Effectiveness of exercise interventions on muscle mass among older adults with sarcopenic obesity: A scoping review

A disease known as sarcopenic obesity is characterized by decreased lean body mass in conjunction with excessive amounts of adipose tissue. Skeletal muscle mass, also known as SMM, is responsible for the largest share of fat-free mass in the body and plays an extremely vital role in the maintaining of metabolic health. Physical activity and exercise boosts the physiological health and overall quality of life of senior citizens. The objective of the study is to investigate the effectiveness of varied exercise interventions among the geriatric people with sarcopenic obesity. During the time period (2016-2023), a scoping review was undertaken using PubMed, orthopedic journals, and the Google Scholar database, and six literature evidences relating to the topic were discovered and subsequently analyzed. The study includes six randomized control trial publications that investigated the effectiveness and impact of exercise therapies on sarcopenic obesity. According to the pre and post-test values found in the reviewed articles, we discovered that resistance exercise is more effective than aerobic or combination exercise therapies. In conclusion, according to this scoping analysis, resistance training is more effective than other types of exercise in improving muscle mass in older people with sarcopenic obesity.

[Ochronosis: A case report]

INTRODUCTION

Ochronosis, also known as alkaptonuria, is a rare autosomal recessive disease. It is caused by a lack of homogentisic acid oxidase, which causes homogentisic acid deposition in the tissues.

CASE REPORT

We report a 69-year-old patient who presented with chronic mechanical low back and radicular pain. The clinical examination revealed lumbar lordosis loss, lumbar spinal stiffness, and knee joint limitations of range of motion. On an extra-articular level, the pavilions of the ears and the internal angles of the eyes had a bluish color. Extensive lumbar disc calcifications, vacuum discal phenomenon and osteophytic bridges were demonstrated on standard radiographs of the spine. Clinical and radiographic criteria were used to make the diagnosis of ochronosis.

CONCLUSION

Alkaptonuria is a degenerative arthropathy that leads to reduction of functional ability. The use of molecular analysis and genetic research is useful.

AB0847 Profile of Spondyloarthritis in the Moroccan population: Results of a multicenter study

Background

Spondyloarthritis (SpA) is a frequent group of chronic inflammatory rheumatic diseases, their epidemiology varies considerably in different regions of the world.

Objectives

The aim of our study was to describe the epidemiological, clinical, paraclinical and therapeutic profile of SpA in the Moroccan population.

Methods

This is a multicenter descriptive study, including patients followed for SpA. 8 hospital centers participated in this study. All data were measured by standard instruments.

Results

Seven hundred patients were included, 54% were men, the mean age was 40.42±14.19 years at the time of diagnosis [14 years-90 years]. The patients lived in urban and rural areas in 83.5% and 13.8% of cases, respectively. 38.4% were without occupation. A history of tuberculosis was noted in 5.9% of cases. Associated pathologies were autoimmune in 2.3% and neoplasia in 1.5% of cases. 15.6% of patients were smokers. A family history of SpA was noted in 11.7%, psoriasis in 1% and Inflammatory bowel disease (IBD) in 0.6% of cases. The average diagnostic delay was 59.76 months [0-444 months]. The revealing symptomatology was axial in 19%, peripheral in 10.1%, enthesitis in 0.4%, and a combination of the 3 forms in 22.1% of cases. Dactylitis was noted in 2.3% of cases. SpA was non-radiographic in 14% of cases. The forms of SpA were: ankylosing spondylitis (80.1%), IBD associated with SpA (9.4%), psoriatic arthritis (6%), and undifferentiated SpA (4%). Juvenile SpA accounted for 15.5% of cases. The prevalence of HLA-B27 was 65.51%. The mean BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was 4.42 ± 1.67 and the mean ASDAS (Ankylosing Spondylitis Disease Activity Score) was 3.19 ± 1.24. Systemic involvement was dominated by uveitis (11.3%), followed by IBD (9.4%), restrictive syndrome (2.7%), renal involvement (0.6%) including amyloidosis (0.1%), IgA nephropathy (0.4%), interstitial nephropathy (0.1%), and aortic insufficiency in 0.2% of cases. The most commonly used treatments were non-steroidal anti-inflammatory drugs (81.7%), sulfasalazine (24.2%), methotrexate (22.9%) and 31.8% of patients were on biotherapy. Surgery for arthroplasty was necessary in 5.6% of patients.

Conclusion

This is a study of the clinical and demographic characteristics of Spondyloarthritis in a population in Morocco, on which a large scale data base could be initiated, in order to better determine the role of genetic and environmental factors in the pathogenesis of the disease.

References

[1]Sharip A, Kunz J. Understanding the Pathogenesis of Spondyloarthritis. Biomolecules. 2020 Oct 20;10(10):1461.

[2]Slimani S, Hamdi W, Nassar K, Kalla AA. Spondyloarthritis in North Africa: an update. Clin Rheumatol. 2021 Sep;40(9):3401-10.

[3]Wang R, Ward MM. Epidemiology of axial spondyloarthritis: an update. Current Opinion in Rheumatology. 2018 Mar;30(2):137-43.

Disclosure of Interests

None declared

AB0245 PULMONARY INVOLVEMENT IN RHEUMATOID ARTHRITIS AND SECONDARY SJÖGREN SYNDROME

Background

Rheumatoid arthritis (RA) is a severe inflammatory disease that affects the joints and other organs such as the lung. Gougerot-Sjögren’s syndrome (GSS) is an autoimmune disease. Secondary GSS can be primary or secondary and is defined by (1) the presence of another connective tissue disease, (2) the existence of dry eyes or dry mouth, and (3) objective evidence of ocular or salivary involvement. The presence of anti-SSA or anti-SSB antibodies is not necessary for the diagnosis of secondary SMS (4). The association of the two pathologies (RA-SGS) is frequent, and apart from osteoarticular involvement, various organs can be affected, in this case the lungs, by one or the other pathology with similar pulmonary lesions.

Objectives

To determine the incidence of pulmonary involvement in a population of RA-SGS patients.

Methods

Retrospective study, conducted from January 2019 to October 2021, at the rheumatology department of the CHU Ibn Rochd of Casablanca. Inclusion criteria: patients followed for RA according to the diagnostic criteria (EULAR/ACR 2010) associated or not with secondary GSS. Exclusion criteria: patients followed for primary GSS alone or other inflammatory rheumatic diseases with pneumopathy.

Results

139 patients were included in our study, with a female predominance of 96.40%. The mean age was 56.31 years, the mean duration of RA was 9.89 years (4 months - 34 years). GSS was associated in about 1/3 of the patients, 33.81%. In the study population 24.46% of patients had pulmonary involvement which was present in the majority of RA-SGS patients (63.83%). Clinically, exertional dyspnea was found in all these patients and chronic dry cough in 66.67%. On standard radiography, an interstitial syndrome was found in all of these patients and on the pulmonary CT scan, 2 patients were at the stage of pulmonary fibrosis, i.e. 6.67% (PR-SGS).

Discussion

Secondary GSS is found in 30% of patients with rheumatoid arthritis (3). Pulmonary infiltrative disease is similar in both conditions. In RA these diseases are in the foreground after pleural involvement. They have the same clinical, radiological and functional characteristics, associated to varying degrees with exertional dyspnea, dry cough, crepitus rales, and digital hippocrasis (5,6). Pulmonary involvement is frequent in SSc, mainly represented by diffuse interstitial lung disease and bronchial and bronchiolar involvement (7). In SSc, the prognosis is rarely life threatening (8). In RA, the overall prognosis of rheumatoid lung disease remains poor with significant morbidity and mortality. A particular evolutionary mode characterized by acute exacerbation of interstitial lung disease associated with connective tissue diseases has been reported, particularly in RA (9,10).

Conclusion

In our series, the frequency of association of secondary SSG with RA is similar to the data in the literature and lung involvement is particularly frequent in these patients. No study in the literature has looked specifically at the clinical and prognostic features of lung involvement in RA-SGS patients.

References

[1]Crestani B and al. Respiratory manifestations in Gougerot-Sjögren’s syndrome. Rev Mal Respir 2007.

[2]Sauvezie B and al. Syndrome de Gougerot-Sjögren. Encycl Méd Chir Appareil locomoteur. Elsevier SAS, Paris, 2000.

[3]Picone O and al. Gougerot-Sjögren syndrome in obstetric gynecology. J Gynecol Obstet Biol Reprod 2006.

[4]Vitali C and al. Classification criteria for Sjogren’s syndrome. Ann Rheum Dis 2002.

[5]Despaux J and al. Incidence and etiopathogenic aspects. Rev Med Interne 1997.

[6]Remy-Jardin M and al. Lung changes in rheumatoid arthritis: CT findings. Radiology 1994.

[7]Y. Uzunhan et al. Pulmonary and bronchial manifestations of Gougerot-Sjögren syndrome. 28.02.2021.

[8]Z. Teyeb et al. Pulmonary involvement in Sjögren’s syndrome.

[9]Tsuchiya Y et al. Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome. Eur Respir J 2011.

[10]Suda T et al. Acute exacerbation of interstitial pneumonia associated with collagen vascular disease. Respir Med 2009.

Disclosure of Interests

None declared

Structural, vibrational, electronic properties, hirshfeld surface analysis topological and molecular docking studies of N-[2-(diethylamino)ethyl]-2-methoxy-5-methylsulfonylbenzamide

The theoretical (Freebase, Cationic species) and experimental investigations on the molecular structural, spectroscopic characterization, and electronic properties of N2M5MB are reported. The most stable structure of the N2M5MB was analysed by employing Density Functional Theory (DFT) at different functional such as B3LYP, PBEPBE, TPSSTPSS and IEF-PCM (Freebase) and Cationic (B3LYP, IEF-PCM)/ 6-311++G (d,p) basis set level. The Potential Energy Scan (PES) analysis has been employed to investigate the conformational preference of the title molecule. The optimized molecular geometry, vibrational assignments (FT-IR, FT-Raman) of wavenumbers have been performed for freebase, cationic species (Gas, PCM) for the individual modes of vibration. The experimental UV-Vis absorption spectrum was obtained and compared with the simulated (Freebase, Cationic species) Time-Dependent (TD-DFT-M062X) method. The FMO's, electron-hole distributions, HOMA, FLU, Hirshfeld surface analysis, Electrostatic potential surface (ESP), Fukui functions, and topological parameters were discussed. Molecular docking studies were performed for the N2M5MB (ligand) into the active site of targeted proteins (1H22, 4DTL, 5OV9) which belong to AChE inhibitors with the minimum binding energy was detected.

POS1077 CLINICAL AND RADIOLOGICAL FEATURES OF SEROPOSITIVE PSORIATIC ARTHRITIS

Background:

Rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP) are two highly specific laboratory markers for rheumatoid arthritis. However, they can also be found in other chronic inflammatory arthritis such as psoriatic arthritis (Psa).

Objectives:

The aim of our study is to analyze the different epidemiological and paraclinical characteristics of seropositive psoriatic arthritis.

Methods:

Descriptive and analytical retrospective study from January 2010 to December 2020 conducted in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca.

Inclusion criteria: patients diagnosed with psoriatic arthritis according to the CASPAR or ASAS 2009 criteria, regardless of the immunological status (RF/anti-CCP).

The patients were then divided into two groups: seropositive (positive anti-CCP and / or positive RF) and seronegative. A univariate analytical study was performed by jamovi version 1.2.27

Results:

80 patients were enrolled. 22 patients were seropositive (Group 1) and 58 were seronegative (Group 2). In the group 1, the mean age was 51.1 years (+/- 9.45). The sex ratio M/F was 0.29, the mean age of onset was 43.5 years (+/- 10.4), the mean duration of disease was 9.55 +/- 8 years. All patients had skin involvement. Polyarticular involvement was present in all cases; axial involvement was present in 68.18% of cases and enthesitis in 68.18% of cases. All patients were HLA B 27 negative. The presence of X-ray and / or ultrasound bone erosions in addition to signs of destruction was in 81.8% of cases. The response to treatment with (corticosteroids / NSAIDs / DMARDs) was partial in 70.58%. In group 2, the mean age was 50.7 years (+/- 15.8). The sex ratio M/F was 1.14, the mean age of onset was 37.4 years (+/- 16.5), the mean duration of disease was 13.3 years (+/- 9.5). Skin involvement was present in 50% of patients. Polyarticular involvement was present in all cases, axial involvement was present in 67.24% of cases and enthesitis in 56.9% of cases. All patients were HLA B 27 negative. The presence of X-ray and / or ultrasound bone erosions in addition to signs of destruction was in 56.9% of cases. The response to treatment with (corticosteroids / NSAIDs / DMARDs) was partial in 57.14%.

Conclusion:

The presence of anti-CCP according to several studies is linked to the presence of deformities, dactylites and radiological erosions (1,2). In our series, seropositivity was accompanied by the erosive nature of the destruction, as well as a tendency to resistance to treatment.

References:

[1]Kim KY, Lee YH. Anti-cyclic citrullinated peptide antibody in psoriatic arthritis: a meta-analysis of its frequency and association with clinical features. Z Rheumatol. mai 2020;79(4):397-403.

[2]Hagiwara S, Tsuboi H, Terasaki T, Terasaki M, Toko H, Shimizu M, et al. Association of anti-cyclic citrullinated peptide antibody with clinical features in patients with psoriatic arthritis. Modern Rheumatology. 3 mars 2020;30(2):365-72.

Table 1.

Comparison of characteristics of seropositive and seronegative PsA patients

ItemsGroup 1Seropositive patients (n=22)Group 2Seronegative patients(n=58)p-valueAge (years)51.1 +/-9.4550.7 +/- 15.80.9Sex ratio M/F0.291.140.013Age onset (years)43.5 +/- 10.437.4+/- 16.50.123Skin involvement (%)100500.009Bone erosions (%)81.156.9<0.001Response to treatment (%)70.5851.14<0.001

Disclosure of Interests:

None declared.

AB0819 PROFILE OF RHEUMATOLOGIC EMERGENCIES IN THE DEPARTMENT OF RHEUMATOLOGY OF THE UNIVERSITY HOSPITAL OF IBN ROCHD IN 2019

Background:

Rheumatology is a medical field often referred to as “cool” because of the low frequency of life-threatening pathologies in common practice (1). However, rheumatologists may be solicited to manage situations that are often depicted as urgent from the point of view of the patient.

Objectives:

To profile the consultations received in the emergency unit of the Department of Rheumatology of the University Hospital of Ibn Rochd in Casablanca.

Methods:

We conducted a retrospective study on the 2019 emergency consultations register of the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. We collected epidemiological, clinical, and therapeutic data.

Results:

407 emergency consultations were carried out in 2019. The average age of the patients was 50.7 (range 14 - 88). 20% of the consultants were 65 years old or older. The sex ratio M/F was 0.4. 95.6% of the patients were from the Casablanca-Settat region. 86.4% of the patients came from the emergency department of the hospital, 10.6% came from other intra-hospital services, and 3% were referred directly to our department. The most represented socio-professional categories were respectively people without professional activity other than retirees (67.6%), followed by intermediate professions (9.7%), executives and higher intellectual professions (5.8%), and retirees (5.3%). Regarding social insurance, 49.4% of the consultants benefited from a public health assistance scheme, 30% had a public health insurance, 14.4% had no health insurance, and 9.9% had a private health insurance. The most frequent reasons for consultation were polyarthralgia (26.8%), oligoarthralgia (18.9%), low back pain (22.6%), lumbar radiculalgia (16.7%), monoarthralgia (11,8%), neck pain (8.1%), cervicobrachial neuralgia (6.4%), monoarthritis (5.4%), polyarthritis (3.4%), and oligoarthritis (2,7%). The general condition of the patients was good in 83% of cases, 5.2% had asthenia, 4.4% had a fever above 38°C, and 3.7% had anorexia. Extra-articular signs were present in 24.7% of cases. At the end of the consultation, a diagnosis could be made in 57.2% of cases. The diagnoses comprised degenerative (51%), inflammatory rheumatic (8.6%), infectious (7.3%), metabolic (6.7%), and tumor (2.1%) pathologies. The main treatments prescribed were level 1 analgesics in 65.6% of cases, non-steroidal anti-inflammatory drugs in 45% of cases, local treatment in 28.9% of cases, symptomatic slow-acting drugs in 21.9% of cases, muscle relaxants in 17% of cases, rest in 12.5% of cases, and supportive orthotics in 11.6% of cases. Regarding the outcomes of the consultants, 75.4% were referred to a conventional hospital consultation for rheumatology follow-up, 13.6% of patients were referred to other specialized departments, 9.1% of patients were lost to follow-up, and 3.9% were hospitalized in our department.

Conclusion:

The polyarthralgia and the low back pain were the most frequent reasons for consultation in our rheumatology emergency unit. Degenerative pathology is in the lead of the etiologies. Level I analgesics and non-steroidal anti-inflammatory drugs play an important role in symptomatic emergency treatments.

References:

[1]Gutiérrez-González LA. Rheumatologic emergencies. Clin Rheumatol. 2015 Dec;34(12):2011–9.

Disclosure of Interests:

None declared

AB0617 BISPHOSPHONATES DANS L’OSTÉOPOROSE ET LE RISQUE D’OSTÉONÉCROSE DE LA MÂCHOIRE, ENVIRON 896 CAS

Background:

Bisphosphonates (BF) are used in the treatment of osteoporosis, Paget’s disease of bone, hypercalcemia and in patients with cancer. When used to treat osteoporosis, the optimal duration of treatment is 3 to 5 years; however, their long-term use has been rarely associated with osteonecrosis of the jaw.

Objectives:

To assess the risk of developing osteonecrosis of the jaw in patients followed for osteoporosis and on bisphosphonates (BP).

Methods:

Type of study: retrospective study conducted at the rheumatology department of the IBN ROCHD CHU in Casablanca.

Duration: from October 2013 to October 2020 (7 years).

Inclusion criteria: all patients followed for osteoporosis in the weakening osteopathies unit of the bone and treated with oral or intravenous bisphosphonates.

Exclusion criteria: patients followed for other than osteoporosis.

Results:

896 patients were treated during this period. The average age was 62.74 years (28 to 90 years), of which 85.16% were women and 14.84% were men, for a sex ratio (F / M) of 5.74. As a history, 18.75% of patients are diabetic, 26.56% followed for breast neoplasm, 14.06% of patients had received long-term corticosteroid therapy for various pathologies such as chronic inflammatory rheumatism. Osteoporosis was postmenopausal in 687 patients, ie 76.67% of cases, 14.06% after long-term corticosteroid therapy, 8.15% following hormone therapy (anti-aromatases) and 6.92% following chemotherapy; note that 18.16% of these patients were found in at least two of the situations. The mean bone mineral density (BMD), T-score pair considered in all [T-score (BMD)] is -3 (0.736) in the lumbar spine (L1-L4), -2.9 (0.658) at the femoral neck, -2.6 (0.804) at the total hip before the start of treatment. 69.97% of the patients were put on Alendronic acid, 12.50% on Residronic acid, 10.93% on Zolidronic acid, 3.46% on Pamidronic acid and 3.14% received Strontium Ranelate, note that before the start of the treatment all the patients benefited from a dental consultation followed by care of any lesions, the bisphosphonates were only introduced after having ruled out all their dental contraindications, the average duration of treatment for all the molecules was 4.71 years (2 to 5 years) and no patient developed osteonecrosis of the jaw. The change in control BMD on average after 2 years of treatment was -2.7 (0.782) at the lumbar spine, -2.6 (0.749) at the femoral neck and -2.4 (0.713) at the hip total, after 5 years -2.4 (0.874) at the spine, -2.1 (0.809) at the femoral neck and -1.93 (861) at the total hip.

Conclusion:

The occurrence of ONJ in the treatment of osteoporosis with the use of BFs is rare, and appears to be unpredictable; but maintaining therapeutic caution, consisting in diagnosing and treating any dental lesions before starting treatment, can considerably reduce or even cancel the risk of occurrence; especially in patients treated with long-term intravenous pamidronate.

References:

[1]Dr Halidou Idrissa Abdoul-Rahamane, Pr Kawtar Nassar, PR Saadia Janani.

[2]Rheumatology department of the IBN ROCHD CHU in CASABLANCA. Casablanca Faculty of Medicine and Pharmacy. Hassan II University. Morocco

Disclosure of Interests:

None declared.

AB0662 IMPACT OF THE SARS-CoV-2 PANDEMIC IN A POPULATION OF PATIENTS FOLLOWED IN A RHEUMATOLOGY DEPARTMENT

Background:

The COVID-19 pandemic had various impacts onpatients’ realities. It had many physical but also psychological repercussions. It led to the onset of general stress, anxiety and depression affecting different age groups. In this study, we report the frequency of anxiety in patients followed in the department of rheumatology during the COVID-19 outbreak.

Objectives:

To assess the impact of the COVID-19 pandemic in patients followed for inflammatory rheumatic disorders (IRD) or degenerative diseases in the Department of Rheumatology during the period of breakdown and health restrictions.

Methods:

This is a cross-sectional study conducted in the department of rheumatology over a 5-month period from August 2020 to December 2020.Included patients were followed for IRD or degenerative pathology in the department. A pre-established questionnaire collected the symptoms and results of COVID-19 tests, the possible deterioration of the general condition since breakdown, as well as the increase of the disease activity of the rheumatism, pain, fatigue, anxiety, and the onset of signs of depression or sleep disturbances.The impact of the decrease in physical activity and the cessation of basic treatments of rheumatism with the different causes was also collected.

Results:

159 patients were included: 27 with Rheumatoid arthritis, 58 with Spondyloarthropathies, 32 with chondrocalcinosis, 9 with gouty arthropathies, and 33 with osteoarthritis. Of these, 15% had symptoms consistent with COVID-19. 25 patients performed the PCR test, of which 17 were positive and only 3 required hospitalization.None were put on oxygen. 32% reported a worsening of their rheumatism since the beginning of the epidemic, of which 35.9% reported increased pain and 21 noted a decrease in physical activity. 27.1% felt more stressed and irritated, and 14% felt more depressed. 54% had more sleepdisturbance, 22.2% had more fatigue compared to their state before the epidemic. 41.2% were afraid to come for consultation or hospitalization. 11.8% had stopped the basic treatment of their rheumatism, either for a shortage of the product in the pharmacy, or for the inability to obtain a travel authorization from the authorities

Conclusion:

The physical and mental impact of the COVID-19pandemic affected approximately one-third of our population. Patients described worsening rheumatism and pain, as well as impaired sleep, fatigue and anxiety[1].Decreased physical activity was associated with increased rheumatism activity and pain. More than 50% of the patients presented a deterioration in their physical and mental health linked to the health situation[2]. Our results are consistent with the literature. It is classically admitted that rheumatic pathologiesare disabling and therefore lead to a withdrawal into oneself, generating an anxious state. It is essential to assess the psychological status of patients followed for rheumatism in order to develop preventive treatments and prevent its worsening linked to the impact of the pandemic[3].

References:

[1]ChenN,ZhouM,DongX,etal.Epidemiologicalandclinicalcharacteristicsof99casesof2019novelcoronaviruspneumoniainWuhan,China:adescriptivestudy.Lancet2020;395:50713

[2]GuanWJ,NiZY,HuY,etal.Clinicalcharacteristicsofcoronavirusdisease2019inChina.NEnglJMed2020,http://dx.doi.org/10.1056/NEJMoa2002032

[3]HuangC,WangY,LiX,etal.Clinicalfeaturesofpatientsinfectedwith2019novelcoronavirusinWuhan,China.Lancet2020;395:497–5064

Disclosure of Interests:

None declared.

AB0829 WHAT ARE THE DIFFERENCES BETWEEN YOUNG AND ELDERLY SUBJECTS IN URGENT RHEUMATOLOGY CONSULTATIONS?

Background:

The pattern of rheumatological diseases shows significant differences depending on age. It is commonly admitted that inflammatory rheumatic diseases is the prerogative of young people (1), while degenerative pathology is more important in older ages (2). In the context of the emergency, little epidemiological data exist about the differences between young and old populations.

Objectives:

To study the influence of age on emergency rheumatology consultations received in the Department of Rheumatology of the University Hospital of Ibn Rochd.

Methods:

We conducted a retrospective study on the 2019 emergency consultations register of the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. Patients were divided in 2 groups: young subjects included patients aged less than 65 years, and the elderly subjects included people aged 65 and above. The studied parameters were gender, medical coverage, socio-professional category, reasons for consultation, joint involvement, duration of symptoms, diagnoses, and treatments.

Results:

407 emergency consultations were carried out, including 81 in the elderly (19.9%) and 326 in young subjects (80.1%). The characteristics are summed up in Table 1. Although we noted a female predominance in both groups, men were more represented in the elderly group. Radiculalgia was a more frequent reason for consultation in the elderly population, while arthralgia was more frequent in the young population. Young subjects more frequently had peripheral joints complaints. Degenerative and tumor pathologies were more common in the elderly population, while inflammatory, septic, and tendon pathologies were more prominent in the young population. Regarding treatments, non-steroidal anti-inflammatory drugs were more prescribed in young subjects, while the other treatments had a homogeneous distribution in the two groups.

Conclusion:

In our emergency unit, the epidemiological distribution of our patients according to age matches the general epidemiological characteristics of rheumatological pathologies: inflammatory causes are more frequent in young ages, while degenerative pathologies are found at a later age.

References:

[1]Kobak S, Bes C. An autumn tale: geriatric rheumatoid arthritis. Therapeutic Advances in Musculoskeletal. 2018 Jan;10(1):3–11.

[2]Loeser RF. The Role of Aging in the Development of Osteoarthritis. Trans Am Clin Climatol Assoc. 2017;128:44–54.

Table 1.

Patients’ characteristics depending on age

≥ 65 years (81 cases)19,9%< 65 years (326 cases)80,1%Sex-ratio M/F0,500,38Social coveragePublic health assistance scheme32 (39,5%)122 (37,42%)Public/Private insurance21 (25,92%)91 (27,91%)Without28 (34,57%)113 (34,66%)ProfessionPrécisé = 45Précisé = 162Without36 (80%)104 (64,2%)Retirees7 (15,55%)4 (2,47%)Farmer1 (2,22%)1 (0,62%)Intermediate professions1 (2,22%)18 (11,11%)Higher intellectual professions012 (7,41%)Employees09 (5,55%)Traders and craftsmen09 (5,55%)Workers05 (3,09%)Reason for consultationBack pain35 (43,2%)137 (48,15%)Radiculalgia22 (27,16%)55 (16,87%)Arthralgias34 (41,97%)165 (50,61%)Arthritis10 (12,34%)37 (11,35%)Joint involvementAxial41 (50,61%)170 (52,15%)Peripheral53 (65,43%)248 (76,07%)Duration of symptomsAcute (< 3 weeks)21 (25,92%)73 (22,39%)Chronic (≥ 3 weeks)60 (74,08%)253 (77,61%)DiagnosesOsteoarthritis30 (58,82%)89 (48,9%)Knee osteoarthritis21 (41,17%)50 (27,47%)Lumbar osteoarthritis16 (31,37%)44 (24,17%)Septic2 (3,92%)11 (6,04%)Metabolic6 (13,35%)9 (4,94%)Inflammatory1 (1,96%)22 (12,08%)Tumor3 (5,88%)2 (1,09%)Tendinopathies3 (9,68%)29 (15,93%)TreatmentsAnalgesics47 (71,21%)155 (63,52%)NSAIDs19 (28,78%)118 (48,36%)Corticosteroids1 (1,51%)2 (0,82%)Local treatments18 (27,27%)72 (29,5%)Symptomatic slow-acting drugs19 (28,78)49 (20,08%)DMARDs0 (0%)2 (0,82%)

Disclosure of Interests:

None declared

POS1367 PROCALCITONIN IN RHEUMATOLOGY

Background:

The differentiation between infection and aseptic inflammation is difficult and often a challenge in the daily practice of rheumatology.Procalcitonin (PCT) is a preferred marker for bacterial infections that allows the rheumatologist to make an early diagnosis, choose an appropriate antibiotic therapy for bacterial infection, and avoid unnecessary antibiotic therapy for inflammation.

Objectives:

To study the levels of PCT in various inflammatory states observed in a rheumatology department, and to assess its possible discriminating role in the differentiation of bacterial infection from other inflammatory processes.

Methods:

This is a preliminary monocentric retrospective study conducted from January 2018 to December 2020 in our rheumatology department. The inclusion criteria were all patients hospitalized in rheumatology for a rheumatic or autoimmune disease or a bone and joint infection.PCT samples from patients were analyzed along with general signs (fever/chills) and with routine assessment (blood count including white blood cell count(WBC), erythrocyte sedimentation rate (ESR)and C reactive protein(CRP)) in patients admitted to hospitalfor a fever or a biological inflammatory syndrome, or both, with a laboratory cut-off value of 0.5 ng/ml.

Results:

20 patients were included. Their mean age was 46.1 (extremes 19 – 66)and the with sex ratio was 1. Three patients had a history of autoimmune disease, 2 of neoplasia, 1 with chronic terminal kidney failure and hemodialysis, and 4 patients took antibiotics before hospitalization. The mean PCT was 100.01ng/ml (extremes 0.01-200), and Sensitivity at 57.44% and specificity at 100%, PPV: 100%, NPV: 81.25%.

The patients were divided according to their final diagnosis into 3 groups: bacterial or fungal infection; inflammatory abacterian disease (autoimmune or rheumatic flare, neoplasia, metabolic, reactive arthritis); infection + inflammatory abacterian disease. Group 1 included 4 patients, their mean PCT was 6.92ng/ml (0.16-26.80),mean CRP was 131.725 mg/L, and mean ESR was 50 mm, and 25% had hyperleukocytosis.2 patients had already taken antibiotics before admission. Group 2 included 13 patients, their mean PCT was 0.025 ng/mL (0.01-0.13), mean CRP was 132.25mg/L, mean ESR was 84.38mm, and 30.77% of them had hyperleukocytosis. Group 3 included 3 patients, their mean PCT was 66.88 ng/mL (0.02-200), mean CRP was 560 mg/L, mean ESR was 107.33 mm, and 33.33% had hyperleucocytosis. The patient with the highest PCT was admitted for a sepsis with uremic encephalopathy that improved after hemodialysis. A control PCT was made in 2 patients with infection who received antibiotics,showing a decrease or negativation compared to the initial value of PCT.

Conclusion:

Our study showed that PCT levels only increased significantly in bacterial infections. The PCT values were more discriminating than the level of WBC and CRP in differentiating a bacterial infection from another inflammatory process, hence the value of using this marker in case diagnosis doubt.

Group 1(n=4)Group 2(n=13)Group 3(n=3)Mean age4546.7744.67Sex ratio M/F2/28/50/3Reason for hospitalizationPhlegmon of the left shoulder and inflammatory gonalgia in a feverish context 25%Multiple vertebral fractures 25%Acute monoarthritis of the left knee 25%Pain in the left hip with functional impairment 25%Inflammatory polyarthralgia15.38%Inflammatory back pain 23.07%Activity of his autoimmune 15.38%diseaseChronic hip pain 7.69%Acute febrile polyarthralgia 30.77%Biarthritis 7.69%Acute febrile polyarthralgia 66.67%Flare of polymyalgia rheumatica 33.33%HistoryNeoplasia 25%Autoimmune disease 23.07%End-stage chronic renal disease with hemodialysis 33.33%PCT indicationSuspected septic arthritis 75%Exploration of inflammatory syndrome 25%Suspicion of arthritis 46.15%Exploration of inflammatory syndrome 53.85%Suspicion of sepsis 33.33%Exploration of inflammatory syndrome 66.67%Mean PCT value (ng/ml)6.920.02566.88fever/chills75%30.77%33.33%Biological parametersHyperleukocytosisESR (mm)CRP (mg/L)25%50131.72530.77 %84.38132.2533.33%107.33560

Disclosure of Interests:

None declared

POS0292 OSTEOPOROSIS IN BREAST CANCER PATIENTS ON AROMATASE INHIBITORS THERAPY: ABOUT 200 CASES

Background:

Breast cancer is the most common cancer affecting women both before and after the menopause. Aromatase inhibitors (AIs) used as adjuvant therapy cause bone loss and increase the risk of osteoporosis (OP) (1).

Objectives:

To assess the bone status and the frequency of OP in breast cancer patients using AIs.

Methods:

We conducted a retrospective study in the rheumatology department, over 5 years (2016-2020).

Inclusion criteria: patients followed for breast neoplasm in oncology department on AIs therapy and referred to rheumatology department for bone evaluation.

All of these patients underwent an evaluation of bone mineral density (BMD) and phosphocalcic assessment.

Exclusion criteria: patients treated by another type of hormone therapy and having other risk factors for OP.

Results:

200 breast cancer women were enrolled for the study, 92 patients (46%) were treated with AIs, the average age was 58.22 years (41 - 75 years) with an average age of discovery of the breast cancer of 46.75 years and the average time between the start of AIs therapy and the diagnosis of OP was 21.6 months. the characteristics of the patients are summed up in Table 1.

97% of patients were postmenopausal and 38% of them had menopause secondary to treatment.

In AIs users, 85 patients (92.3%) were osteoporotic, and 11% had bone fractures. In regard to osteodensitometry measurement, lumbar spine was the most affected site (88%) with mean T score of -2.98 and mean BMD of 0.854, followed by femoral neck (17%) with mean T score of - 2.8 and mean BMD of 0.740 and total hip (14%) with mean T score of -3.10 and mean BMD of 0.497.

The cancer was metastatic in 15.18% patients, 75% of the group had bone metastasis and 25% had visceral metastasis.

The phosphocalcic status of the osteoporotic patients was: mean calcemia: 92.83 mg / l, mean calciuria: 131.8 mg / 24h, mean phosphatemia: 48.09 mg / l, mean 25 OH Vit D level: 19.78 ng / ml, mean PTH: 79 pg / ml.

Osteoporotic patients were treated with bisphosphonates, 60% women had received Alendronate, 17% Risedronate and 12% Zoledronate in addition to dietary measures and correction of calcium and vitamin D deficiency.

Conclusion:

AIs are correlated with a high risk of OP and fractures in 30% of patients (2), the frequency of OP in our series is estimated at 42.5%.

Assessment of bone status and OP clinical risk factors should be systematic in all breast cancer patients receiving adjuvant AIs therapy.

Bisphosphonates appear to be beneficial in treating secondary OP, in preventing bone fractures, and in reducing the incidence of breast cancer bone metastases.

References:

[1]Aromatase Inhibitor-Associated Bone Loss Clinical Considerations P Shubham, L. Shapiro Drugs 2008; 68 (18): 2591-2600

[2]Aromatase inhibitor-associated bone loss and its management with bisphosphonates in patients with breast cancer M.Bauer, J. Bryce, P.Hadji Breast Cancer. 2012; 4: 91–101

Table 1.

Characteristics of osteoporotic patients using AIs therapy

ResultsTotal of patients92 (46%)Mean age58.22 yearsMean age of breast cancer diagnosis46.75 yearsDelay between AIs therapy and OP21.6 monthsPost menopausal patients97%Menopausis due to AIs38%Osteoporotic patients85 (92.3%)Fractures11%Sites of OP in osteodensitometrylumbar spine88%femoral neck17%total hip14%Cancer metastasis15.18%Bone75%Visceral25%Phosphocalcic status (mean values)calcemia92.83 mg / lcalciuria131.8 mg / 24hphosphatémie48.09 mg / l25 OH vitaminD19.78 ng / mlPTH79 pg / mlBiphosphanates therapyAlendronate60%Risedronate17%Zoledronate12%

Disclosure of Interests:

None declared

AB0738 JUVENILE IDIOPATHIC ARTHRITIS AND SCHOOLING

Background:

Juvenile idiopathic arthritis (JIA) refers to all chronic inflammatory rheumatism in children without a recognized cause, onset before the age of 16. JIA is associated with significant short- and long-term disability, which influences the education and socio-professional integration of patients who suffers from it.

Objectives:

Evaluate the impact of JIA on the education and professional integration of affected patients.

Methods:

This is a retrospective, descriptive and cross-sectional study carried out in the rheumatology department.

We included all patient followed in our JIA training.

The following information was collected from a questionnaire survey: Educational attainment, main problems experienced during studies, cause of dropping school, and professional data.

Results:

Forty-two patients were included. The average age was 27.15 years old [18 - 61 years old]. Sex-Ratio (M / F) was 0.9. The forms of JIA were dominated by spondyloarthropathy (48.64%) and the seropositive polyarticular form (18.91%). The mean age of onset of JIA was 10.8 years [6 months - 16 years]. The mean duration of JIA progression was 14.4 years [4 - 27 years].

Regarding education, 2.94% were illiterate, 23.52% had a primary level, 55.87% a secondary level and 17.64% a higher level. The majority of patients (85%) experienced several problems during their studies: joint pain and stiffness (73.52%), absenteeism (50%), limitation in activities (26.47%), problem with adaptation and social integration (11.76%) and fatigue (5.88%). Only 2.94% of patients benefited from an individualized reception protocol apart from a sports exemption which represents 38.23%. 73.52% of patients received encouragement to continue their studies by those around them (parents, teachers and attending physicians).

Discontinuation of schooling was observed in 70.58% of patients with 8.82% of patients dropping school before the onset of JIA and 61.76% of patients related to JIA. School studies were still ongoing in 23.52% of patients.

Regarding the professional side, unemployment affects 52.94% of these patients and workers represent 23.52%.

Conclusion:

In our series, the level of education of JIA patients does not exceed secondary level in 80% of cases. The implementation of an individualized reception protocol is strongly recommended to facilitate the education of these patients and to fight against the main problems experienced. The professional integration of patients with JIA should also be adopted.

Disclosure of Interests:

None declared

AB0477 EFFECT OF ANTI-TNF THERAPY ON BONE MINERAL DENSITY IN ANKYLOSING SPONDYLORTHITIS

Background:

Osteoporosis is common in spondyloarthritis, due to reduced spinal mobility, and inflammation. Anti-inflammatory treatments have a beneficial effect on the bone, and there is a significant increase in bone density during treatment with anti-TNF alpha.

Objectives:

to study bone mineral density in patients with ankylosing spondyloarthritis (AS) treated with anti-TNF alpha.

Methods:

This is a retrospective descriptive study of patients with AS meeting the modified New York criteria. Bone mineral density, assessed by dual energy x-ray absorptiometry (DXA), of AS patients treated with anti-TNF alpha was compared to that of a control group of AS patients not treated with anti-TNF alpha.

Inclusion criteria:

- Male patients

- Patients who do not have an abnormality disrupting phosphocalcic and bone metabolism

- For Patients on anti-TNF alpha: the treatment must be received for more than 6 months

Results:

A total of 22 patients were included, including 11 patients on anti-TNF alpha and 11 patients not on anti-TNF. The mean age (standard deviation) was 28 (± 7.2) years and 41 (± 14.8) in the cases and controls respectively. The mean body mass index in the AS group on anti-TNF was 22.16 kg / m2 and in the control group was 19.64 kg / m2. In the AS group on anti-TNF alpha, the mean bone mineral density of the spine was 1.092 g / cm2 (mean T score = -0.63) and that of the femoral neck, the mean bone mineral density was 0.888g / cm2 (mean T score = -1.04). In the control group, the mean bone mineral density of the spine was 0.959 g / cm2 (mean T score = -1.91) and the mean bone mineral density of the femoral neck was 0.774 g / cm2 (mean T score = -1.99). Bone mineral density in the spine and cervix was higher in the group receiving anti-TNF alpha (p = 0.09, p = 0.173 respectively)

Conclusion:

Our study shows the increase, although not statistically significant, in bone mineral density in AS patients receiving anti-TNF alpha agents compared to controls. Our results agree with those of the literature which support the bone protective effect of anti-TNF alpha. The non-significant difference can be explained by the delay in the introduction of biotherapy at the advanced stage of the structural evolution of AS. The best solution is to start TNF inhibitors at the early inflammatory stage of AS.

Disclosure of Interests:

None declared.

AB0711 FOLLOW-UP OF PATIENTS UNDER BIOLOGICS IN THE ERA OF LOCKDOWN

Background:

The management of patients with inflammatory rheumatic diseases under biologics has raised many questions about the global management of patients in the time of COVID-19 pandemic. This period could have been particularly painful for the patients due to the virus itself, and to the difficulty to access to healthcare facilities due to the lockdown.

Objectives:

To assess the impact of the lockdown in patients under biologics.

Methods:

This is a descriptive study, conducted between 03/01/2021 and 07/31/2021 in the Department of Rheumatology of the University Hospital of Ibn Rochd in Casablanca. Inclusion criteria were all patients on biologics during the lockdown period. The number of painful, swollen joints, pain visual analogue scale, and disease activity were collected before and during the lockdown.

Results:

Thirty-one patients under biologics were included. The average age was 43.4 years. There were 17 males and 14 females (sex ratio M/F 1,21). Cormibidities were hypertension and type 2 diabetes (9.7%), hypertension and dyslipidemia (6.5%), arrhythmia (6.5%), smoking (9.7%), hypertension and dysthyroidism (3.2%). All the patients were under biologics with an average duration of 2 years distributed as follows: 3 patients on etanercept (9.67%), 8 patients on tocilizumab (28.8%), 10 patients on infliximab (32.25%), 5 patients on adalimumab (16.12%)), 4 patients under golimumab (12.90%), 1 under secukinumab (3.22%). Biologics were associated with conventional synthetic disease-modifying antirheumatic drugs in 38.7% (methotrexate 12.9%, salosopyrine25, 8%), corticosteroids in 25.7%, non-steroidal anti-inflammatory drugs in 16.1%. The disease activity before COVID-19 of the patients was: 48.39% weak activity, 35.4% remission, 16.13% moderate activity. No patient reported a flare of the disease. During lockdown, 5 patients reported a flare of their disease (16.12%) They were followed for: 2 spondyloarthritis, 1 rheumatoid arthritis, 1 psoriatic arthritis, 1 adult onset Still’s disease. All the patients have temporarily stopped their drugs because they couldn’t come to their appointments because of the lockdown.

Conclusion:

Our study notes that the patients who kept their follow-up during lockdown have maintained a control of their disease activity. Our results are consistent with the observations of a French study on the impact of lockdown on the activity of rheumatoid arthritis. However, those who couldn’t come to their control appointment due to the lockdown had a flare of their disease. This study remains limited due to the monocentric nature and the small size of our sample.

Disclosure of Interests:

None declared

AB0600 VISCOSUPPLEMENTATION VERSUS PHYSICAL REHABILITATION IN KNEE OSTEOARTHRITIS COMPARATIVE STUDY ABOUT 117 CASES

Background:

Viscosupplementation with hyaluronic acid, and physical rehabilitation are part of the adjunct treatments for osteoarthritis, and particularly knee osteoarthritis.They can be used alone or combined.

Objectives:

To compare the efficacy of rehabilitation and viscosupplementation in patients followed for stage II and III osteoarthritis.

Methods:

This is a cross-sectional study, conducted in the department of rheumatology of the University Hospital ofIbn Rochd, Casablanca, between August 2020 and December 2020. Inclusion criteria: patients with stage II and III knee osteoarthritis fulfilling the ACR criteria. The diagnosis was made on standard x-rays including antero-posterior and lateral views. The functionalassessmentwas made with functional algo indices, WOMAC and Lequesnne. Pain was assessed with a visual analogue scale (VAS) on Day 0 and after 3 months. The patients were divided into 3 groups of 39 patients, the first (G1) received an infiltration of hyaluronic acid according to different protocols (multiple injections or single injection), the second (G2) benefited from a rehabilitation program twiceor three timesa week for three months, and the third group (G3) benefited from viscosupplementation associated with rehabilitation. Patients who received an intra-articular corticosteroid injection in the last 3 months were excluded.

Results:

There were 117 patients. The mean age was 59.6 ± 8.6, with a female predominance of 96.8%. Knee osteoarthritis was clinically patent for 5.8 years, with an average of 7.4 painful flares. Gonarthrosis was bicompartmental in 52 patients and tri-compartmental in 18 patients. 45% had a family history of osteoarthritis. 28% were hypertensive, 18 patients were diabetic and 51.87% were obese according to the body mass index, with an average of 30.5 ± 5.2 kg/m2. 65% had already received oral anti-arthritis drugs for an average of 1 year. Functional improvement was approximately 38% in G1, 26% in G2, and 42% in G3. A significant algo-functional improvement was noted in G1 (p = 0.04) and G3 (p = 0.03). LEQUESNE’s index went from an average of 8 in the 3 groups to an average of 4 inG1 and G3 versus 6 in G2, which corresponds to an average handicap (p = 0.2). The final value of the WOMAC index in G1 was 26.57 versus 32.21 in G2 (p = 0.01) and versus 22.36 in G3 (p = 0.02).

Conclusion:

In our study, the final evaluation showed a decrease in pain and an improvement in functional capacity ranging from 36 to 58%. This improvement in algo-functional indices was significantly more marked in G3[1]. Our study shows that the combination of visco-supplementation with physical rehabilitation gives better results by improving the algo-functional indices than by visco-supplementation alone. Our findings are consistent with the results of the literature[2].

References:

[1]Lebib S, Ben SalahFZ, Ksibi I, Dziri C. The ’rapeutiques non me ’dicamen-teuses de l’arthrose des membres infe ’rieurs: e ’tats de lieux et perspectives. RevFr Geriat Gerontol 2006;126(XIII):296–30

[2]Bruyere O, Cooper C, Pelletier JP, Branco J, Luisa BrandiM, GuilleminF, etal. AnalgorithmrecommendationforthemanagementofkneeosteoarthritisinEuropeandinternationally:areportfromataskforceoftheEuropeanSocietyforClinicalandEconomicAspectsofOsteoporosisandOsteoarthritis(ESCEO). Semin Arthritis Rheum. 2014;44(3):253–26

Disclosure of Interests:

None declared.

POS0998 SPONDYLOARTHRITIS AND SLEEP DISORDERS

Background:

Spondyloarthropathies (SpA) are a group of chronic and progressive diseases, characterized in particular by a progressive stiffening of the spine, spreading to neighboring joints or to certain tissues, which could lead in the long term to progressive stiffening and functional impairment. This conditioncancauseinsomnia problems and impaired sleep quality.

Objectives:

To assess the impact of SpA on the quality of sleep.

Methods:

This is a retrospective study over a period of 4 years from January 2015 to December 2019, including all the medical records of patients with SpA followed in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. We evaluated for each patient two validated scores: the Epworth somnolence scale rated from 0 to 24, and the Pittsburgh sleep score rated from 0 to 21 with 7 components. Patients with a psychiatric history or who were followed up for neurological pathologies were excluded.

Results:

178 patients were included. 60.67% were men with an average age of 36.32 years (14-68 years). 45.01% had axial SpA, 29.77% had psoriatic arthritis, and 25.22% were followed for SpA associated with inflammatory bowel disease. 45% had associated comorbidities: there were 18 diabetics and 34 hypertensive, 16.58% were smokers. Clinically, 85.42% presented a back pain initially on examination, 55% presented a polyarthralgia, and 39.88% an oligoarthritis. 63% had radiological sacroiliitis, and 35.14% had bilateral coxitis. 13.48% had a positive HLA B27 and 58.89% had a positive inflammatory assessment with very high activity indices,with a mean of 4.6. 64.66% of the patients received NSAIDs,of which 11% responded well. 57% were treated with csDMARDs, and 17.86% were treated with biologics. At the time of our study, the mean visual analog scale was 5.84 ± 1.7 out of 10 (2-9). The mean Epworth score was 8.38 ± 5.2 (0-21). 56.1% of patients had no sleep debt, 33.3% had a sleep deficit, and only 10.6% had signs of drowsiness. For the overall Pittsburgh score, the mean was 7.02 ± 3.6 (1-18). The mean of “subjective quality of sleep” was 1.12, “sleep latency” was 1.22, “duration of sleep” was 1.06, “usual sleep efficiency” was 0.74, “Sleep disturbance” of 1.28, “use of a sleep medication” of 0.54, and the average of the component concerning “poor shape during the day” was 1.03 out of 3. The LEQUESNE index went from an average of 6 to 8, which corresponds to an average handicap (P = 0.2) over a period of 3 years. 68% of the patients had an alteration in the quality of sleep, starting on average three years after the onset of symptoms. 11% reported having experiencedanxiety and depressive symptoms, and reported having used antidepressants or anxiolytics in the past 5 years.

Conclusion:

Our study showed the negative impact of SpA on the duration and overall quality of sleep. The degree of pain as well as functional impairment can cause and worsen sleep disturbances in SpA. We have shown that the Pittsburg score increases significantly with the increase of pain.The Lequesne score and that the Epworth score increase with disease activity[1].

References:

[1]StolwijkC,vanTubergenA,Castillo-OrtizJD,BoonenA.Prevalenceofextra-articularmanifestationsinpatientswithankylosingspondylitis:asystematicreviewandmeta-analysis.AnnRheumDis2015;74:65—73.

Disclosure of Interests:

None declared.

AB0620 MODIFICATION OF THE DECISION OF THE ANTI-OSTEOPOROSIS TREATMENT AFTER PERFORMING THE VFA

Background:

Spinal fractures are the most common of all osteoporotic fractures. Its diagnosis is essential, because the discovery of a vertebral fracture testifies the gravity of osteoporosis and modifies the therapeutic intervention threshold by justifying a specific anti-osteoporosis treatment. The evolution of densitometers now makes it possible to take a true X-ray image using software called “Vertebral Fracture Assessment” or VFA.

Objectives:

To assess the impact of VFA results on therapeutic decision-making after measuring bone mineral density.

Methods:

We conducted a retrospective and descriptive study in the rheumatology department.

We included all patient followed at the consultation for bone pathologies, in whom a measurement of bone mineral density and a supplementation of VFA were performed. Clinical data, BMD, VFA and the therapeutic decision by anti-osteoporosis treatment before and after VFA were collected.

Results:

Sixty-one patients were included. The mean age was 62.8 years [38 - 85 years]. Sex ratio (female / male) was 19.3. At BMD level, patients with osteoporosis and osteopenia were 49% and 51% respectively. VFA objectified at least one spinal fracture in 64% of patients. Prior to VFA, anti-osteoporosis therapy was indicated to 49% of patients, based on clinical data and BMD. After performing VFA, the prescription of anti-osteoporosis therapy was indicated to 80% of patients.

Conclusion:

Patients who had no indication for osteoporosis treatment based on BMD data, VFA was able to modify their therapeutic treatment by detecting vertebral fractures in patients who had back pain.

Disclosure of Interests:

None declared.

AB0685 IMPACT OF COVID-19 ON PATIENTS WITH RHEUMATIC DISEASES: EXPERIENCE OF THE DEPARTMENT OF RHEUMATOLOGY OF THE UNIVERSITY HOSPITAL OF IBN ROCHD OF CASABLANCA

Background:

The COVID-19 outbreak has been a source of major concern for the management of rheumatic patients, particularly those under immunosuppressants. It is generally admitted that patients followed for autoimmune diseases have an increased risk of infectious complications compared to the general population (1). However, to date, there is no established relationship between autoimmune diseases and an increased risk of infection with SARS-CoV-2 (2).

Objectives:

The primary objective was to assess the severity of COVID-19 in patients followed in our department. The secondary objective was to assess the subgroup of patients on immunosuppressants.

Methods:

We conducted a descriptive retrospective study of patients followed in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. The patients who presented with COVID-19 between 08/2020 and 12/2020 were included. Epidemiological, clinical, therapeutic, and evolutionary data were collected and analyzed.

Results:

Our series included 30 patients, with a sex ratio M/F of 0.3. The mean age of the patients was 46.4 years (±16.3), with a mean follow-up time of 8.1 years. 7 patients had a metabolic syndrome. Patients were followed for rheumatoid arthritis (n = 4), spondyloarthritis (n = 10), systemic lupus erythematosus (n = 5), scleroderma (n = 2), polymyalgia rheumatica (n = 1), adult onset Still’s disease (n = 1), polyosteoarthritis (n = 6), benign osteopathy (n = 1). 17 patients were in low disease activity when they presented the COVID-19. 8 patients presented moderate to high activity, of which 2 (25%) developed a form requiring hospitalization. 7 patients were under NSAIDs, 13 under corticosteroids, 19 under csDMARD, 7 under bDMARD. The COVID-19 disease was symptomatic in 83% of cases, with fatigue (68%), cough (52%), back pain (48%), anosmia (48%), ageusia (44%), arthritis (44%), fever (36%). The diagnosis was made with polymerase chain reaction (83%), serology (10%), CT scan (23%). The CT lung lesions reached 25-50% in 2 lupus patients with a moderate disease activity, under corticosteroids and hydroxychloroquine. The involvement was > 75% in 2 patients, who admitted to intensive care: one was followed for polyarthrosis and was hypertensive and poorly balanced diabetic, and the other was followed for Horton’s disease. The treatment was administered on an outpatient basis in 77.4% of cases, in an intensive care unit in 16% of cases. 30 patients fully recovered from infection, one patient died secondary to pulmonary embolism. The subgroup of patients on immunosuppressants consisted of 23 patients (76%), of whom 5 (22%) developed a moderate to severe form of COVID-19 requiring hospitalization. Among these hospitalized patients, 2 (40%) had moderate to high disease activity of their rheumatism.

Conclusion:

Most of the patients in our series presented a mild form of COVID-19, including those under immunosuppressants. Patients who were under hydroxychloroquine were not spared from COVID-19, but developed a mild form. The disease activity of the chronic rheumatism did not appear to influence the severity of the COVID-19.

References:

[1]Grange L, Guilpain P, Truchetet M-E, Cracowski J-L. Challenges of autoimmune rheumatic disease treatment during the COVID-19 pandemic: A review. Therapies. 2020;75(4):335-42.

[2]Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-42.

Disclosure of Interests:

None declared

AB0794 CONTRIBUTION OF LABIAL SALIVARY GLAND BIOPSY: EXPERIENCE OF THE DEPARTMENT OF RHEUMATOLOGY OF THE UNIVERSITY HOSPITAL OF IBN ROCHD (ABOUT 57 CASES)

Background:

Labial salivary gland biopsy (LSGB) is a histological examination indicated for the diagnostic workup of systemic diseases such as Sjogren’s syndrome, amyloidosis, or sarcoidosis.

Objectives:

To study the contribution of LSGB to the diagnosis of Sjogren’s syndrome, amyloidosis, and sarcoidosis.

Methods:

We conducted a retrospective study of LSGB histopathological reports and clinical data of patient medical records collected in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca, between January 2019 and June 2020. Histology assessed Chisholm and Masson’s sialadenitis score, looked for amyloidosis, and sarcoidotic granulomas.

Results:

A total of 57 LSGBs were performed, of which 2 were excluded from our study because of lack of clinical data. The sex-ratio M/F was 0.1, and the median age was 53 (22 – 85). The indications were subjective eyes and mouth dryness in 40% of cases, the search for sarcoidosis and amyloidosis in 23.6% of cases, the assessment of a dryness syndrome in the context of chronic inflammatory rheumatism in 18.2% of cases, isolated dryness of the mouth in 14.5% of cases, and the search for amyloidosis in the context of a known primary Sjögren syndrome in 3.6% of cases. The stages of Chisholm and Masson for sialadenitis found were: stage I at 56.6%, stage II at 24.5%, stage III at 11.3%, and stage IV at 7.5%. Among the LSGBs performed for dryness syndrome, stages III and IV were found in 18.2% of cases among subjective eyes and mouth dryness, in 12.5% of cases among isolated mouth dryness, and in 20% of cases among chronic inflammatory rheumatisms. Three cases of AA amyloidosis (5.5%) were diagnosed. No sarcoidosis granulomas were found.

Conclusion:

LSGB is a simple and frequent investigation. The Chisholm stage most often found in our series was stage I, followed by stages II, III, and IV respectively. This is consistent with the results of the study of Baeteman et al (1). In addition, amyloidosis was only found in our series in 5.5% of cases, also matching with the results of Baeteman et al. (4.2%). Their study showed that LSGB has a great diagnostic interest in these two pathologies, with a sensitivity of 52-75% and a specificity of 90-100% for Sjogren’s syndrome, and a sensitivity of 48-80% and a specificity of 93-100% for amyloidosis (2). LSGB remains a simple investigation test, contributing to the diagnosis of Sjogren’s syndrome, amyloidosis, and sarcoidosis.

References:

[1]Baeteman C, Guyot L, Bouvenot J, Chossegros C, Cheynet F, Loudot C, et al. Faut-il encore effectuer des biopsies des glandes salivaires accessoires? Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2008 Jun;109(3):143–7.

[2]Scardina GA, Spanó G, Carini F, Spicola M, Valenza V, Messina P, et al. Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome. Med Oral Patol Oral Cir Bucal. 1 déc 2007;12(8):E565-568.

Disclosure of Interests:

None declared

AB0828 INFLUENCE OF SEASONAL VARIATIONS ON EMERGENCY RHEUMATOLOGY CONSULTATIONS

Background:

The influence of the seasons on the onset of diseases has been demonstrated in epidemiological studies, particularly in infectious pathologies. In rheumatology, recent studies have suggested the role of seasons in the disease activity of rheumatoid arthritis (1,2). However, no epidemiologic data exist on the influence of seasons in urgent rheumatology consultations, all causes combined.

Objectives:

To study the influence of seasonal variations on urgent rheumatology consultations received in the Department of Rheumatology of the University Hospital of Ibn Rochd in Casablanca.

Methods:

We conducted a retrospective study on the 2019 emergency consultations register of the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. The seasons were divided as follows: winter from December to February, spring from March to May, summer from June to August, and fall from September to November. The studied parameters were age, sex, reasons for consultation, affected joints, and diagnoses.

Results:

407 emergency consultations were carried out, with an average patient age of 50.7 years (range 14 - 88), and a sex ratio M/F of 0.4. The characteristics of the patients throughout the seasons is summed up in Table 1. The distribution of consultations by season was as follows: 29.5% in winter, 26.3% in spring, 25.4% in summer, and 18.8% in fall. The average age of the consultants depending on the season was homogeneous. The most frequent reasons for emergency consultation were respectively back pain (48.6%), polyarthralgia (23.1%), followed by arthritis (12.0%). Back pain slightly predominant in the cold seasons (fall, winter). Polyarthralgias had a winter peak. Arthritis presented a bimodal distribution in seasons of transition (spring, fall). The knees and lumbar spine were the most frequently involved joints throughout the year, with no major differences between the seasons. The most frequent diagnoses over the year were degenerative (51%), inflammatory (8.6%), infectious (7.3%), metabolic (6.7%), and tumor (2.1%) pathologies, respectively. %). Osteoarthritis flares were less frequent in spring and summer. Inflammatory pathologies have not experienced a seasonal peak. Gout flares and infectious pathologies peaked in the spring. Finally, tumor pathologies peaked in the fall.

Conclusion:

Seasonal variations seem to have an impact on the distribution of the reasons for consultation as well as the diagnoses made in the context of the rheumatologic emergencies. The cold seasons seemed to favor the onset of back pain and polyarthralgia, while the seasons of transition were conducive to the development of arthritis.

References:

[1]Mori H, Sawada T, Nishiyama S, Shimada K, Tahara K, Hayashi H, et al. Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis. BMC Musculoskelet Disord. 2019 Dec;20(1):30.

[2]Azzouzi H, Ichchou L. Seasonal and Weather Effects on Rheumatoid Arthritis: Myth or Reality? Pain Research and Management. 2020 Sep 7;2020:1–5.

Table 1.

Characteristics of the patients throughout the seasons

Wintern = 120(29.5%)Springn = 107(26.3%)Summern = 104(25.4%)Falln = 76(18.8%)Totaln = 407(100%)Age51,2 (16 – 86)51,6 (14 – 84)51,3 (16 – 88)48 (16 – 79)50,7 (14 – 88)Sex-ratio M/F0,250,440,60,360,4Reasons for consultationArthritis (%)8,31511,51412,0Polyarthritis (%)3021,520,218,523,1Back pain (%)51.744.945.254.048.6Joint involvementShoulder (%)33,321,522,122,427,2Hand (%)16,720,015,413,216,5Knee (%)49,241,048,146,146,2Ankle (%)13,314,013,514,513,8Cervical spine (%)6,010,39,67,98,4Lumbar spine (%)44,239,338,047,041,8DiagnosesOsteoarthritis (%)53,443,947,556,850,2Knee osteoarthritis (%)31,522,828,838,630,0Lumbar osteoarthritis (%)28,822,830,531,828,3Septic (%)2.77.01.72.33.4Gout (%)5.510.55.16.86.7Inflammatory (%)9.68.86.76.89.9Tumor (%)1.31.81.74.52.1

Disclosure of Interests:

None declared

AB0619 CLINICAL RISK FACTORS, BONE DENSITY AND FALL’S HISTORY AND FRACTURES RELATION: STUDY BY HOSPITAL SURVEY ABOUT 448 CASES

Background:

Osteoporosis is a disease that affects bone mineral density (BMD) and bone microarchitecture at the origin of an increased risk of fracture. The reduction in bone density assessed by dual-energy X ray absorptiometry (DXA) and fall history represent the first two risk factors of non-vertebral fracture after menopause. Given the high prevalence of osteoporosis among fallers subjects with common risk factors, causing a surisk of fracture. Several publications including the osteoporosis recommendations indicate DXA in women experienced falls in search of bone fragility may justify a treatment for osteoporosis, especially as the FRAX tool does not include at present the fall of history, an important parameter in the assessment of fracture risk.

Objectives:

Because of the low attention given to the evaluation of falls’risk, the main objective of the study was to determine the prevalence and the relationship between the past history of fall, reduction of bone mineral density and prevalent fracture.

Methods:

Transversal and descriptive epidemiological cohort study conducted for 24 months in 448 patients referred by physicians regularly use prescription of BMD. The realization of this exploration by the same DXA-Hologic in the rheumatology department at Ibn Rochd University Hospital was the criterion for entry into the study. All patients were interviewed on the same day on the risk factors for osteoporosis and fractures justifying the prescription of a BMD.

Results:

Data included 413 women and 35 men. Most women were postmenopausal (89.6%). The average age was 59 years (σ = 13.40), 33.7% were ≥ 65 years. The mean BMI was at 27.50 (σ = 5,2). 18.5% of patients had at least a history of falls in the previous 12 months and 22.5% a history of fracture after a low-energy trauma. 42.9% were osteoporotic and 57.1% had osteopenia in at least one of these sites: lumbar spine, femoral neck, total hip. We did not find significant association between BMD osteoporosis and fall history (p = 0.916). Thus, cases of osteoporosis fractures were not statistically associated with a fall (p = 0.170). Also, the falls were occurring than 18.4% of osteopenic patients (p = 0.220). However, in our study, the fall was an independent risk factor for fracture (p = 0.003) and osteopenic fractures were significantly higher among fallers (p = 0.009 and 0.006 respectively, a drop of history and at least one past fall history).

Conclusion:

The fall history is a independent risk factor for fracture. This risk is particularly important in case of fragility bone densitometry. The clinical history and fall risk factors should be taken into consideration in the assessment of fracture risk and in the anti-ostoporotique treatment strategy. Thus, the fall seems to be a legitimate indication for DXA and as a parameter to be integrated into the assessment of fracture risk by the FRAX score.

References:

[1]MH. Edwards, K. Jameson, H. Denison, NC.Harvey, Sayer A. Aihie, EM Dennison, and C Cooper. Clinical risk factors, bone density and fall history in the predection of incident fracture among men and women. Bone. 2013; 52(2): 541–547.

Table 1.

Multivariate Logistic Regression Results: Adjustment for predictors factors of falls

VariablesOR (95% IC)p-valueAge ≥ 65 ans0,986 (0,412-2,357)0,974Past history of fracture4,271 (1,719-10,611)0,02Walking aid11,214 (2,815-44,670)0,01Vision disturbances8,587 (3,540-20,829)<0,001Rhumatoid arthritis8,047 (2,218-29,192)0,02Diabete3,194 (1,217-8,382)0,018Corticosteroid ≥ 3 mois0,603 (0,156-2,331)0,463Smoking0,241 (0,013-4,518)0,341Ostéopenia (-1 ≤ T-score < -2,5)2,204 (0,875-5,552)0,094

Disclosure of Interests:

None declared.

PES, molecular structure, spectroscopic (FT-IR, FT-Raman), electronic (UV-Vis, HOMO-LUMO), quantum chemical and biological (docking) studies on a potent membrane permeable inhibitor: dibenzoxepine derivative

The dibenzoxepines derivatives have found a broad application in biological and pharmaceutical fields as new prospective drugs. So, the molecule (3aS,12bS)-5-Chlor-2-methyl-2,3,3a,12b-tetrahydro-1H-dibenzo[2,3:6,7]oxepino[4,5-c]pyrrol has been characterized by DFT (Density Functional Theory) approach to predict the important properties of it. The minimum energy conformer has been found by PES (Potential Energy Surface) and then the structure is optimized. Further, the structure is characterized spectroscopically by FT-IR and FT-Raman techniques to know the functional group and chemically active atoms. The geometrical parameters, PED (Potential Energy Distribution) assignments have also been reported. The electronic properties of the title compound have been explained by UV-Vis and HOMO-LUMO analyses that describe the charge transfer between the atoms of the molecule. Molecular Electrostatic Potential (MEP), Electron Localization Function (ELF) and Localized Orbital Locator (LOL) have been depicted to know the chemically active regions. The electrophilic and nucleophilic regions have been shown by Fukui functions. The Non-Linear Optics (NLO) for non-linear optical effects and the Natural Bond Orbital (NBO) for charge delocalization were studied. To study the biological activity of the title compound, molecular docking has been performed which suggests that the title molecule may act as a membrane permeable inhibitor.

Diagnosis of ventilator-associated pneumonia: comparison between ante-mortem and post-mortem cultures in trauma patients

PURPOSE

To evaluate the diagnostic utility of ante-mortem tracheal aspirates for diagnosis of ventilator-associated pneumonia (VAP). Trauma victims represent an otherwise healthy population, who are on multiple invasive life-support devices, which predispose them to severe infections like VAP. The diagnosis of VAP is challenging, due to the difficulty in obtaining a representative sample from lungs. We studied the diagnostic utility of tracheal aspirates by comparing its results with the post-mortem lung cultures.

MATERIALS AND METHODS

A total of 106 fatal trauma patients were included in the study. Lung samples and cardiac blood were taken for culture at the time of autopsy. The results of ante-mortem and post-mortem cultures were compared.

RESULTS

Septicemia was the cause of death in 51 (48%) of the fatal cases and VAP was identified in 36 (34%) cases. A total of 96 (90.5%) cases had pathogens isolated from lung samples. In 62 (58%) cases, the same organism was isolated from ante-mortem and post-mortem respiratory samples.

CONCLUSIONS

Culture results of a properly collected tracheal aspirate should be taken into consideration along with Centre for Disease Control and Prevention (CDC's) diagnostic criteria to maximise the diagnosis of VAP.

[Intra-articular use of sodium hyaluronate (2,2,-2,7 MDa) in the treatment of Moroccan patients with knee osteoarthritis: randomized controlled trial]

OBJECTIVE

To assess the efficacy of intra-articular sodium hyaluronate, administred once weekly for 3 weeks (3 injections) in Moroccan patients with knee osteoarthritis over 6-month period.

MATERIAL AND METHODS

We prospectively studied the outcome of 75 patients with painful knee osteoarthritis in grade 1, 2 and 3 on ACR radiological criteria in our rheumatology clinic in Morocco. Group 1: 45 patients were treated with 3-weekly injections of intra-articular sodium hyaluronate (1%; 2,2-2,7 MDa). Group 2 : 30 patients treated with symptomatic slow-acting drugs for osteoarthritis (SYSADOA). The efficacy parameters were Visual Analogue Scale (VAS) and Lequesne index.

RESULTS

In group 1: 35/45 were female, a mean age of patients was 57.2 (± 8.2) years, and a mean Body Mass Index (BMI) was 28 (± 1.4) kg/m2. In group 2: 23/30 were female, a mean age of patients was 58.6 (± 2.8) years, and a mean of BMI was 27.8 (± 1.4) kg/m2. Before treatment in group 1, the mean of VAS was 6.5 cm (± 1), and of Lequesne index 10.5 (± 2.1). At 3 and 6 months after the third injection of sodium hyaluronate, there was a significant improvement from baseline of Lequesne index and VAS (P = 0.001). In group 2 before treatment, the mean of VAS was 7 cm (± 0,7), and of Lequesne index 8 (+ 1.1), but the improvement from baseline at 3 and 6 months of treatment was lower than group 1.

CONCLUSION

The results of this prospective study, showed the efficacy of 3-weekly injections of sodium hyaluronate in the treatment of knee osteoarthritis in Moroccan patients over a 6-month period.

[Pachydermoperiostosis. A case report]

INTRODUCTION

The pachydermoperiostosis (PDP) or primitive hypertrophic osteoarthropathy (HOA) is a rare hereditary disease.

CASE RECORD

We report a 22-year-old man born to consanguineous marriage who presented presented with PDP. This patient disclosed an arthropathy, a clubbing, a diffuse periostosis, and a pachyderma of the hands, the feet and the forehead. All the examinations that were performed to look for an etiology remained negative. Diagnosis of PDP was considered and the patient treated with colchicine.

DISCUSSION

We discuss the diagnostic issues raised by PDP, especially with the secondary HOA and chronic inflammatory rheumatisms.

Hypereosinophilic syndrome

Hypereosinophilic syndrome is a leukoproliferative disease characterised by sustained overproduction of eosinophils. The three diagnostic criteria for this disorder are (1) Eosinophilia of greater than 1500 cells/ml, persisting for longer than 6 months, (2) lack of another diagnosis to explain the eosinophilia and (3) signs and symptoms of organ involvement. We report a 15-year-old boy who was diagnosed as Hypereosinophilic syndrome based on these criteria.

Psoriasis et ostéomalacie à propos d’une nouvelle observation

INTRODUCTION

The association psoriasis and osteomalacia is very rare.

EXEGESIS

We report the case of a young girl, aged 17, who was consulting for ostealgia and erythematic and squamous cutaneous lesions. She had a staturo-ponderal delay, ostealgia and a bending of the general state. The osteo-articular examination showed a sternal protrusion with painful limitation of the movements of all joints. The dermatologic examination noted a dry erythrodermis to hick squamous with scalp's crush. The biological (hypocalcaemia, diminished urinary calcium) and radiological (demineralized bone with Looser-Milkmann fractures) results suggest an osteomalacia, diagnostic confirmed by the bone histological study that found out osteoid lines. The cutaneous biopsy was compatible with psoriasis diagnosis. A vitamino-calcic treatment associated to local nursing was undertaken. The evolution was favorable, noted by a cutaneous bleaching with a return back of the articular function. The present receding is of nine years.

CONCLUSION

Different studies underlined that outside of its action on the phosphocalcic metabolism, the vitamin D acts on the skin, especially on the proliferation of the keratinocytes that allowed its indication in the treatment of the psoriasis.

Diagnosis of mucopolysaccharidoses: how to avoid false positives and false negatives

OBJECTIVE

This paper advocates a complete procedure, which includes both quantitative and qualitative analysis of urinary GAGs in the diagnosis of MPS in a clinically suspected population.

METHODS

Urine samples from 219 clinically suspected mucopolysaccharidoses (MPS) patients and 91 controls were analysed using a combination of methods. Quantitation of isolated urinary glycosaminoglycans (GAGs) were carried out using acid alcian blue complex formation method and qualitative urinary GAG analysis by multisolvent sequential thin layer chromatography

RESULTS

Of the 219 patients analysed, 131 were confirmed to be suffering from MPS. Quantitation of urinary GAGs alone would have missed 60 low GAG excreting MPS patients and misdiagnosed 26 high GAG excreting nonMPS as MPS patients. Further qualitative analysis and enzyme estimation were needed to identify these 60 low GAG excreting MPS patients and 26 high GAG excreting non MPS patients.

CONCLUSION

These results emphasize that quantitation of urinary GAGs alone cannot diagnose MPS patients, it should be coupled with qualitative analysis and enzyme estimations for differential/definitive diagnosis.

DNA damage and integrity of UV-induced DNA repair in lymphocytes of smokers analysed by the comet assay

DNA damage was assessed in smoker lymphocytes by subjecting them to the single cell gel electrophoresis (SCGE) assay. In addition to the appearance of comet tails, smoker cells exhibited enlarged nuclei when analysed by the comet assay. On comparing basal DNA damage among smokers and a non-smoking control group, smoker lymphocytes showed higher basal DNA damage (smokers, 36.25+/-8.45 microm; non-smokers, 21.6+/-2.06 microm). A significant difference in DNA migration lengths was observed between the two groups at 10 min after UV exposure (smokers, 65.5+/-20.34 microm; non-smokers, 79.2+/-11.59 microm), but no significant differences were seen at 30 min after UV exposure (smokers, 21.13+/-10.73 microm; non-smokers, (27.2+/-4.13 microm). The study thus implies that cigarette smoking perhaps interferes with the incision steps of the nucleotide excision repair (NER) process. There appeared be no correlation between the frequency of smoking and DNA damage or the capacity of the cells to repair UV-induced DNA damage that suggests inherited host factors may be responsible for the inter-individual differences in DNA repair capacities. The study also suggests monitoring NER following UV insult using the SCGE assay is a sensitive and simple method to assess DNA damage and integrity of DNA repair in human cells exposed to chemical mutagens.

Sciatica as the first manifestation of a leiomyosarcoma of the buttock

We report the case of a 22-year-old woman who was admitted for inflammatory right-sided sciatica with a decline in general health. Laboratory tests showed severe inflammation. Ultrasonography and computed tomography of the buttock and pelvis demonstrated a large tumor in the deep muscles of the right buttock, with an intrapelvic component that displaced the pelvic organs without invading them. Histologic examination of a biopsy specimen taken via the buttock established the diagnosis of leiomyosarcoma. Surgery by a pelvic approach allowed partial resection of the tumor, which was seen to invade the sciatic nerve. Radiation therapy was given. Six months later the residual tumor was considerably larger and the patient's general health had deteriorated further. Leiomyosarcomas are rare tumors whose diagnosis rests on histologic examination of biopsy or surgical specimens. The treatment is surgical. Recurrences are seen in 40 to 60% of cases, and metastases in 27 to 60%. The place of radiation therapy and chemotherapy in the treatment of leiomyosarcoma remains unclear.

Diffuse arthralgia and myalgia as the first manifestation of benign myeloradiculopathy due to cytomegalovirus infection in an immunocompetent patient

CMV-induced neurological manifestations are uncommon, especially in immunocompetent subjects. We report a case of CMV-induced myeloradiculopathy with a favorable outcome in an immunocompetent patient who presented with diffuse myalgia and inflammatory polyarthralgia. Presence of both peripheral and central neurological abnormalities with monocytosis and positive serological tests in the blood and cerebrospinal fluid established the diagnosis. Mixed neurological involvement is rare during CMV infection and usually occurs in association with a deficiency in immunological responses.

Sino-bronchial syndrome in children with asthma

Thirty children in the age group of 2 to 12 years were brought with a history of recurrent non-seasonal moderate to severe wheezy episodes associated with symptoms of nasal congestion, sneezing and occasional headache. All of them had maxillary or pan sinusitis with 26 having associated right, left or bilateral lower lobe pneumonitis or bronchiectasis. Serum immunoglobulins were normal in 22 and was not done in eight. There was positive (2 to 4+ above negative control) skin test response to dust and dust mite in 15 of the 22 children tested. Throat swabs/sputum or nasal secretions grew B-hemolytic streptococcus or streptococcus pneumoniae in twenty-seven. All the children were put on bactericidal drugs for 6 to 8 weeks and bronchodilators were used when needed. At the end of 6 to 8 weeks follow-up X-ray of sinuses and chest showed significant clearing of the lesions which coincided with marked clinical improvement. Sinus X-ray should be considered in bronchial asthma resistant to medical management since untreated bacterial sinusitis can be an underlying cause of chronic poorly controlled asthma.