scale (VAS) was 4.5 ± 1.9, and the root VAS was 2.6 ± 2.5. Neuropathic pain was found in 26% of patients. The average BMI was 27 ± 3.7 kg/m2. Only serum level of IL-8 was significantly higher in subjects with LBP compared to healthy controls (p <10-3). IL-1β was indetectable in both patients and controls. Positive correlations were found between IL-8 levels and anxiety/functional scores (r = 0.3; p = 0.02/ r = 0.3; p = 0.04). IL-6 was positively correlated with BMI, and negatively correlated with the Schober test. No correlations were found between serum levels of IL-6, IL-8, IL-10, TNF-α and pain intensity (VAS), neuropathic pain (DN4), fibromyalgia (FIRST), depression (HAD) and various radiological data.

Conclusion:

Interleukin-8 is a biomarker of common low back pain and correlate with anxiety and functional disability. These results suggest that IL-8 may be a therapeutic target to reduce chronic back pain and reduce the social and profession impact.

Disclosure of Interests:

None declared

AB0836 DIAGNOSIS VALUE OF INTERLEUKIN 17 IN SPONDYLOARTHRITIS

Background:

Interleukin 17 (IL-17) is pro-inflammatory cytokine that plays a crucial role in spondyloarthritis via the Th17/IL-17 axis. (1)

Objectives:

We aimed to study the diagnosis value of IL-17 serum in spondyloarthritis.

Methods:

We conducted a case-control study, including 104 subjects divided into 2 groups:

-G1: 52 patients meeting the Assessment of SpondyloArthritis International Society (ASAS) criteria for spondyloarthritis (SA)

-G2: 52 healthy controls matched for age and sex.

The IL-17 level was measured using Enzyme-linked immunosorbent assay (ELISA).

We performed a ROC analysis and computed the air under the curve (AUC) at IL-17 to assess the ability of IL-17 to diagnose SA.

Statistical analysis was performed using “IBM SPSS Statistics” software version 25.

Results:

Eighty per cent of the patients were men (n=41). The mean age was 44.96 ± 13.09 years. The mean age at the onset of the disease was 35.07 ± 12.66 years. The disease duration was 9.25 ± 8.09 years. Axial radiographic spondyloarthritis and peripheral involvement were found in 53.8% (n=28) and 44.2% (n=23) of cases, respectively. Psoriasis was noted in 46% of cases (n=24). The mean ASDAS-CRP was 3.21 ± 1.64.

IL-17 level was significantly higher in patients compared to healthy controls (92.76 ± 71.85 pg/mL and 2.67 ± 9.01 pg/mL, respectively, p<0.0001).

As shown in Figure 1, the AUC value to distinguish between spondyloarthritis and healthy control was 0.987 (p<0.0001). IL-17 cut-off was 13.79 pg/mL (Sensibility= 94.2%, specificity=98.1%).

Figure 1.

AUC at IL-17 between SA patients and healthy controls 0.987 (p<0.0001)

Conclusion:

According to previous studies, our study showed that serum IL-17 level is significantly higher in SA patients compared to healthy controls (2).

Interestingly, IL-17 was able to distinguish between SA patients and healthy controls with a cut-off of 13.79 pg/mL. This finding suggests that IL-17 may be useful for the diagnosis of SA.

References:

[1]Ruiz de Morales JMG, Puig L, Daudén E, Cañete JD, Pablos JL, Martín AO, et al. Critical role of interleukin (IL)-17 in inflammatory and immune disorders: An updated review of the evidence focusing in controversies. Autoimmun Rev. janv 2020;19(1):102429.

[2]Chen W-S, Chang Y-S, Lin K-C, Lai C-C, Wang S-H, Hsiao K-H, et al. Association of serum interleukin-17 and interleukin-23 levels with disease activity in Chinese patients with ankylosing spondylitis. J Chin Med Assoc. juill 2012;75(7):303-8.

Disclosure of Interests:

None declared

AB0509 FREQUENCY AND RISK FACTORS OF HIP INVOLVEMENT DURING SPONDYLOARTHRITIS IN MILITARY PATIENTS

Background:

Hip involvement can reveal a spondyloarthritis (SA) or appear later. It hampers patient’s life quality and can be responsible of significant handicap (1). Military patients are a special population. They are more exposed to physical stress which makes their SA characteristics quite different to other patients.

Objectives:

We aimed to determine the frequency of hip involvement in SA and to study its characteristics and associated factors in military patients.

Methods:

We conducted a cross-sectional study carried out in Rheumatology department of Military Hospital of Instruction of Tunis over a 10-year period (2010-2020) including SA patients meeting The Assessment of SpondyloArthritis international Society (ASAS). For each patient we collected the following informations: age, characteristics of hip involvement, ASDAS (Ankylosing Spondylitis Disease Activity Score), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASMI (Bath Ankylosing Spondylitis Metrology Index) and BASRI (Bath Ankylosing Spondylitis Radiology Index). We also measured Erythrocyte Sedimentation rate (ESR) and C-reactive protein (CRP).

Results:

One hundred forty-one patients were included. They were 103 men and 38 women. The mean age was 43.01± 12.9 years. The mean age at the onset was 34.28±12.05 years. The mean delay of the disease was 9.16±8.98 years.

The mean BASDAI and l’ASDAS-CRP were 3.89±2.29 and 3.07±1.83, respectively.

Hip involvement was noted in 35.5% of the cases (n=50). It was bilateral in 41 of the cases. The number of affected hips was thus 91. The mean delay between the onset of SA and the discovery of hip involvement was 32.24±53.58 months [0-264 months].

A significant difference was noted in the axial mobility between patients who have hip involvement and those who don’t (BASMI was 3,8±2.45 versus 1,45±1.8, p<0.0001).

Moreover, functional impact was higher in patients with hip involvement (BASFI was 5.7±2.24 versus 3.45±2.86, p<0.0001).

Patients with hip involvement had significantly higher BASRI compared to patients with no hip involvement (5.79±3.17 versus 3.14±2.42, p<0.0001).

However, no difference was found between patients who have hip involvement and those who don’t with these following parameters: ESR, CRP, BASDAI and ASDAS-CRP.

Conclusion:

Our study showed that hip involvement is quite common in military SA patients. It is responsible of an important functional impact and it seems to be associated to a major limitation of axial mobility. Nevertheless, hip involvement was not associated neither to inflammation parameters levels nor to the disease activity, this suggest that hip involvement may progress independently of the disease activity in military patients due to physical stress and micro traumas.

References:

[1]López-Medina C, Castro-Villegas MC, Collantes-Estévez E. Hip and Shoulder

Involvement and Their Management in Axial Spondyloarthritis: a Current Review. Curr

Rheumatol Rep. sept 2020;22(9):53.

Disclosure of Interests:

None declared.

POS1012 HOW IMPORTANT WOULD BE THE IMPACT OF SPONDYLOARTHRITIS ON MILITARY POPULATION’S WORKING LIFE?

Background:

Spondyloarthritis is a group of chronic inflammatory diseases involving axial and peripheral joints. It mainly affects young patients typically of working age. Therefore, its impact on work outcomes may be considerable particularly in military patients.

Objectives:

The aim of this study was to evaluate the impact of spondyloarthritis on work ability and productivity in military patients, and to assess relationship between work productivity loss and disease activity.

Methods:

Thirty Three patients diagnosed with spondyloarthritis in the militay hospital of Tunis were included in the study. Age, gender and C-reactive protein were recorded. Data related to duration of the disease, Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were also recorded. Employed patients completed Work Productivity and Activity Impairment (WPAI) questionnaire witch assesses four subscales: presenteism, absenteism, overall work impairemend and daily activity impairement in the 7 past days.

Results:

Among the thirty three patients, 63 % were men and 37% were women. The average age was 43,7 ± 13,5. The average duration of disease was 8,5 ± 7,75 years. Mean C-Reactive protein was 27,5 ± 39,3. Mean ASDAS and BASDAI were 3,12 ± 1,39 and 4,26 ± 1,78 respectively. 22 patients (66%) had an active disease and 11 (33%)were in remission. 48,4% of patients were using NSAIDs, 48,4% were under DMARDs and 42% were under biologics (12 patients using TNF-alpha blockers and 2 patients were given IL-17 inhibitors). Among this patients, 27 were employed. Three patients (11%) had a total work disability and were retired from work and two have been outplaced.

Employed patients worked an average of 35,6 ± 10,3 hours per week and missed an average of 3,48 ± 6,49 hours per week. The mean rates of absenteeism, presenteeism and work productivity loss were 8,8 ± 16,9 %, 48,4 ± 19,9 % and 48,6 ± 19,7 %.

There was a statistically significant correlation between BASDAI and work missed hours (p<0,05, r=0,48), absenteeism (p<0,05, r=0,48), presenteeism (p<0,01, r=0,669), work impairement (p<0,01, r=0,669), activity impairement (p<0,05, r=0,475) and work productivity loss (p<0,05, r=0,475), as well as between ASDAS CRP and presenteeism (p<0,05, r= 0,593), work impairement (p<0,05, r=0,593), activity impairement(p<0,05, r=0,460) and work productivity loss (p<0,05, r=0,460). No relation was found between WPAI indexes and C-reactive protein.

Conclusion:

This study demonstrates that spondyloarthritis has a major impact on military patients’ work productivity with a significant correlation between WAPI indexes and disease activity scores (ASDAS CRP and BASDAI). No relation was found with C-reactive protein.

Disclosure of Interests:

None declared.

AB0182 HEMOGLOBIN RATE AS A PREDICTOR OF SUBCLINICAL LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN RHEUMATOID ARTHRITIS

Background:

The role of rheumatoid arthritis as an ischemic heart disease and heart failure risk factor is well acknowledged even if the physiopathological pathways are still debated. The effect of anemia on myocardial deformation has already been established and a hemoglobin level below 9g/dL was associated with a significantly lower global longitudinal strain (GLS) patients with no history of CVD or chronic inflammatory diseases.[1]

Objectives:

In the present study, we looked into the effect of anemia and hemoglobin on the myocardial impairement in RA patients.

Methods:

We conducted a monocentric cross-sectional study between march 2019 and september 2019 on 36 RA patients without any history of cardiovascular disease and non-altered left ventricular ejection fraction in the outpatient population of the rheumatology department of the military hospital of Tunis matched with 36 healthy control subjects. Both groups underwent conventional echocardiography and STE to measure GLS; subclinical left ventricular systolic dysfunction was defined as a GLS > −18%, and a complete blood cell count; anemia was defined as Hemoglobin levels < 12 g/dL for women and < 13 g/dL for men.

Results:

Myocardial deformation study revealed that rheumatoid arthritis patients had a significantly worse GLS than healthy controls (18.99±2.81% vs 20.42±1.33%; P=.015). We also observed that third of the RA patients had subclinical left ventricular systolic dysfunction.

In our report 36% of RA patients were anemic. In our univariate analysis anemia was found to be significantly correlated with GLS (r=−0.368, P=.027) and hemoglobin was found to be the best predictor of subclinical LVSD in our ROC curve analysis (AUC=0.752, 95% CI: 0.577-0.927, P=.02). In our multivariate analysis anemia was the only factor that was independently related to subclinical LVSD (OR: 11.39, 95% CI: 1.57-82.89, P=.016).

Figure 1.

ROC curve analysis for Hemoglobin as a predictor of subclinical left ventricular systolic dysfunction

Conclusion:

To our knowledge, this is the first study to look into the relationship between GLS and anemia among RA patients, and now it is safe to say that anemia is yet another added burden on the myocardial function in RA patients that needs to be taken into account when discussing therapeutic action.

References:

[1]Zhou Q, Shen J, Liu Y, Luo R, Tan B, Li G. Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography. Anatol J Cardiol. 2017;18(3):194–9.

Disclosure of Interests:

None declared

AB0134 RELATIONSHIP BETWEEN INFLAMMATORY RATIOS AND RADIOGRAPHIC JOINT DAMAGE IN RHEUMATOID ARTHRITIS

Background:

The tight control strategy is recommended in rheumatoid arthritis to tailor treatment for patients. This strategy requires regular monitoring of both disease activity and structural damage. However, radiographic assessement cannot be performed frequently and the modified Sharp score is rarely evaluated in current practice. Besides, no biomarker was able to mirror structural damage (1).

Objectives:

Our study aimed to assess the relationship between the modified Sharp score and the inflammatory ratios (platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), fibrinogen to albumin ratio (FAR) and CRP to albumin ratio (CAR)).

Methods:

We performed a cross-sectional study including 53 patients with rheumatoid arthritis (RA). A cell blood count, fibrinogen and an albumin blood test were measured for each patient. Inflammatory ratios were also measured (PLR, NLR, LMR, FAR, and CAR). Modified Sharp score and its components (erosion score and joint space narrowing score) were evaluated using the radiograph of hand and foot.

Patients with infectious or hematological diseases were excluded from the study.

Statistical analysis was performed using SPSS (Statistical Package for Social Sciences).

Results:

Of the 53 patients, 39 were female (Sex Ratio: 2.8). The mean age was 53.9 ± 12.7 years. The mean disease duration was 10.1 ± 8.2 years.The average age of the onset of the disease was 43.8±13.5 years.

The mean DAS 28-ESR score was 4.64 ± 1.23. Forty three patients had a score higher than 3.2 (patients with moderate or high disease activity).

The mean values of PLR, NLR, LMR, FAR and CAR were 161.62 ± 86.59, 2.84 ± 2.39, 4.99 ± 3.23, 0.12 ± 0.06 and 1.15 ± 1.38.

The mean scores of joint erosion and joint space narrowing were respectively 12.76 ± 15.05 and 33.57 ± 25.80. The mean modified Sharp score was 46.33 ± 37.74.

There was a positive correlation between modified Sharp score and following ratios: PLR (r: 0.501; p <10-3), NLR (r: 0.302; p:0.031), FAR (r: 0.300; p:0.030), CAR (r:0.286; p:0.042).

Moreover, a positive correlation between joint space narrowing score and these ratios was identified: PLR (r: 0.558; p <10-3), NLR (r: 0.428; p:0.002), FAR (r: 0.371; p:0.007), CAR (r:0.387; p:0.005).

Joint erosion score correlated with PLR (r: 0.299; p:0.033).

No correlation was found between LMR and radiographic score.

Conclusion:

Our study showed that the modified Sharp score correlated with PLR, NLR, FAR and CAR in patients with RA. This finding suggests that these ratios could be used as inexpensive and reliable markers to reflect radiographic joint damage.

Longitudinal studies are necessary to confirm our results.

References:

[1]Syversen SW, Landewe R, Van Der Heijde D, Bathon JM, Boers M, Bykerk VP, et al. Testing of the OMERACT 8 draft validation criteria for a soluble biomarker reflecting structural damage in rheumatoid arthritis: a systematic literature search on 5 candidate biomarkers. J Rheumatol. 2009;36(8):1769-84.

Disclosure of Interests:

None declared

POS1287 ANXIETY, DEPRESSION, FIBROMYALGIA SYNDROME AND PAIN INTENSITY IN PATIENTS WITH LOW BACK PAIN

Background:

Common low back pain (LBP) is a common health problem affecting 50 to 80% of working age adults resulting in significant personal, social and occupational impairment. Chronic pain has a negative impact on quality of life and psychological well-being.

Objectives:

The aim of this study was to examine the relationship between anxiety, depression and pain intensity in patients with low back pain in a population made of military agents.

Methods:

It was an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology and orthopedics at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized clinical assessment. Patients completed the «hospital anxiety and depression scale» (HADS) and the «Fibromyalgia Rapid Screening Tool» (FIRST) to evaluate psychological impact of chronic LBP. Pain intensity was assessed using a visual analog scale (VAS).

Results:

The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. LBP duration was 66.4 months. The mean lumbar visual analog scale (VAS) was 4.5 ± 1.9, and the root VAS was 2.6 ± 2.5. Neuropathic pain was found in 26% of patients. Abnormal level of anxiety and depression were found in 58% and 62% of the patients respectively. Out of them 20% and 26% were borderline abnormal for anxiety and depression respectively, while 38% (16.4%) and 36% were certainly abnormal for anxiety and depression respectively. Twelve percent of the patients had fibromyalgia syndrome associated with LBP as they had a FIRST score ≥5. Positive correlations were found between lumbar VAS and HAD anxiety/depression scores (r = 0.35; p<0.01/ r = 0.3; p = 0.04). Positive correlations were also found between root VAS and HAD anxiety/depression (R= 0.38; P<0.01/ R=0.29; P=0.03). There was positive correlations between Fibromyalgia syndrome (FIRST scale) and lumbar VAS (r= 0.42; p=0.01) and root VAS (R= 0.29; P<0.01).

Conclusion:

The results of this study showed that anxiety, depression and fibromyalgia syndrome are not only frequent with patient suffering from chronic LBP but they are also correlated to the pain intensity. As a consequence, assessment of and intervention in anxiety, depression symptoms and fibromyalgia syndrome is crucial in the provision of pain-relief nursing treatment in patients with low back pain.

Disclosure of Interests:

None declared

AB0840 DIAGNOSIS VALUE OF INTERLEUKIN 23 IN SPONDYLOARTHRITIS

Background:

Interleukin 23 (IL-23) is a pivotal pro-inflammatory cytokine in the Th17/IL-23 axis which became the center of attention in researches during these last decades, especially during spondyloarthritis (1).

Objectives:

We aimed to study the diagnosis value of IL-23 serum in spondyloarthritis.

Methods:

We conducted a case-control study, including 144 subjects divided into 2 groups:

-G1: 72 patients meeting the Assessment of SpondyloArthritis International Society (ASAS) criteria for spondyloarthritis (SA)

-G2: 72 healthy controls matched for age and sex.

For each SA patient we collected the following parameters: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), ASDAS (Ankylosing Spondylitis Disease Activity Score), BASFI (Bath Ankylosing Spondylitis Functional Index), and BASRI (Bath Ankylosing Spondylitis Radiology Index).

The IL-23 level was measured using Enzyme-linked immunosorbent assay (ELISA).

Erythrocyte Sedimentation rate (ESR) and C-reactive protein (CRP) were also measured.

We performed a ROC analysis and computed the air under the curve (AUC) at IL-23 to diagnose SA patients.

Statistical analysis was performed using “IBM SPSS Statistics” software version 25.

Results:

The study included 57 men and 15 women. The mean age was 44.84 ± 13.42 years. The mean age at the onset of the disease was 35.97 ± 12.88 years. The disease duration was 8.54 ± 7.7 years.

Seventy-nine per cent of our patients had axial radiographic spondyloarthritis (n=57). Peripheral involvement was found in 45.8% (n=33). Eighteen patients had both axial and peripheral involvement concomitantly. Psoriasis was found in 36.1% of the cases (n=26).

The mean BASDAI and ASDAS-CRP were 3.21 ± 1.64 and 3.05 ± 1.51, respectively.

The mean was BASFI 3.88 ± 2.69. The mean was BASRI 5.26 ± 4.14.

The mean ESR and CRP were 36.74 ± 29.38 mm/hr and 20.45 ± 25.19 mg/dL, respectively.

IL-23 level was significantly higher in patients compared to healthy controls (23.1 ± 2.72 pg/mL and 5.02 ± 0.59 pg/mL, respectively, p<0.0001).

As shown in Figure 1, the AUC value to distinguish between spondyloarthritis and healthy control was 0.705 (p<0.0001). IL-23 cut-off was 7.96 pg/mL (Sensibility= 69.4%, specificity=98.6%).

Figure 1.

AUC at IL-23 between SA patients 0.705 (p<0.0001) Nevertheless, no correlation was found between serum IL-23 levels and the following parameters: ESR, CRP, BASDAI, ASDAS-CRP, BASFI and BASRI.

Conclusion:

As reported to previous studies, our study showed that IL-23 is significantly higher in SA patients (2).

Interestingly, IL-23 was able to distinguish between SA patients and healthy controls with a cut-off of 7.96 pg/mL. This finding suggests that IL-23 may be practical for the diagnosis of SA.

References:

[1]K V, D E. IL-23 Responsive Innate-Like T Cells in Spondyloarthritis: The Less Frequent They Are, the More Vital They Appear [Internet]. Vol. 17, Current rheumatology reports. Curr Rheumatol Rep; 2015 [cité 13 avr 2020]. Disponible sur: https://pubmed.ncbi.nlm.nih.gov/25874346/

[2]Wang X, Lin Z, Wei Q, Jiang Y, Gu J. Expression of IL-23 and IL-17 and effect of IL-23 on IL-17 production in ankylosing spondylitis. Rheumatol Int. sept 2009;29(11):1343-7.

Disclosure of Interests:

None declared

AB0519 PHYSICAL ACTIVITY AND OBESITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Ankylosing Spondylitis (AS) is associated with an increased cardiovascular risk. Obesity and limited activity in patients with AS may contribute to this cardiovascular risk.

Objectives:

We aimed to evaluate physical Activity and obesity in patients with AS.

Methods:

We conducted a cross-sectional observational study of 40 patients with AS, over a period of 3 months. We evaluated the level of physical activity using the IPAQ (International Physical Activity Questionnaire). We also measured body mass index (BMI), body fat percentage, waist circumference, hip circumference and their ratio in all patients.

Results:

The mean age of our population was 44±10 years. A male predominance was noted with a sex ratio =11.1. The mean ASDAS-CRP and BASDAI levels were 2.1±0.95 and 2.25±1.33. The mean of IPAQ was 3900 MET minutes per week, with a median of 3069 and extremes of 339 and 11000. 45.5% of patients had moderate physical activity and 20% had low activity.The mean BMI was 26.5 + 4.7 kg/m2. Twenty percent of patients were obese. The mean body fat percentage was 25% with a median of 23.7% and extremes of 8-46%. Forty-five percent of the patients had a high fat mass. The mean waist circumference was 95±13 cm, hip circumference 104±9.5 cm. The mean waist to hip ratio was 0.9±0.07. Thirty-seven percent of patients had a high waist to hip ratio. BMI and body fat percentage were negatively correlated with HDL level; (r=-0.365,p=0.024)and(r=-0.393,p=0.015) respectively.

Conclusion:

The majority of our patients have moderate or low levels of physical activity. The increase in BMI and fat mass appear to be associated with disturbance of the lipid balance, with low HDL values.

Disclosure of Interests:

None declared.

AB0518 ATHEROSCLEROTIC RISK IN PATIENTS WITH ANKYLOSING SPONDYLITIS: BIOMARKERS VERSUS SCORE

Background:

Chronic inflammatory rheumatic diseases are associated with a high cardiovascular risk. However, data in ankylosing spondylitis (AS) are still limited.

Objectives:

The aim of our study was to assess the atherosclerotic risk in patients with AS, by comparing the Systematic coronary risk evaluation: SCORE, with biomarkers of atherosclerosis: High sensitivity C-reactive protein (Hs-CRP), LDL/HDL ratio and apoliprotein A1 (Apo A) /apolipoprotein B (Apo B) ratio.

Methods:

We conducted a cross-sectional observational study of 40 patients with AS, over a period of 3 months. Socio-demographic data, clinical characteristics of the disease, as well as biological, radiological and therapeutic data were collected for each patient. Coagulated blood samples were collected following a 12-hour fast. Cardiovascular risk was considered high for Hs-CRP>3.0 mg/L [1], LDL/HDL> 3.5 in men and 3.0 in women [2], and ApoB/ApoA level>0.9 [3,4]. SCORE was calculated for all patients.

Results:

The mean age of our population was 44±10 years. Male predominance was noted with a sex ratio =11.1. The mean ASDAS-CRP and BASDAI levels were 2.1±0.95 and 2.25±1.33. Thirty-two percent of the patients had a high risk of cardiovascular diseases according to Hs-CRP level, with an average of 10.7 mg/L. The mean LDL/HDL ratio was high in twenty-two percent of the patients. The mean value of ApoA1 and ApoB was respectively 1.3 g/l. and 0.9 g/l. Low values of Apo A1 were determined in 12.5% of the subjects, and high values of ApoB were found in 15% of subjects. The mean value of ApoA/ApoB ratio was 0.7. Ten percent of the studied subjects had an unfavourable ApoB/ApoA1. The predicted 10-year risk of CV mortality according to SCORE was high in 5% of the patients, very high in 2.5% and moderate in 35% of them. Over 17 patients with moderate, high and very high risk according to SCORE: Four patients (23.5%) had high LDL/HDL ratio, 8 (47%) had high waist/hip ratio, 5 (29.4%) had high Hs-CRP level, and 2 (11.7%) had high ApoB/ApoA ratio.

We found ApoB/ApoA to be positively correlated with Hs-CRP (r=0.31, p=0.05). The SCORE was correlated to the age at the onset of the disease (r=0.78, p<10-3).

Conclusion:

The atherosclerotic risk in our population ranged from 10 to 43%. SCORE presented with the highest percentage, making it more suitable for mass screening. Biomarkers on the other hand are more precise. Hs-CRP is biomarker to be included in daily practice, even when AS is in remission. Accuracy of the apoB/apoA ratio is significantly great and appears to be associated with inflammation.

References:

[1]Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM, et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Laboratory Science Discussion Group. Circulation [Internet]. 2004 Dec 21 [cited 2020 Oct 20];110(25).

[2]Munoz. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. VHRM. 2009 Sep;757.

[3]Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. The Lancet. 2001 Dec;358(9298):2026–33.

Disclosure of Interests:

None declared.

AB0071 RELATIONSHIP BETWEEN PRO-INFLAMMATORY CYTOKINE AND ATHEROGENIC INDEXES IN AXIAL RADIOGRAPHIC SPONDYLOARTHRITIS

Background:

The cardiovascular burden in inflammatory rheumatic diseases is well recognized. This burden has been reported in spondyloarthritis. Atherogenic indexes are known with their role of predicting cardiovascular risk.

Objectives:

The aim of our study was to determine the relation between pro-inflammatory cytokines and atherogenic indexes in spondyloarthritis.

Methods:

We performed a cross sectional study including 38 patients with spondyloarthritis according to ASAS criteria. For each patient we measured interleukin (IL)1, IL6, IL17, IL23 and tumor necrosis factor (TNF) alpha, total Cholesterol (CT), Triglycerides (TG), High density lipoprotein Cholesterol (HDLc) and Low density lipoprotein cholesterol (LDLc). We also calculated the following ratios: CT/HDLc, TG/HDLc, LDLc/HDLc, and LogTG/HDLc.

Disease activity was measured using ASDAS (Ankylosing Spondylitis Disease Activity Score) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index).

Statistical analysis was performed using IBM SPSS Statistics 25.

Results:

The mean age were 45.4±12.5 years. There were 33 Male (sex ratio were 6.6).

The mean C-reactive protein(CRP) were 29.6 ±40.34mg/L, mean erythrocyte sedimentation rate(ESR) were 41±33.9mm.

The mean ASDASCRP, BASDAI were 2.8±1.24, 3.7±2.12, respectively.

Active disease were noted in 68 % of patients using ASDASCRP score.

The mean IL1, IL6, IL17, IL23, TNF alpha were 11.6 ±25pg/ml, 15.4±45.9pg/ml, 84.6±77.9pg/ml, 15.3±15.26pg/ml, 25.3± 47.9pg/ml respectively.

The mean CT,HDLc,LDLc, TG were 4.47±0.93mmol/l, 1.09±0.3mmol/L, 2.77±0.78mmol/L, 1.29±0.54mmol/L respectively.

The mean CT/HDLc, TG/HDLc, LDL/HDLc, LogTG/HDLc were 4.28±1.26, 1.22±0.6, 2.7±1.06, 0.03±0.23, respectively.

Correlations were found between TG/HDLC ratio and IL1 (p<0.01, r=0.515), IL6(p<0.05; r=0.407), Log TG/HDLc and IL1 (p< 0.05, r=0.369), and IL6(p<0.05; r=0.333)

However, no correlations were noted between atherogenic indexes and IL7, IL17, IL23, TNFalpha.

Conclusion:

Our study showed a correlations between atherogenic indexes and both IL1 and IL6.

These findings suggests that serum IL-6 and IL1 levels in spondyloarthritis contribute to the development of cardiovascular disease atherosclerosis.

References:

[1]Lau et al. Role of Adipokines in Cardiovascular Disease. Circ J. 2017; 81(7): 920-8.

Disclosure of Interests:

None declared

AB0178 COMORBIDITIES IN RHEUMATOID ARTHRITIS: DO THEY INTERFERE WITH MYOCARDIAL FUNCTION?

Background:

Patients with rheumatoid arthritis are at increased risk for cardiovascular disease (CVD).The early myocardial dysfunction in RA patients may be detectable sooner using speckle-tracking echocariodgraphy to evaluate ventricular strain especially the global longitudinal strain (GLS), this has provided more comprehensive information on ventricular dysfunction in these patients.

Objectives:

In the present study, we evaluated comorbidities that interfered the most with the GLS in rheumatoid arthritis patients.

Methods:

The study population was comprised of a case group (36 patients with rheumatoid arthritis with no history of CVD and normal LVEF in the outpatient population of the Rheumatology department in the military hospital of Tunis) and a matched control group (individuals without a history of rheumatoid arthritis or cardiac abnormalities referred for clinical check-ups). In both groups, 2D and 3D echocardiographic examinations were performed by a single cardiologist to assess cardiac functional parameters.

Results:

Anemia (36%) was found to be the most common comorbidity followed by diabetes mellitus (25%), arterial hypertension (17%) and dyslipidemia (17%).

Myocardial deformation study revealed that rheumatoid arthritis patients had a significantly worse global longitudinal strain than healthy controls (18.99±2.81% vs 20.42±1.33%; P=.015). Moreover, a third of the rheumatoid arthritis patients (and no healthy controls) exhibited subclinical left ventricular systolic dysfunction (GLS<18%).

Anemia (r=−0.368, P=.027), Age (r=−0.365, P=.029), Diabetes mellitus (r=−0.540, P=.001) and E/A (r=0.351, P=.036) were significantly correlated with GLS in our univariate study. Receiver operating characteristic curve analysis revealed hemoglobin as the best predictor for subclinical LVSD (AUC=0.752, 95% CI: 0.577-0.927, P=.02) when compared to Age and E/A.

Conclusion:

This prospective comparative study highlighted the diabetes mellitus and anemia burden on myocardial dysfunction in RA patients.

Disclosure of Interests:

None declared

POS1289 CHRONIC LOW BACK PAIN: THERAPEUTIC STRATEGIES AND CLINICAL OUTCOMES IN A MILITARY POPULATION

Background:

Low back pain is an extremely common patient complaint. Most cases resolve quickly after the acute episode. However, a significant number of patients develop chronic low back pain; a persistent disabling condition. Patients suffer from unremitting pain and often become functionally impaired.

Objectives:

The aim of this study is to describe the characteristics of chronic LBP, physical examination abnormalities, treatment strategies and the impact of LBP on the professional life of the patients.

Methods:

It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology and orthopedics at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized investigation and clinical assessment.

Results:

The study included 80% of active military serving members and 20% of administrative officers. The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. Four patients were suffering from diabetes; two patients were suffering from high blood pressure. All the patients were suffering from chronic LBP lasting for an average of 66.4 months. LBP was associated with radicular pain in 78% of the cases. It was a unilateral radicular pain in 72% of the cases and bilateral in 28% of the cases. The main triggering factors were: carrying heavy loads in 98% of the cases, standing or sitting for long periods in 90% and 76% of the cases, tremors in 74% of the cases. Neuropathic pain was found in 26% of patients. Physical examination showed paravertebral muscle tenderness in 66% of the cases and slack abdominal muscles in 56% of the cases. Assessement of range of flexion of the lumbar spine showed: fingertip to floor test was 18 ±12.2 cm [054cm], schober test was +3.8±1.2cm [16cm]. The extension of lumbar spine was painful in 80% of the cases. A trigger point was found in 28% of the cases. Lasegue sign was positive in 18% of the cases. Leri’s test was positive in 8% of the cases. Required treatments during the last episode of LBP were: Paracetamol (62%), nonsteroidal antiinflammatory drugs (26%), tramadol (4%), myorelaxant (4%) and pregabalin (2%). Half of the patients needed functional rehabilitation. Forty percent of the patients reported improvement; 46% of them reported improvement then recurrence of the pain, 8% of them reported no improvement and 4% reported worsening of the symptoms. Thirty six percent of the patients needed an average of 21 days of leave and 35% of them needed exemption from work for LBP problems. One patient needed an outplacement from his original work and one patient needed an early retirement.

Conclusion:

Chronic low back pain can cause significant functional disability, and commonly becomes frustrating for both patients and physicians to cope with and treat. There is still no consensus on the best way to manage chronic low back pain, and clinical guidelines are scarce. A combination of pharmacological agents and non-pharmacological methods is the most appropriate therapeutic regimen.

Disclosure of Interests:

None declared

AB0507 ASSESSMENT OF FIBRINOGEN TO ALBUMIN RATIO IN RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: CORRELATION WITH DISEASE ACTIVITY

Background:

Radiographic axial spondyloarthritis is a chronic inflammatory disease that involves the spine and the sacroiliac joints. No specific biomarker that reflects disease activity is yet available.

Objectives:

This study aimed to assess the relationship between fibrinogen (Fib) to albumin (ALB) ratio (FAR) and disease activity in radiographic axial spondyloarthritis.

Methods:

We performed a cross-sectional study including 51 patients with radiographic axial spondyloarthritis. Disease activity was assessed using Ankylosing Spondylitis Disease Activity Score (ASDAS). C-reactive protein (CRP), fibrinogen (Normal value: 2 -4g/L), erythrocyte sedimentation rate (ESR) and albumin levels (Normal value: 35 -50 g/L) were measured. The fibrinogen to albumin ratio (FAR) was calculated. We excluded patients with infectious disease, hematological disease, and those with malabsorption syndrome

Statistical analysis was performed using SPSS 26.

Results:

The study included 43 males and 8 females with a mean age of 41.25 ± 10.97 years. The mean disease duration was 117.92 (85.4 months). The mean fibrinogen and albumin levels were 3.94 ± 1.24 g/L and 36.94 ± 5.89 g/L, respectively. Fibrinogen level was elevated in 45% patients and albumin levels was decreased in 51% cases. Mean FAR was 0.11 ± 0.44.

ESR levels were elevated in 67% with a mean of 40.22 ± 34.64 mm. CRP levels were high in 61% with a mean of 28.57 ± 33.25 mg/L. Mean ASDAS was 3.32 ± 1. 27 patients had very high disease activity (ASDAS>3.5).

Significant correlation was found between FAR and following parameters: ESR (r = 0.836, p< 0.001), CRP (r = 0.785, p < 0.001), and ASDAS (r = 0.463, P < 0.001).

The ability of FAR to distinguish patients with very high disease activity from those without very high disease activity was excellent, with Aire under the curve of 0.819. The optimal FAR cutoff value with the highest accuracy was 0,1065 with a sensitivity of 0,792 and specificity of 0,852.

Conclusion:

Our study showed that fibrinogen to albumin ratio correlate with ESR, CRP and ASDAS. This finding suggests that this ratio may be a used to assess disease activity in radiographic axial spondyloarthritis (1).

References:

[1]Liu M, Huang Y, Huang Z, Zhong Z, Deng W, Huang Z, et al. The role of fibrinogen to albumin ratio in ankylosing spondylitis: Correlation with disease activity. Clin Chim Acta. juin 2020;505:136-40.

Disclosure of Interests:

None declared.

AB0724 IS THERE A LINK BETWEEN RADIOGRAPHIC SACROILIITIS AND HIP INVOLVEMENT IN SPONDYLOARTHRITIS?

Background:

Hip involvement is a common feature in spondyloarthritis (SpA). Whether the hip is part of the axial or appendicular skeletal is still a matter of discussion.

Objectives:

We aimed to assess the relationship between sacroiliitis, spinal and hip involvement in SpA.

Methods:

Patients with SpA diagnosed according to the assessment of Spondyloarthritis International Society criteria were included in this retrospective cross-sectional study.

The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) were used to assess the radiographic involvement of the spine.

The sacroiliac joints were scored according to the modified New York criteria.

Radiological hip involvement was scored using the Bath Ankylosing Spondylitis Radiology Index hip (BASRI-h).

Patients were divided into two groups: G0 including patients without hip involvement and G1 patients with hip involvement.

Results:

We included 112 patients with a sex ratio of 2.4. The average SpA symptom duration was 9.33 ± 8.93 years. The diagnostic delay was 42.92 ± 52 months.

Radiographic hip involvement was noted in 39.28% of cases. It was bilateral in 31 patients (70.4%). The total number of coxitis was 75. Severe and moderate hip involvement (BASRI-h ≥ 3) affected 21 hips. The most common radiographic pattern was early coxitis (n=31, 41.3%) followed by the destructive form (n=22, 29.3%, mimicking-osteoarthritis form (n=15, 20%), condensing form (n=5, 6.6%) and ankylosing form (n=2, 2%).

Radiographic sacroiliitis was noted in 75.8% of patients. It was bilateral in 91.7% of cases. Among the 161 sacroiliac joints fulfilling the m-New-york criteria, 32.9% had grade 4 and 37.2% had grade 3.

The mean mSASSS was 10.26 ± 15. The mean BASRI-t, BASRI-C, and BASRI-L were 3.99 ± 2.9, 0.89 ± 1.3, and 1.1 ± 1.3 respectively.

Radiographic sacroiliitis was more common in patients with hip involvement (G1) (90.9% vs 68.2%, p=0.00). Patients in G1 had higher mSASSS (15.78 ± 18.24 vs 6.29 ± 11.85, p=0.01), BASRI-L (1.73±1.46 vs 0.75 ± 1.131, p=0.009), and BASRI-s (5.46 ± 3.02 vs 3.19 ± 2.46, p< 10-3) than patients in G2. There was no significant difference between the two groups regarding the BASRI-C.

Multivariable analysis revealed that radiographic sacroiliitis was associated with hip involvement (OR=14.81, 95%, [1.1-198], p=0.042).

When comparing patients with severe and moderate hip involvement (BASRI-h ≥ 3) and those with mild involvement, we didn’t find significant differences regarding BASRIs, BASR-L, BASRI-c, mSASSS, and sacroiliac involvement.

Conclusion:

As reported in previous studies [1], we concluded that structural axial lesions were higher in patients with coxitis. Structural damage to the sacroiliac joint in SpA was predictive of hip involvement.

We suggest that sacroiliitis, spinal and hip involvement are part of the same spectrum.

References:

[1]Chen H-A, Chen C-H, Liao H-T, Lin Y-J, Chen P-C, Chen W-S, et al. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2011;40 (6):552-8

Disclosure of Interests:

None declared

AB0725 FACTORS ASSOCIATED WITH RADIOGRAPHIC SPINAL INVOLVEMENT IN SPONDYLOARTHRITIS

Background:

Spondyloarthritis (SpA) is characterized by significant radiographic changes in the spine. The structural spine damage can be assessed using several scorings such as the Bath AS Radiology Index (BASRI) and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS).

Objectives:

We aimed to identify factors associated with structural damage in the spine using these scores.

Methods:

We conducted a cross-sectional study including patients with SpA diagnosed according to the assessment of Spondyloarthritis International Society criteria.

To assess the radiographic involvement of the spine, we used the mSASSS, the BASRI-spine (BASRI-S), the BASRI-lumber (BASRI-L) and the BASRI-cervical (BASRI-C).

Disease activity was assessed using the BASDAI and ASDAS-CRP.

Results:

Among the 112 patients, 72.32% were men. The mean age was 43.78 ± 12,91 years. The mean age at diagnosis was 37.8 ± 13.45 years. The diagnostic delay of 37,8 ± 46 months.

Forty-nine patients were smockers (43.8%).

The mean BASDAI score and ASDAS–CRP score were 4.04 ± 1.99 and 3.30 ± 0.87.

The mean ESR and CRP were 36.21 ± 27 (mm/H) and 31.28 ± 47.25 mg/L

The mean BASRI-S was 3,99 ± 21,96 and the mean mSASSS was 10,26 ± 15,41.

Twenty-five patients (22.3%) had non-radiographic axial SpA.

Men had higher BARSI-L (1.36 vs 0.7, p= 0.045) and BASRI-S (4.3 vs 3.09; p=0.047) than women.

Moreover, smokers’ patients had higher mSASSS (14.07 vs 7.02; p=0.031), BASRI-C (1.23 vs 0.62; p=0.031), and BASRI-S (4.82 vs 3.35; p= 0.009) than nonsmokers’ patients.

A positive correlation was noted between age and BASRI-C (r= 0.260, p=0.012). There was no correlation between age at the onset of SpA and structural spine damage.

We found a positive correlation between disease duration and the following scores: BASRI-C (r=0.245, p=0.018) and BASRI-S (r=0.274, p=0.003).

Patients with non-radiographic axial SpA had lower mSASSS (4.05 vs 12.14; p=0.034), BASRI-s (1.2 vs 4.9; p< 10-3), and BASRI-L (0.42 vs 1.4; p=0.003) than patients with radiographic axial SpA.

There was no correlation between the radiographic index and BASDAI and ASDAS-CRP.

Conclusion:

We confirmed previous observations that male gender, smoking and disease duration are associated with structural damage in the spine [1].

However, CRP and other inflammatory biomarkers were not associated with radiographic evidence of spine involvement.

As observed in previous studies, the radiographic spine damage did not correlate with disease activity (BASDAI) [1].

References:

[1]Sari I, Haroon N. Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification. Curr Rheumatol Rep. 2018 Nov 8;20(12):82.

Disclosure of Interests:

None declared