First report of Sarcocystis falcatula in naturally infected Razorbill auks (Alca torda) collected in Tunisian Mediterranean Sea shores

Sarcocystis spp. are apicomplexan cyst-forming parasites that can infect numerous vertebrates, including birds. Sarcosporidiosis infection was investigated in three muscles (breast, right and left thigh muscle) and one organ (heart) of four Razorbill auks (Alca torda) stranded between November and December 2022 on the shores of the Mediterranean Sea in Nabeul and Bizerte governorates, Northern Tunisia. Two of the four tested A. torda were PCR positive for 18S rRNA Sarcocystis spp. gene. Among the examined 16 muscles/organs, only one breast and one right thigh were Sarcocystis spp. PCR-positive (12.5% ± 8.3, 2/16). Our results showed a relatively high molecular prevalence of Sarcocystis spp. in Razorbill auks (A. torda). Sarcocystis spp. sequence described in the present study (GenBank number: OR516818) showed 99.56-100% identity to Sarcocystis falcatula. In conclusion, our results confirmed the infection of Razorbill auks (A. torda) by S. falcatula. Further research is needed on different migratory seabirds' species in order to identify other Sarcocystis species.

A Review on Crimean-Congo Hemorrhagic Fever Infections in Tunisia

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic tick-borne disease, caused by an arbovirus of the genus Orthonairovirus and the family Nairoviridae. Crimean-Congo hemorrhagic fever virus (CCHFV) is widespread in several regions of the world. While the virus is not pathogenic to all susceptible livestock and wild mammals, it can lead to severe hemorrhagic fever in humans. In this review, we compiled published data on CCHFV infections in humans, animals, and ticks in Tunisia. Based on that, we discussed the epidemiology and the distribution patterns of CCHFV infections highlighting the risk factors for this virus in the country. CCHF infection prevalence in humans was estimated to 2.76% (5/181) and 5% (2/38) in Tunisian febrile patients and Tunisian slaughterhouse workers, respectively. Concurrently, seroprevalence in domestic ungulates (sheep, goats, cattle, and dromedaries) ranged from zero to 89.7%, and only one Hyalomma impeltatum tick specimen collected from dromedaries in southern Tunisian was positive for CCHFV by reverse transcriptase-polymerase chain reaction (0.6%; 1/165). As Tunisian studies on CCHFV are geographically scattered and limited due to very small sample sizes, further studies are needed to improve the knowledge on the epidemiology of CCHF in Tunisia.

AB1115 COVID-19 VACCINE HESITANCY AMONG RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGICS

Background

Vaccine hesitancy is defined by the OMS as ”a delay in acceptance or refusal of vaccines despite availability of vaccination services” [1], and it is considered as one of threats to global health. This hesitancy emerges around Covid-19 vaccination. Patients on biologic Disease-Modifying Anti-Rheumatic Drug (bDMARD) are vulnerable to Covid-19 infection and their perception to vaccination is unknown.

Objectives

The aim of our study was to identify Covid-19 vaccine hesitancy among rheumatoid arthritis (RA) patient on bDMARD.

Methods

We conducted a monocentric, cross-sectional study, including patients with RA who met the ACR/EULAR 2010 criteria. All patients were on bDMARD with or without conventional synthetic (Cs) DMARD for at least 3 months. Disease activity was assessed using the Disease Activity Score (DAS) 28 (CRP) and the functional impairment using the Health Assessment Questionnaire (HAQ). A structured interview was done using a prepared questionnaire evaluating their vaccine hesitancy behavior.

Results

We enrolled 60 patients: 10 male (16.7%) and 50 females (83.3%). Their average age was 58.16±9.04 years [34-80]. For the education level; 38.5% of patients were illiterate, 34.6% had primary education, 23.1% had secondary education, and 3.8% have a university degree. Forty-four patients (73.3%) had no occupation, 13 patients (21.7%) were employed, and 5% were retired. The majority of patients lived in urban areas (85%) and 98.2% with their families. The average duration of RA was 15.23±8.92 years [2-39]. The average DAS28 (CRP) and the average HAQ were 4.05±1.22 [1.5-7.2] and 0.7±0.4 [0-2.4], respectively. Fifteen patients (25%) had a high disease activity and seven (11.7%) were in remission. When asking patients about their Covid19 infection and vaccination status; 15% had caught the virus and 61.7% have already received the vaccine. One third (35.6%) believed that they had enough information about vaccination. Their main sources were their family, friends, and the media. More than half of the asked patients (68.3%) reported vaccine hesitancy. Reasons of vaccine hesitancy were divided into three categories: lack of confidence (66.7%, p<0.005) (63.3% fear related to side effects, 10% conspiracy theory, 6.7% lack of confidence in the provider), complacency problem (16.7%, p=0.01) and lack of convenience (8.6%). There was no association between vaccine hesitancy and sociodemographic data. The existence of comorbidities had no influence on vaccine hesitancy (p=0.4). This hesitancy was not associated with DAS28 (CRP) (p=0.6) and with HAQ (p=0.7). Patients with moderate to high disease activity were more likely to deny the usefulness of Covid-19 vaccination (p=0.09). Regarding to the therapeutic data, there was no association between corticotherapy and vaccine hesitancy (p=0.1). There was no influence on the type of the current bDMARD (p=0.3) or of the rate of administration (p=0.4). The route of administration was associated with hesitation (53.65% intravenous vs 46.34% subcutaneous, p=0.04).

Conclusion

Our study showed that Covid-19 vaccination coverage among RA patients on bDMARDs was not optimal with a high percentage of hesitancy. The reasons are complex and they may be related to a lack of awareness. Rheumatologists should play a key role in the vaccine company.

References

[1]MacDonald NE, SAGE Working Group on Vaccine Hesitancy Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161–4.

Disclosure of Interests

None declared

AB1222 POSITIVE DIAGNOSIS OF TUBERCULOUS SPONDYLODISCITIS: CT-GUIDED PERCUTANEOUS BIOPSY OF SPINAL LESIONS VERSUS CLINICAL, BIOLOGICAL AND IMAGING ARGUMENTS

Background

Tuberculosis is still endemic in Tunisia. Although pulmonary localization is the most common, other localizations, including osteo-articular involvement, are increasingly diagnosed. Spinal or «Pott’s Disease» is the most common expression. A bundle of clinical, paraclinical and evolutionary arguments or a disco-vertebral biopsy puncture (DVBP) contribute to the positive diagnosis.

Objectives

Our aim was to assess the real contribution of DVBP compared to clinical-biological and imaging arguments for the diagnosis of tuberculous spondylodiscitis (SPDT).

Methods

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Diagnosis SPDT was retained based on the results of the DVBP in 15 patients (28.8%); and it was strongly suspected in front of the presence of clinico-biological and imaging arguments in 37 patients (71.2%). Among the clinical arguments suggestive of SPDT were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contributive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging (MRI). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. Once the diagnosis was retained for these patients, the first week noted a most significant clinical improvement (56.8%) in patients diagnosed with a range of suggestive arguments (p = 0.002). During the second week, clinical improvement was most marked in patients diagnosed with suggestive clinical and paraclinical arguments (70.3%) but with no statistically significant difference (p = 0.1). The improvement was statistically greater during the fourth week (66.7%) and the third month (60%) in patients diagnosed with histological examination (p < 0.001).

Figure 1.

SPDT Diagnostic Strategy

SPDT= Tuberculous spondylodiscitis, CBC= Cell blood count, NNA= Normochromic normocytic anemia, CRP= C reactive protein, SR= Sedimentation rate, BK= koch’s bacillus, SPDI= infectious spondylodiscitis, SPDNT= Non-tuberculous spondylodiscitis

Conclusion

Tuberculous spondylodiscitis is a frequent condition that needs to be treated rapidly. A range of highly suggestive clinical, paraclinical and evolutionary arguments contribute in the majority of cases to the positive diagnosis with a comparative clinical evolution to that of the DVBP which remains an invasive exam with variable sensitivity depending on studies.

Disclosure of Interests

None declared

AB1369 DISCO-VERTEBRAL BIOPSY VERSUS INDIRECT DIAGNOSTIC TOOLS IN BRUCELLAR SPONDYLODISCITIS

Background

The diagnosis of brucellar spondylodiscitis can be made by serological examinations or by isolating the germ on disco-vertebral biopsy (DVB).

Objectives

We aimed to study the interest of DVB and other less invasive diagnostic tools in brucellar spondylodiscitis.

Methods

A retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis.

Results

Eighteen cases were collected (13 men and 5 woman).

Nine patients had a DVB. In all cases, microbiological study did not reveal the causative agent (Brucella). A case of superinfection with Staphylococus Xylosus was noted. Histopathological examination was performed in eight patients. It showed osteitis and chronic spondylodiscitis lesions in 4 cases, a non-specific inflammatory infiltrate in 3 cases, and a progressive infectious spondylitis in one case. Wright’s serodiagnosis and the rose bengal test were positive in 7 out of 8 cases performed. As for the diagnosis by indirect immunofluorescence made in 6 cases, it was positive in 5 cases.

For the other nine cases who did not undergo DVB, Wright’s serodiagnosis and rose bengal test were positive in 9 and 6 patients respectively, indirect immunofluorescence made in 5 patients was positive in 4 cases.

Conclusion

Serological examinations in brucellar spondylodiscitis seem more profitable and less invasive than DVB. Other studies with a larger population seem to be necessary to compare the different methods and complete this preliminary study.

Disclosure of Interests

None declared

AB0951 Entheseal involvement in healthy subjects: What can lower limb ultrasonography tell us?

Background

Over the past few years, ultrasonography (US) has been a very useful tool in the detection of subclinical enthesopathy especially in spondyloarthritis patients. However, could US entheseal involvement detection by US in healthy subjects be predictive of evolution to an inflammatory rheumatic disease?

Objectives

To identify by US the prevalence of entheseal abnormalities at the lower limb of healthy subjects and associated risk factors.

Methods

US assessment was performed on 400 entheses of 40 healthy volunteer subjects along with clinical examination. Exclusion criteria: Enthesitis on the physical examination, personal of family history of inflammatory rheumatic disease and previous surgery or procedural interventions in the knees and/or ankles. Quadriceps, patellar and calcaneal tendons, and plantar fascia entheses were scanned. Depending on lesion type, inflammation (thickening, hypoechogenecity, bursitis and Doppler signal) and chronic damage (calcifications, enthesophytes and erosions) scores (0= absent, 1=present) were calculated per entheseal site and per participant. Total score was obtained by adding these two scores. Data about age, gender, body mass index (BMI) and physical activity according to the short form of the International Physical Activity Questionnaire score (IPAQ-SF) were collected.

Results

The mean age of participants was 52.3±14.83 [20-78] and the ratio of males to females was 3:2. Fourteen participants had US subclinical enthesopathy (35%). Among 400 scanned entheses, thickening was the most frequent inflammatory lesion observed in 4 % (n=16) of the entheses, followed by hypoechogenecity (0.5 %, n=2). Enthesophytes were the most frequent chronic damage lesions detected in 1.25% (n=5) of the entheses followed by erosions (0.5%, n=2). The highest total US scores per entheseal site were observed at the calcaneal enthesis [mean (SD) 0.27(0.59)], followed by plantar fascia [0.18(0.50)] and distal patellar tendon origins [0.10 (0.37)]. Age was not associated to higher scores (total, inflammation, chronic damage; p=0.339, p=0.412, p=0.531). Female participants had higher inflammation scores than males (mean inflammation scores (SD) 0.69 (1.44) versus 0.39 (0.71), p=0.044). The BMI was correlated to higher inflammation score (p=0.020, r=0.368) but not to chronic damage nor to total scores (p=0.478, p=0.104). Intense physical activity was associated to higher chronic damage score comparing to moderate physical activity (mean chronic damage scores (SD) 0.30(0.67) versus 0.003(0.00), p=0.058) and to low physical activity (mean chronic damage scores (SD) 0.30(0.67) versus 0.0018(0.00), p=0.043). No association between physical activity and inflammation score had been observed.

Conclusion

Our study demonstrates that US changes within the enthesis are associated with higher BMI and physical activity. These results support the effect of biomechanical forces on the entheses that should be considered when differentiating by US pathological from healthy entheses.

Disclosure of Interests

None declared

POS1568-PARE THE BRIEF-ILLNESS PERCEPTION QUESTIONNAIRE: A METHOD FOR ASSESSING THE COGNITIVE REPRESENTATION OF RHEUMATIC DISEASE

Background

The common-sense model proposes that illness perception (IP), is how patients make sense of their illness and respond emotionally to it, influencing the way they cope with the illness and subsequently illness outcomes. This proposition has gained considerable empirical support, and the relevance of IP in understanding illness-related behaviors or outcomes has also been supported in patients with rheumatic diseases (RD). The Brief Illness Perception Questionnaire (B-IPQ) was designed to provide a simple and rapid assessment of IP. This questionnaire has been widely used in diverse ages, illness types, countries, and languages.

Objectives

This study aimed to examine the construct of IP as measured by the B-IPQ in patients with RD.

Methods

A cross-sectional study was conducted at a Tunisian rheumatology department on 80 patients with RD. Sociodemographic, disease-related variables were reported. Participants completed a questionnaire on illness beliefs (B-IPQ).

Results

Subjects were aged 22-74 years (mean 51 years), 61.6 % were female. Diagnoses included Rheumatoid arthritis (RA) (63%), axial spondylarthritis (AS) (37%). The mean disease duration was 11 years and 7 years for RA and AS respectively. The proportion of physical comorbidities was higher in RA patients (36%) versus AS patients (11%). Disease activity was low in 28.8% of patients. All patients were on medications for their rheumatic disease, and 34,6 % were on biological therapy.

In both diseases, the participants perceived their rheumatic illness as a chronic condition (9.4) that could be controlled by treatment (6.6) but not strongly influenced by personal actions (4.3). Overall, Rheumatic disease was seen as having an important impact on their life (7.9) without significant difference between patients with low or high activity disease (p=0.23). The majority believe that they have a moderate understanding of their illness (6.6). The frequency of symptoms was highly evaluated in RA patients than AS patients (7.3 vs 5.6) (p=0.01). In RA patients, 76% were extremely affected emotionally by their disease, however, the majority of AS patients were moderately affected emotionally with a significant difference (p=0.02). In addition, RA patients considered their disease mainly a result of psychological factors (66.8%). On the other hand, AS patients (73%) attributed their illness to various risk factors (especially physical overexertion).

Conclusion

High scores of B-IPQ shown in our studies, encourage the design of psychotherapeutic trials targeting disease-related cognitions in AS and RA in an attempt to improve patients’ reported outcomes and disease outcomes.

Disclosure of Interests

None declared

AB1454 CLINICAL AND BIOLOGICAL FACTORS CORRELATED WITH MAGNETIC RESONANCE IMAGING RESULTS IN TUBERCULOUS SPONDYLODISCITIS

Background

Tuberculosis is still endemic in Tunisia. Although pulmonary localization is the most common, other localizations, including osteo-articular involvement, are increasingly diagnosed. Tuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). Magnetic resonance imaging (MRI) is the most sensitive (95-100%) and the most early abnormal exam.

Objectives

Our aim was to study the correlation of contributing factors, epidemiological, clinical, biological, radiological and therapeutic data with positive signs of spinal MRI.

Methods

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. Epidemiological, clinical, biological, radiological, and therapeutic data were analyzed. Each patient had spinal MRI. Positive signs have been individualized, represented by intervertebral disc involvement, vertebral body involvement and visualization of a paravertebral abscess.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The positive diagnosis of tuberculous spondylodiscitis was facilitated by the spinal MRI. Positive signs were sought in our patients which are represented by: the achievement of the intervertebral disc with diffuse T2 hypersignal (56.5%) and diffuse or circumferential increase of the signal in sp T1 Gadolinium (50.9%), Involvement of the vertebral body with moderate and extensive condensation (60.4%), macrogeodes (60.4%) and heterogeneous increase in spT1 Gado signal (52.8%) and visualization of a paravertebral abscess (51.9%). Correlations made between the favouring factors, epidemiological, clinical, biological, radiological and therapeutic data and the positive signs of spinal MRI, objecting that six parameters had a statistically significant correlation with MRI signs strongly suggestive of the diagnosis of SPDT: Hospitalization duration was correlated with the diffuse T2 disk hypersignal (p= 0.02; r= - 0.38), Hemoglobin rate was correlated with the diffuse or circumferential increase in T1 disk sp signal (p= 0.03; r= - 0.34), the initial rate of lymphocytes was correlated with the paravertebral abscess (p= 0.04; r= - 0.47). The extra-vertebral tuberculosis location was correlated with the diffuse T2 disc hypersignal (p= 0.03; r= -0.96), the moderate condensation and the extent of vertebral body (p < 0.001) and vertebral body macrogeodes (p < 0.001). The neurological clinical signs were correlated with the heterogeneous increase in vertebral body T1 sp signal (p= 0.04; r= -0.33) and the surgical treatment (p < 0.001).

Conclusion

Tuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Spinal MRI is the first-line exam in case of suspicion. Clinical, biological and therapeutic parameters were correlated with the MRI images highly suggestive of positive diagnosis.

Disclosure of Interests

None declared

AB1576-PARE RHEUMATOID ARTHRITIS ASSESSMENT KNOWLEDGE QUESTIONNAIRE (RAKE) IN TUNISIAN POPULATION

Background

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that has a very high burden on patients their families, and society. So that it is important that RA patients receive education about their disease. The knowledge of RA patients in Tunisia regarding their disease has not yet been assessed.

Objectives

The purpose of the study was to evaluate disease-specific knowledge of patients with rheumatoid arthritis by using the RAKE questionnaire (Rheumatoid Arthritis assessment Knowledge Questionnaire).

Methods

This was a cross-sectional study. Adults with RA fulfilling the ACR/EULAR criteria were asked to participate by responding to RAKE Questionnaire in the short version.

Results

A total of 28 RA patients were included: 23 females (82%) 5 mens (18%). The mean age was 58.5 years with a range of 31 to 79 years. The mean disease duration was 9.8 years. The disease duration was 0-5 years in 5 (17.8%) patients, and more than 5 years in 23 (82.2%) cases. Twenty patients were housewives. Thirteen (46.4%) patients were from rural areas. Almost all of the patients didn’t follow education programs for their RA. Twenty-two (78.5%) patients obtained information’s RA from their rheumatologist. Six patients (21.5%) from other sources (neighbors, nurses, other RA patients, social media). The mean time for answering the questionnaire was11.6 min (9-15 min).The RAKE total score was11.8/32 [3-22]. For the initial part of the questionnaire, related to the general aspects of RA, the mean score was 4.3/8 [0-6]. The mean score of the second component of the questionnaire concerning medications and non-pharmacological management, was respectively 4.3/11 [0-7] and 2.3/5 [0-4]. For comorbidities, the mean score was 0.6/1. The fourth component includes auto-management, pain, and tiredness the mean score was1.4/3 [0-3]. The last component covers psychosocial, occupational, and health system coping skills. Its mean score was 2.1/4. The mean score of unknown answers was 6.7/32 [4-16].

Conclusion

In our study, the knowledge patients of RA was low in all domains of RAKE questionnaire at various degrees. These findings can be used for improving current patient education programs and better disease control.

Disclosure of Interests

None declared

AB1079 INFECTIOUS SACROILIITIS ACCORDING TO THE GERM: ABOUT 42 CASES

Background

Infectious sacroiliitis is a rare rheumatological emergency. Its semiology is misleading due to the deep location of the joint. The responsible germs play an important role in its semiology.

Objectives

The objective of this work was to identify the germs responsible for infectious sacroiliitis and their effect in the sacroiliac joint.

Methods

We conducted a retrospective study, including 42 patients hospitalized for infectious sacroiliitis over a period from 2000 to 2020. Demographic, clinical, biological and radiographic data were collected.

Results

A total of 42 Patients were enrolled (11 men and 31 women). The mean age was 36,7 years [29-76]. Low back pain with difficulty walking were the most common manifestations (88%). The inflammatory syndrome was present in 70% of cases.

Standard radiographs showed loss of cortical margins with erosion of the sacroiliac joints in 34 cases and were normal for the rest of the patients.

MRI and CT scan were performed to confirm the diagnosis in 28 and 13 cases respectively.

A puncture guided by ultrasound or scanner was performed in 24 patients. In the cases of absence of germ on the conventional examinations, we performed a sacroiliac biopsy and histological examinations.

Pyogenic germs were responsible for 46% of infectious sacroiliitis: Staphylococcus Aureus in 11 cases (28%), Escherichia Coli in 7 cases (16 %) and Streptococcus in one case (2%). Tuberculosis and Brucella were responsible for 38% and 7% of the cases respectively. A subcutaneous abscess was associated with tuberculous sacroiliitis in 4 patients.

The outcome was favorable in 36 cases (86%) under appropriate antibiotic therapy. Eight patients presented a treatment-related complication. Progression to multifocal bone tuberculosis and chronic brucellosis was noted in one case each. In 3 cases, rapid ankylosis was found on radiological control.

Unfortunately, one patient died from septic shock.

Conclusion

Common germs are most responsible for infectious sacroiliitis and seem to have the best prognosis. Tuberculosis is responsible for various complications and its treatment has a high iatrogenic risk. Chronicity is the most feared development, mainly during Brucella sacroiliitis and would be related to a loss of antibiotic efficacy.

Disclosure of Interests

None declared

AB1364 IMAGING DIAGNOSIS OF BRUCELLAR SPONDYLODISCITIS

Background

Spondylodiscitis is the most common location in the musculoskeletal involvement of brucellosis.

Objectives

The aim of this study is to describe magnetic resonance imaging (MRI) and computed tomography scan (CT) results in patients with brucellar spondylodiscitis.

Methods

A retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis and having benefited from a CT scan and/or an MRI of the spine.

Results

Eighteen patients were included. In all cases spinal pain was reported, associated with radiculalgia in 8 patients. Low back pain was the most common symptom, present in 17 cases, associated with back pain in 3 cases including one case with neck pain. Isolated neck pain was noted in one patient.

Neurologic examination was normal in all cases.

Standard Radiographs showed disc narrowing in 14 cases, erosions in 9 cases and hazy changes of the vertebral end plate in 2 cases.

A CT scan was performed in 11 cases. It showed disc narrowing in 6 cases, erosions in 3 cases and endplate destructions in 5 cases. Abscesses were found in 4 patients.

Complementary MRI was performed in three of the patients who had already undergone CT. The MRI results were consistent with those of the CT scan, except for one patient in whom it revealed spondylodiscitis while the CT scan revealed degenerative lesions.

Eleven patients underwent MRI in total. It showed unifocal and multifocal spondylodiscitis in 5 and 6 cases respectively, epiduritis in 6 cases, spinal cord compression in 2 cases and abscesses in 4 cases.

Conclusion

Our study showed that CT and spinal MRI allow early diagnosis of spondylodiscitis. They help to identify asymptomatic lesions and neurological complications.

Disclosure of Interests

None declared

AB1224 NON-CONTIGUOUS MULTIFOCAL SPONDYLODISCITIS: A RETROSPECTIVE OBSERVATIONAL STUDY

Background

Non-contiguous multifocal spondylodiscitis (mSpD) is a serious infection. Although literature data highlight the opportunity to miss a non-contiguous spondylodiscitis (SpD), recommendations for which cases an MRI of the entire spine should be performed are missing.

Objectives

The aim of the study was to assess the clinical features of mSpD to reveal risk factors underlining the need for screening a multifocal spine involvement

Methods

We retrospectively evaluated the data of patients with confirmed non-contiguous multifocal spondylodiscitis

Results

Twelve patients suffered from mSpD were included (6 males, 6 females). The mean age was 60 years. Four patients had underlying chronic comorbidity, Diabetes (n=3), hepatitis C virus (n=1). Most patients had spine pain (11 patients,), radiculalgia in one patient, neurologic deficit (3 patients), worsening health status (7 patients). Symptoms onset was acute (n=1) or sub-acute (n=3) or long term (n=8) before admission. The mean duration between the diagnosis and the onset on symptoms was 9,6 months. Tubercular spondylodiscitis was the most detected etiology (n=8), confirmed by histological analysis (n=3) then brucellar, confirmed by serlology lab test, and pyogenic SpD in two patients each. Non-contiguous multi-level involvement in the lumbar, thoracic, and cervical spine was detected in one patient for each region. Seven patients suffered from a lumbar and thoracic spine involvement and SpD occurs in the three regions in two patients. Elevated inflammatory biomarkers (CRP and ESR) were present in all cases. Entire spine MRI was performed for almost all patients, confirmed the diagnosis, showed para-vertebral abscess (n=3), epidural inflammation (n=6), and spinal cord compression (n=3). The majority of cases showed a favorable evolution with appropriate antibiotic therapy. One patient maintain a neurologic deficit, and one suffered from a severe degree of pain. Surgical approach was not indicated.

Conclusion

In our study, mSpD did not appear to be associated with a particular pattern. Tuberculosis was the dominant etiology. That suggests, an MRI of the entire spinal column should be performed for each patient with suspicious SpD, especially when tuberculosis is evocated

Disclosure of Interests

None declared

AB0342 EVALUATION OF SELF-CARE SAFETY SKILLS AND THERAPEUTIC KNOWLEDGE OF RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC DRUGS

Background

The management of rheumatoid arthritis (RA) was revolutionized by the use of biologic therapies (bDMARD). Nevertheless, bDMARDs may carry some specific risks such as infection. However, data about self-care safety skills are poor [1]. An assessment of the level of information and education is therefore essential for patients followed for RA.

Objectives

The purpose of our study was to assess knowledge and safety skills of RA patients under bDMARDs.

Methods

We conducted a descriptive, bi-centric, and cross-sectional study, including RA patients receiving intravenous (IV) or subcutaneous (SC) bDMARD for at least 3 months. Sociodemographic, clinical, and paraclinical data were collected. Knowledges and self-care safety skills were assessed by a pre-specified questionnaire.

The questionnaire was divided into three domains:

- Five questions about general theoretical knowledge domain: assessing patient’s knowledge of the name of the current bDMARD, duration and rate of intake, and a question on annual cost estimation.

- Three questions about the current bDMARD management: assessing cold chain compliance and management of the biologic in SC emphasizing adherence to the steps to be taken prior to giving the injection.

- Tow questions about knowledge regarding safety skills in special situations: infection, cough, contraception, surgery, vaccination, and regarding the need to inform others about the use of bDMARD.

Based on the data analysis, patients were divided into 3 groups according to their knowledge level:

- Group A (low knowledge level: percentage of correct answers <40%)

- Group B (moderate knowledge level: percentage of correct answers >40% and <60%)

- Group C (high level of knowledge: percentage of correct answers > 60%).

Results

Seventy-five patients with RA were collected. Their mean age was 56.92 ± 9.06 years [34-80]. The mean duration of bDMARD was 37.17 ± 39.44 months [4-248] with a mean rank of 1.41 ± 0.9 [1-5]. The SC route was used in 41 patients (54.7%) followed by the IV route in 34 patients (45.3%)

The most prescribed molecules were Infliximab, Certolizumab and Tocilizumab (22.7% respectively). The average order of the current biologics was 1.41 ± 0.9 [1-5] in combination with a csDMARD in 48 patients (64%).

Safety skills were low in 24 patients (32%), moderate in 36 patients (48%), and high in 15 patients (20%).

The mean percentage of correct answers for each domain was respectively: 56.53 ± 18.4% [20-100] for general theoretical knowledge domain, 68.44 ± 26.21% [0-100] for the management of current biologic treatment domain, and 40.8 ± 16.87% [6.67-80] for knowledge regarding safety skills in special situations.

Safety skills levels were significantly related to occupational status (p=0.001), DAS28 CRP (p=0.04), joint deformities (p=0.01) and radiographic erosions (p=0.006), number of previous bDMARDs (p=0.009), and the rank of the current bDMARD (p=0.009).

Conclusion

The major finding of our study was the insufficient level of knowledge and safety skills of RA patients under bDMARDs. We highlight the importance of involving patients in the decision-making process and emphasize the role of the therapeutic patient education programs.

References

[1]Orefice D, Beauvais C, Gossec L, Flipon E, Fautrel B, Marguerie L, et al. Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease. Joint Bone Spine. 2014;81(6):502‑7

Disclosure of Interests

None declared

AB0338 BELIEFS ABOUT BIOLOGIC DRUGS AMONG RHEUMATOID ARTHRITIS PATIENTS

Background

Rheumatoid arthritis (RA) is a chronic inflammatory disease requiring a long-term follow-up and the use of chronic therapies. The management of this disease is based on a multidisciplinary care, requiring total patient involvement. Previous personal experiences, the experiences of others and the daily impact of the disease on patients fuel their perceptions of the treatment especially biologic one. There are few studies evaluating patient’s beliefs about these drugs [1,2].

Objectives

The aim of our study was to investigate beliefs about biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) among patients with RA and to identify factors related to specific beliefs.

Methods

We conducted a bi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARDs associated or no to conventional synthetic (sc) DMARDs. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ).

Results

There were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. The mean age was 56.92 ± 9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed. Sixty-four patients (85.3%) were married. The mean disease duration was 14.85 ± 8.5 years [2-39]. Thirty-three patients had joint deformities. Twenty-seven patients had extra-articular manifestations and thirty-six patients had comorbidities. The mean disease activity scale (DAS28 CRP) was 3.94 ± 1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low disease activity, and 19% were in remission. The mean functional impairment scale (HAQ) was 0.64 ± 0.48 [0-2.2]. Twelve patients had moderate to severe disability and only one patient had severe to very severe disability. The mean duration of the current bDMARD was 37.17 ± 39.44 months and the mean rank of the current biotherapy was 1.41 ± 0.9 [1-5].

Regarding the BMQ, the mean score for General Overuse was 14 ± 2.37 [6-20]. The mean score for General Harm was 10.82 ± 4.42 [4-20].

The mean score of patients’ specific beliefs regarding the necessity of taking the current bDMARD (Specific Necessity) was 20.62 ± 5.71 [5-25]. The mean Specific Concerns score regarding the current bDMARD was 10.33 ± 3.29 [5-25]. Necessity about taking bDMARD was reported by 77.3% patients in the present and 61.3 % patients consider maintaining the bDMARD in the future.

There were 4% of patients who reported concerns about taking bDMARD. Twenty four percent of patients reported concerns about long term effects, and 16% about becoming too dependent on bDMARD.

Beliefs about the necessity to stop occasionally chronic therapies were reported by 13.3% of patients.

Specific necessity was correlated to the current bDMARD duration (p=0.01), Patient Global Evaluation (p=0.03), VAS pain scale (p<10-3), the number of nocturnal awakenings (p=0.01), tender joint count (p<10-3), swollen joint count ((p<10-3), HAQ (p=0.005), DAS28 (CRP) (p<10-3). Specific concerns were correlated to the actual bDMARD rank (p=0.01).

Conclusion

Our study showed stronger beliefs in the necessity of taking biologic drugs if indicated. Disease activity parameters and functional impairment influence those beliefs. Further studies are required to evaluate the impact of beliefs on biologic drug adherence.

References

[1]Cea-Calvo L, Raya E, Marras C, Salman-Monte TC, Ortiz A, Salvador G, et al. The beliefs of rheumatoid arthritis patients in their subcutaneous biological drug: strengths and areas of concern. Rheumatol Int. 2018;38(9):1735‑40.

[2]Heuckelum M van, Linn AJ, Vandeberg L, Hebing RCF, Dijk L van, Vervloet M, et al. Implicit and explicit attitudes towards disease-modifying antirheumatic drugs as possible target for improving medication adherence. Plos One. 2019;14(8):e0221290.

Disclosure of Interests

None declared

AB0365 BELIEFS AND ADHERENCE IN RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC DRUGS

Background

Patients with chronic rheumatic diseases play an important role in their disease management. Adherence to their long-term therapies may depend on their therapeutic beliefs [1].

Objectives

The purpose of our study was to investigate the relationship between beliefs and adherence among patients with rheumatoid arthritis (RA) on biologic therapies (bDMARDs).

Methods

We conducted a multi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARD. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ) and about their therapeutic adherence.

Results

There were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. Their mean age was 56.92±9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed (15%). The mean disease activity scale (DAS28 CRP) was 3.94±1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low activity, and 19% were in remission. The mean duration of the current bDMARD was 37.17±39.44 months [4-248]. The mean Specific Necessity score was 21.02±5.38 [5-25] for adherent patients and 13.5±7.54 [5-19] for non-adherent patients.

The mean Specific Concerns score was 10.07±3.13 [5-15] for adherent patients and 15±2.82 [5-20] for non-adherent patients.

A statistically significant association was found between Specific Concerns beliefs and adherence behavior (p=0.009) and between Specific Concerns beliefs and adherence behavior (p=0.003). No statistically significant association was noted between general beliefs (General Harm and General Overuse) and adherence behavior (p=0.4 and p=0.6 respectively).

Conclusion

Beliefs about therapeutic were identified as a key factor of adherence among rheumatic disease patients. Practitioners should detect negative patient beliefs and perceptions earlier to prevent nonadherence.

References

[1]Suh YS, Cheon YH, Kim HO, Kim RB, Park KS, Kim SH, Lee SG, Park EK, Hur J, Lee SI. Medication nonadherence in Korean patients with rheumatoid arthritis: the importance of belief about medication and illness perception. Korean J Intern Med. 2018 Jan;33(1):203-210.

Disclosure of Interests

None declared

AB1077 INFECTIOUS SPONDYLODISCITIS IN ELDERLY: IS IT MORE SEVERE DISEASE?

Background

Spondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms. In older patients, there are often difficulties in diagnosis and management.

Objectives

This retrospective study aimed to assess the characteristics of infectious spondylodiscitis in patients over 65 years of age.

Methods

This retrospective, monocentric study included patients aged over 65 years olds hospitalized in our department of rheumatology for spondylodiscitis.

Results

A total of 20 consecutive patients (10 males, 10 females) aged over 65 years were analyzed. The mean age of patients was 74 years (65-85). The most common comorbidities included diabetes (20%), chronic renal failure (5%). A history of nodal tuberculosis (10%), a tuberculosis contagion (30%), and raw milk ingestion (15%) were reported. The average delay for diagnosis was 10 months. The most common symptom was axial back pain (100% patients), then worsening health status (34%), and one patient had a significant neurological deficit. C-reactive protein was elevated in 95%. The most common involvement was in the lumbar vertebrae (13 patients, 65%), followed by thoracic and cervical level disease respectively in 3 patients (15%) and 2 patients (10%). Two patients (10%) had a multifocal spondylodiscitis. All patients underwent an MRI exam that confirmed the diagnosis. A percutaneous spine biopsy was performed in 80%. Pyogenic spondylodiscitis was the most common etiology (50%), followed by tuberculosis (35%) and brucellosis (15%). Antibiotic therapy was indicated to all patients with spinal immobilization in 65% of cases. Two patients underwent percutaneous drainage of paravertebral abscesses. The outcome was favorable in almost all cases until 12 months of following-up after completion of treatment. One patient died of septic shock and multi-visceral failure.

Conclusion

Elderly patients with infectious spondylodiscitis have fewer clinical symptoms leading to a delayed presentation. Increasing morbidity and mortality make rigorous monitoring necessary.

Disclosure of Interests

None declared

AB1070 INFECTIOUS SACROILIITIS: A RARE ENTITY IN RHEUMATOLOGY!

Background

Infectious sacroiliitis (ISI) is a rare disease, with misleading clinical symptoms that often delay the diagnosis.

Objectives

The aim of this study was to describe the clinical, microbiological, therapeutic and radiological characteristics of ISI.

Methods

This descriptive, retrospective study included all ISI patients that were hospitalized in our rheumatology department over an 11-year period [2010 - 2021].

Results

Overall, 25 cases of ISI were identified, comprising 15 men (60%) and 10 women (40%), with a mean age of 48.7±10.5 years [21-67]. ISI was caused by pyogenic microorganisms in 12 cases (70.5%), mycobacterium tuberculosis in 7 cases (41.2%), and brucella spp in 6 cases (35.3%). The mean symptoms duration in pyogenic, brucellar and tuberculous ISI was 42 days, 67 days, and 255 days, respectively. The onset was brutal in 88% of pyogenic ISI, while it was progressive in 68% of brucellar ISI and in all cases of tuberculous ISI. Lumbogluteal pain was the most common symptom (80%). The involvement of the sacroiliac joint was always unilateral, and inflammatory in 92% of cases. The other most common symptoms included: fever (80%), impotence (68%), and lumbago (52%). An infectious source was found in 17 patients: 41.2% pulmonary (tuberculosis, n=7), 29.4% urinary, 17.6% gynecological (postpartum, n=3), and 11.7% septicemic (n=2). Fifteen patients (60%) had a biological inflammatory syndrome. Leukocytosis was found in 11 cases (64.7%). Pelvic x-ray showed a narrowing of the sacroiliac joints in 52% of cases. CT of the sacroiliac joints showed erosions in 60% of cases. Sacroiliac MRI showed erosions (45%), joint effusion (32%), and psoas abscess (14%). A second infectious site was found in 20% of cases: psoas abscess (n=2), and a collection of the soft tissues facing the joint (n=1). A pathogenic agent was isolated by means of blood culture (48%; staphylococcus aureus 56%, streptococcus 28%, and staphylococcus with negative coagulase 16%), articular biopsy (40%), cytobacteriological examination of urine (20%), Wright serology (20%), and Tuberculin skin test (6.2%). All patients received germ-adapted antibiotics. No patients have had surgical treatment. Evolution was favorable in most cases (n=11). Four patients complained of residual pain in the sacroiliac region. None of the patients relapsed.

Conclusion

Although IS is rare, it remains an emergency diagnosis. A rigorous physical examination is essential in order to detect this infection early. Antibiotics often lead to clinical improvement, making thus the need for surgery exceptional.

Disclosure of Interests

None declared

AB1482 PROGNOSTIC FACTORS FOR TUBERCULOUS SPONDYLODISCITIS

Background

Tuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). It accounts for 46% to 64% of infectious spondylodiscitis and is the most common form of vertebral tuberculosis. Pott’s disease still poses a public health problem in Tunisia due to the endemicity of tuberculosis and the increase in extra-pulmonary forms.

Objectives

Our aim was to study factors impacting SPDT outcome.

Methods

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. The diagnosis was based either on a range of highly evocative clinical, biological and radiological arguments or on the disco-vertebral biopsy puncture. The study included correlations of the promoting factors of SPDT (tuberculosis infection, history of tuberculosis, diabetes, corticosteroids and trauma), epidemiological, clinical, biological, radiological and therapeutic data with good clinical outcome in the fourth week of the anti-tuberculosis drugs treatment.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were aged under 65 years versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The diagnosis of SPDT was based either on a range of highly evocative clinical, biological and radiological arguments (71.2%) or on the disco-vertebral biopsy puncture (28.8%). Among the clinical arguments suggestive of tuberculous SPD were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contibutive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. The treatment was based on anti-tuberculosis drugs for at least nine months. Only four factors had an unfavourable predictive value (p ≤ 0.05): Normochromic normocytic anemia observed in 53.8% of our patients (p = 0.018; Odds Ratio = 6.66), initial lymphocytosis (p = 0.048), fever in 36.5% of our patients (p = 0.01; Odds Ratio = 9.6) and standard X-ray vertebral compression in 67.3% of our cases (p = 0.001; Odds Ratio = 13).

Conclusion

Tuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Poor prognosis factors have been identified to provide insight into disease progression.

Disclosure of Interests

None declared

AB1459 IMPACT OF SOCIOECONOMIC FACTORS ON THE DISEASE ACTIVITY: DATA FROM THE TUNISIAN BINAR REGISTRY

Background

Despite the considerable therapeutic progress of inflammatory rheumatic diseases, access to treatment still challenging in developing countries because of scarce health resources and low socioeconomic status.

Objectives

To determine the influence of socioeconomic factors on disease activity in a national registry cohort, the Biological National Registry (BINAR) in Tunisia.

Methods

We enrolled patients with inflammatory rheumatic diseases under the first received biological drug and included in the BINAR registry from 2016 to 2020. Data on the inflammatory rheumatic disease (rheumatoid arthritis (RA) and spondyloarthritis (SA)), disease activity of RA and SA (DAS28-CRP and ASDAS-CRP respectively) at baseline, gender, active smoking, marital and work status and educational attainment were collected. Two groups were identified: Groupe 1 (G1) for patients with remission or low disease activity and groupe 2 (G2) for moderate or high disease activity according to DAS28-CRP and ASDAS-CRP.

Results

The study included 298 patients with a mean age of 49.2 years [18-79]. The mean disease duration was 6.7 ± 3.5 years [1-14] in patients with RA and 6.5 ±3.6 years [1-12] in patients with SA. G1 was made of 13 patients and G2 of 285 patients. The were no significant difference between G1 and G2 for (49.5 ± 11.9 versus 49.5±14.2, p=0.93) gender (% of females, 46.2% versus 37.1%, p=0.51) and marital status (% of single patients, 30.8 % versus 33.7%,p=0.82). Patients of G1 had better employability than G2 (61.5% % versus 45.6%) but this difference was not significant (p=0.26). Smoker patients had better disease outcomes comparing to nonsmokers but this difference was not significant (23.1 % versus 13.7%, p=0.34). Illiterate patients had more active diseases, comparing to literate, but this difference was not significant (30.8% versus 40.4%, p=0.49).

Conclusion

Our results did not confirm any difference in disease activity according to the collected socioeconomic factors. Data on the personal income, health insurance type and geographic distribution of our population should be further studied.

Disclosure of Interests

None declared

AB0193 BIOLOGIC DRUGS RETENTION IN ELDERLY RHEUMATOID ARTHRITIS: WHAT FEATURES?

Background

The elderly RA population is expanding. The management of RA in elderly patients can be challenging because of comorbidities, the frequency of adverse events. The efficacy and safety of RA therapies; particularly biologics drugs (bDMARDs); are poorly studied in this age group.

Objectives

To investigate the therapeutic response to bDMARDs in elderly rheumatoid arthritis.

Methods

We conducted a cross-sectional and observational study. Files of patients with RA on biologics drugs (archived from the files of patients on the National Health Insurance Fund of Tunis) were studied. The characteristics of RA, and the current treatments were studied. We have divided our population into two age groups. G1 aging under 65 years and G2 aged 65 or over. The therapeutic maintenance rate as well as the biologics survival was analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.

Results

Three hundred and seventy-four files were selected. Their average age was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41]. Subjects over the age of 65 represented 22.2% of the workforce, i.e. 83 patients. The first biotherapy prescribed was etanercept in 54% of cases, adalimumab in 14% of cases, certolizumab pegol 13%, infliximab 6%, tocilizumab 6% and rituximab in 7% of cases. The 4-year survival was 54.41% and 60.94% for subjects under 65 and 65 or older, respectively. Treatment maintenance for RA in the elderly (≥ 65 years old) was 42.21 months, [53.51–46.92]. In our study, age did not influence the survival of biologics with a Hazard Ratio (HR) = 0.997 (p=0.667).

Conclusion

RA therapy is generally effective and safe in elderly patients. We did not find any influence of age on survival and therapeutic maintenance of biological treatments. Further studies with a broader spectrum are needed to better understand this notion

Disclosure of Interests

None declared

POS1516-HPR CHRONIC INFLAMMATORY RHEUMATISMS: DOES PERIODIC FASTING REDUCE THE DISEASE ACTIVITY?

Background

Many experimental studies have emphasized the role of periodic fasting in the adaptive responses that reduce inflammation.

Objectives

Our purpose was to assess the impact of periodic fasting on the activity of chronic inflammatory rheumatisms (CIR).

Methods

We conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). CIR activity was assessed during the period of Ramadan (periodic fasting) and three months following Ramadan using clinical parameters including the Patient’s Global Assessment of disease activity (PGA), 10-cm Visual Analog Scale (VAS) pain score, morning stiffness, nocturnal awakenings, and joint count for RA (tender joint count (TJC) and swollen joint count (SJC)); biological parameters including C-reactive protein (CRP); disease activity scores including the SDAI, CDAI and DAS28 CRP for RA, BASDAI and ASDASCRP for SpA. An analysis of variance (ANOVA) was used to assess the statistical relationship between fasting and CIR activity.

Results

We enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. RA was erosive in 92% of cases. Rheumatoid factor and anti-citrullinated peptides antibodies were positive respectively in 82% and 84% of cases. Seventy-five percent of RA patients were on corticosteroids with a mean dose of 10.20 mg/day of prednisone equivalent, and 81% of SpA patients were on non-steroidal anti-inflammatory drugs. Eighty-three percent of our patients were treated with conventional synthetic DMARD, and 40% with biological DMARD. The following parameters were lower in the month of Ramadan compared to the period following Ramadan in RA patients: mean PGA 4.3 vs 4.6 (p=0.01); mean morning stiffness 1.1 vs 1.5 (p=0.01); mean SJC 4.7 vs 8.5 (p=0.01); mean DAS28 CRP 3.56 vs 4.25 (p= 0.05); mean CDAI 17.5 vs 20.35 (p= 0.01), and mean SDAI 13.87 vs 18.44 (p=0.01). As for SpA, the following parameters were lower in the month of Ramadan compared to the period following Ramadan: mean morning stiffness 1.3 vs 2.1 (p= 0.01); mean ASDASCRP 2.9 vs 3.3 (p= 0.01), and mean BASDAI 3.6 vs 4.9 (p= 0.05). However, we found no statistically significant correlation between periodic fasting and VAS pain score, nocturnal awakenings, TJC, and CRP.

Conclusion

Our study concluded that periodic fasting was associated to a lower CIR activity. The incorporation of periodic fasting may promote optimal health and reduce the activity of some chronic inflammatory diseases.

Disclosure of Interests

None declared

AB0321 ADHERENCE TO MEDITERRANEAN DIET AND PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN RHEUMATIC DISEASES

Background

Rheumatic diseases (RD) are autoimmune inflammatory arthritis. However involvement to other organs can occur and leads to atherosclerosis and cardiovascular (CV) risk factors. Mediterranean diet (MD) has attracted considerable interest because it seems to offer significant benefits to that end.

Objectives

To evaluate the role of MD in the development of the cardiovascular risk factors in RD.

Methods

We conducted a cross-sectional study including patients with RA (ACR-EULAR 2010 criteria) or with SA (ASAS 2009 criteria), in remission or in low activity disease and with no history of cardio vascular risk factors before the diagnosis of their RD. Sociodemographic and disease related data were collected: Disease Activity Score (DAS28-CRP), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP) and medication. We asked the patients to complete the 14-items MD adherence questionnary. We evaluated the association of adhrence to MD with cardiovascular risk factors: obesity, type-2 diabetes, hyperlipidemia and hypertension. We estimated odds ratios for each cardiovascular risk factors and their 95% confidence intervals. In all analyses, the high adherence category of MD adherence score [10–14) was considered the reference category.

Results

We included 61 patients (40 women and 21 men) with a mean age of 42.2 ± 1.1 years old [20-66]. Among them, 32.7% belong to urban environment and 26.2% were professionally active. The mean disease duration was 83.2 months [9-180]. The mean DAS28-CRP was 1.2 [0.8-1.9] and the mean ASDAS-CRP was 1.8 [1.1-2.01]. Methotrexate was used by 52.4%, either as monotherapy or combination and biological in 47.6 %. Thirty patients had high adherence to MD (H-MD) and thirty-one had medium or low adherence to MD (L-MD). We found that higher adherence to the MD is inversely associated with the prevalence of each of the four cardiovascular risk factors, results are shown in Table 1.

Table 1.

Prevalence of cardiovascular risk factors and odds ratio in high adhrence to Mediterranean diet in rheumatic diseases.

Prevalence %Odds ratio95% confidence intervalsObesity57.40.017[0.03-0.93]Type-2 diabetes50.80.01[0-0.019]Hyperlipidemia50.80.126[0.04-0.3]Hypertension42.60.13[0.43-0.4]

Conclusion

Our results suggest that the healthy effects of the MD observed in epidemiologic studies are exerted partly through plausible mechanisms: low prevalence of obesity, of type2 diabetes, of hyperlipidemia and of hypertension. Interventional studies may eventually provide stronger evidence. In the meantime, an increasing of knowledge supports the Mediterranean diet as a useful tool in managing individuals with RD, who are at high risk ofcardiovascular diseases.

Disclosure of Interests

None declared

AB1078 SPECTRUM OF INFECTIONS DURING RHEUMATOID ARTHRITIS

Background

Immunosuppression during rheumatoid arthritis (RA) induced by the disease but especially immunomodulatory treatments, is responsible for an increased frequency of infections in these patients.

Objectives

The purpose of this study is to assess the incidence of infections during RA and to determine their nature and management.

Methods

A retrospective study over a period of 10 years, including 150 patients with RA. We identified 33 patients who had at least one infectious episode during their follow-up.

Results

There were 19 women and 14 men. The mean age was 51 years old [39-63]. RA was immunopositive and erosive in all cases. The average disease duration was 8 years. A comorbidity was associated with RA in 14 patients (42%): diabetes in 7 cases, hypertension in 3 cases, ethylism in 2 cases and history of pulmonary tuberculosis in 2 cases.

As an extra-articular manifestation, 15% of patients had Sjogren’s syndrome and 18% had pulmonary interstitial fibrosis (3 cases) or pulmonary nodules (3 cases).

The most prescribed DMARDs was Methotrexate, prescribed in monotherapy at the average dose of 17.5 mg/week [10-25mg] in 18 cases. The other patients received Methotrexate associated to Hydroxychloroquine in 4 cases, Sulfasalazine in 3 cases and biotherapy in 8 cases. Corticosteroid therapy at an average dose of 7.5 to 15 mg/day was received in 16 cases (48.5%).

All infections noted in our population were community acquired. Urinary tract infection was the most common infection noted in 15 cases: pyelonephritis in 3 cases and cystitis in 12 cases. Other infection sites were ENT in 4 cases, bronchopulmonary in 6 cases including 2 cases of tuberculous infection and viral hepatitis (B and C) in 4 cases. Osteo-articular infections were noted in 3 cases: one cervical spondylodiscitis and two septic arthritis. Finally, one case of RA treated with rituximab was complicated by staphylococcal sepsis.

Germs causing these infections were identified in 14 cases (42%).

Conclusion

The risk of infections is increased during RA, this is due to lymphocyte and autoimmune abnormalities but also to treatments and comorbidities that predispose to the emergence of infectious agents.

Disclosure of Interests

None declared

AB1578-PARE A PATIENT-REPORTED OUTCOME SCALE: RASQ FOR MEASURING SYMPTOMS OF RHEUMATOID ARTHRITIS

Background

Patient-reported outcome (PRO) instruments are used to assess the patient experience of rheumatoid arthritis (RA) symptoms and impacts and can capture RA treatments effects. Also, there are often discrepancies between patient and physician perspectives.

Objectives

The objective of our study was to proceed with a psychometric evaluation of patients with RA using the Rheumatoid Arthritis Symptom Questionnaire (RASQ).

Methods

Adults with clinically confirmed RA, as defined by the ACR/EULAR criteria, were recruited for this cross-sectional study, and then completed the RASQ. Medical records were reviewed, clinical features, treatments, and outcomes were analyzed.

Results

In total 28subjects (82% females) with RA were included. The meanagewas58.5years (31-79 years). Comorbiditieswerepresentin86 %, diabetes (50%), high blood pressure (32,1%), dyslipidemia (25%), thyroid disease (3,7%), Depression (7.1%).The mean duration since RA diagnosiswas9,8 years. Almost all the patients had at least one of the disease severity criteria, high level of CRP (76%), radiographic erosion (96%), C1-C2 involvement (18%), or hip involvement (14,2%). All of the patients received CsDMARDs and biological therapy. Disease activity evaluated by the DAS28 score was in remission or very low disease activity in 38%, moderate (46%), and high (16%). Functional impact evaluated by the Health Assessment Questionnaire (HAQ)was an average of 1.1 (0.2–3). The RASQ total symptomwas6.6 (2-10). The mean of each item was joint pain (5.4), joint swelling (5.5), joint stiffness (6.1), joint tenderness (4.1), joint warmth (4.3), muscle pain (6), tiredness (5.7). The RASQ total symptom was statistically significantly different (p=0.01) across the DAS28severityrankings but only the first two single items of the RASQ were not statistically significantly different (p=0.9 and p=1,6). A medium positive correlation was found between subjects’ HAQ score and the total symptom score of the RASQ (r=0,38).

Conclusion

The primary goal of treating patients with RA is to maximize the long-term health-related quality of life. In this order, measurement of all of the signs and symptoms of RA that are significant and relevant to patients living with the disease is important to achieve this main objective.

Disclosure of Interests

None declared

POS1515-HPR CONJUGAL RELATIONSHIPS IN MARRIED PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISMS

Background

The consequences of chronic inflammatory rheumatisms (CIR) on the sexuality and the relationships between the subject and his/her partner are still underestimated and insufficiently studied.

Objectives

The aim of this study was to investigate the impact of CIR on conjugal relationships.

Methods

We conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). All the patients included in the study were married. We collected demographic data, and participants were asked to complete a questionnaire on their conjugal relationships.

Results

We enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. The mean duration of marriage was 9.5 ± 2.6 years. The mean age at marriage was 27 ± 6.41 years [19-33]. The mean number of off-springs was 4. Forty-nine percent of patients and 22.3% of the partners had a profession, respectively. Forty one percent of the partners had a chronic disease: diabetes (n=12), hypertension (n=10), dyslipidemia (n=7), CIR (n=7), coronary disease (n=3), and other conditions (n=5). A psychiatric illness was noted in 22.6% of cases: depression (n=9), anxiety (n=6), and bipolar disorder (n=2). Sixty-four percent of patients consider their spouses sympathetic to their illness. Eighty-nine percent of participants have noticed a change in their life as a couple before and after the CIR onset. According to 64% of participants, the CIR had a negative impact on their married lives. The spouses’ emotional reactions to the disease were as follows: indifference (30.6%), denial (29.3%), anger (26.6%), and fear (13.6%). Patients reported being accompanied by their spouses to their medical appointments in 36% of cases, and 40% of them were asked questions by their spouses about their disease and treatment. The CIR has resulted in the termination of the marriage in 2.6% of cases.

Conclusion

Patients suffering from chronic diseases such as CIR are more frequently exposed to difficulties in their conjugal relationships. The disease has thus important consequences on the subject’s quality of life, emotional and interpersonal state. A better compliance with the chronic disease and its treatment may improve the couples’ relationships.

Disclosure of Interests

None declared

AB0950 Detection of asymptomatic entheseal involvement in patients with psoriasis: A case-control ultrasound study

Background

Enthesopathy is one of the major features of psoriatic arthritis (PsA). The clinical screening for enthesopathies and synovitis in patients with psoriasis is nonspecific during the subclinical phase. Ultrasonography (US) has already demonstrated its ability to study entheses and joints in early stages of PsA.

Objectives

To evaluate the prevalence of ultrasonographic subclinical synovitis and enthesopathies in psoriasis patients with no clinical evidence of PsA compared with controls.

Methods

A cross-sectional study conducted on 40 patients with psoriasis and 40 healthy sex- and age- matched controls. The Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada (SPARCC) were used to evaluate entheseal involvement. US examination of 18 joints (wrists, metacarpophalangeal, and proximal interphalangeal joints) was performed along with 22 entheseal sites (deep flexor of the fingers, lateral epincondyle, triceps, quadriceps, patellar and calcaneal tendons and plantar fascia). Inflammatory-score (thickening, hypoechogenocity, bursitis and Doppler signal) and damage-score (calcifications, enthesophytes and erosions) were calculated (0= absent, 1=present for each abnormality). A total-score was obtained by adding these two scores.

Results

The mean age of psoriatic patients 51,90±15,90 [19 -76] and the sex ratio of males to females was 3:2. US synovitis were more frequent in psoriatic patients 7/1040 (0,68%) than in controls 3/1040 (0,29%) but this was not significant (p= 0,420). Patients with psoriasis had more US enthesopathies 37 (92,5%) comparing to controls 16 (40%) (p < 0,001). The total number of enthesopathies was higher in the psoriatic group 184/880 (20,90%) comparing to controls 42/880 (4,78%) (p < 0,001). Entheses with more US abnormalities in the psoriasis group comparing to controls were deep flexor tendons of the fingers entheses (p<0,001), distal patellar tendon entheses (p<0,001) and calcaneal tendon entheses (p<0,001). LEI and SPARCC scores were positively correlated to higher number of US enthesopathies (p=0,046, p=0,006). SPARCC was positively correlated to inflammatory-score and damage-score (p=0,009, p=0,024). The mean C-reactive protein level was higher in psoriatic arthritis 5,77±10,10 mg/L than in controls 2,15±3,26mg/L (p=0,037).

Conclusion

Our results confirm that US enthesopathies and synovitis are more frequent in patients with psoriasis comparing to healthy population. The US screening for subclinical enthesopathies should be the object of longitudinal investigations to define its value in predicting the clinical onset of PsA.

Disclosure of Interests

None declared

AB1225 TUBERCULOUS SPONDYLODISCITIS: DIAGNOSTIC DELAY AND OUTCOMES

Background

Tuberculous spondylodiscitis (SPDT) is a serious clinical condition that must be treated promptly. Despite the actual availability of more effective diagnostic tools, early diagnosis of SPDT remains difficult and a high index of suspicion is needed due to the chronic nature of the disease and its insidious and variable clinical presentation.

Objectives

Our aim was to study the correlation between the diagnostic delay of SPDT and its outcomes.

Methods

We conduct a monocentric retrospective and descriptive study in a rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2001-2021) who have been diagnosed with SPDT. An early diagnosis is defined by a diagnosis within the first six months versus a late diagnosis that is retained after 6 months of symptoms.

Results

Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21±17.79 years [19-91]. Late diagnosis was more common: 41 patients (78.8%) versus 11 patients (21.2%) diagnosed early. Complications were more frequent (61%) in patients diagnosed late, but with no statistically significant difference (p=0.1). Disease-related complications, such as spinal compression, spinal deformation and recurrence of the disease, was statistically higher (45.5%) in early diagnosed patients (p < 0.001). Drug complications, such as disruption of liver balance, hyperuricemia and major intolerance to anti-tuberculosis, were more frequent (36.6%) in patients diagnosed late (p = 0).

Conclusion

Despite highly sensitive imaging techniques, the diagnosis of tuberculous spondylodiscitis is often late, which may lead to severe deformity and early or late neurological complications.

Disclosure of Interests

None declared

AB1572-PARE VIEWPOINTS OF YOUNG TUNISIAN WOMEN WITH RHEUMATOID ARTHRITIS REGARDING THE IMPACT OF THE DISEASE ON FERTILITY: ARE THEY AWARE ENOUGH?

Background

Rheumatoid Arthritis (RA) is one of the most common chronic inflammatory disease in women in reproductive age. It seems difficult to acheive parenthood in RA, therefore, reproductive health in these patients is an important issue. Many factors may interfere with procreation such as high disease activity and medication. Female perception and behavior towards fertility are not often assessed.

Objectives

We aimed to evaluate the fertility perceptions and related behavior among young women with RA.

Methods

We conducted a cross sectional study involving young female patients with RA (2010 ACR-EULAR criteria). Sociodemographic data and the following disease-related parameters were collected: diseases activity score (DAS28CRP) and NSAID (Non steroidal Anti-inflammatory Drugs), prednisone and DMARDs being used. We asked the patients about their knowledge about the risk of infertility due to the disease itself, the activity of RA and medication.

Results

Sixty-two females patients were included. The average age was 26.1 ±2.1 years [20-35]. The majority of patients, 54 women, live in rural enviroment and 8 women live in urban enviroment. Forty-two women (67%) were illiterate, ten women (16%) had primary or secondary school level and ten women (16%) had university school level. Only twenty percent (20%) were employed. There were no smokers included. Sixty-six percent (66%) were married. Forty-one women (66%) aimed to have children: 35 women got pregnant and 6 still didn’t get pregnant. The average of gestity was 1.6 [0-4]. The average of parity was of 1.2 [0-3]. The average of time to pregnancy (TTP) was 12 months ± 2 [6-24]. Pregnancy resulted in a live-born baby in 30 women (73%), 4 women (9%) miscarried and there was one intra-uterine fetal death (2%). Ten pregnant women had had fertility treatment to get pregnant. The mean duration of the RA was 3.1 years ± 1.2 [2-10]. The mean DAS28CRP were 3.1 ± 1.25[2-3.9]. Both rheumatoid factor and anti-citrullinated peptides antibodies were positive in 58 women (93%). RA was erosive in 48 cases (76.1%) and deformed in 2 cases (3%). Half of patient were using NSAID daily and 60% were using prednisone with an average daily dose of 5.1 mg/day [2.5-7.5]. Sixty-one percent (61%) of patients were using Methotrexate with an average weekly dose of 15.1 mg/week [10-22.5], 10% Leflunomide, 10% Sulfasalazine, and 45% biotherapy. About half of patient think that RA may cause fertility problems, infertility in 60% and abortion in 40% and they had this information in 60% from media, 30% from siblings and only 10.1% from their rheumatologist. None of patients think that disease activity may interfere with pregnancy and that they should strive low disease activity before trying to conceive. None of patients think that NSAID or COX2 inhibitor or prednisone may interfere with fertility and about 10 women used NSAID in pregnancy. About 24% think that DMARDs may interfere with procreation especially infertility (100%) with respectively: MTX (70%), Leflunomide (3%), Sulfasalazine (5%), biotherapy (20%). Women who didn’t get pregnant accused their impaired fertility to their DMARDs and eight women stopped their DMARDs in pregnancy for fear that it affected their baby. Only 5 women (8%) saw a rheumatologist in the preconception period.

Conclusion

The relationship between RA and fertility seems to be misunderstood in young women with RA. Clinicians must routinely discuss this issue with these young patients to preserve their fertility by learning them the mechanisms by which RA may affects their fertility: the disease itself and medication. Appropriate information about fertility can help women in productive age reach and carry a healthy pregnancy.

Disclosure of Interests

None declared

AB1080 BRUCELLAR SPONDYLODISCITIS: EPIDEMIOLOGICAL, CLINICAL AND BIOLOGICAL ASPECTS

Background

Brucellosis is a systemic infection characterized by significant clinical polymorphism and non-specific manifestations. The spine is a common location for brucellosis.

Objectives

The aim of this study was to describe the epidemiological, clinical and biological characteristics of brucellar spondylodiscitis.

Methods

A retrospective study over a period of 15 years, including 18 patients diagnosed with brucellar spondylodiscitis on clinical, biological and/or imaging data.

Results

Eighteen cases were collected (13 men and 5 woman). The mean age was 52 years [19-76].

The main symptom was unifocal or diffuse spinal pain associated or not with radiculalgia. Inflammatory pain was reported in 12 cases.

Thirteen patients consumed raw milk, eleven had contact with farm animals or professional exposure.

The average duration of symptoms was 5.7 months [0.5-12], the disease had a progressive onset in 13 patients.

The general signs were frequent: deterioration of general condition (13 cases), fever (12 cases) and night sweats (6 cases). All patients had a biological inflammatory syndrome.

Wright’s serology, performed in 17 patients, was positive in 15 cases. The Rose Bengal test was positive in 13 of the 15 patients tested. Diagnosis by indirect immunofluorescence, performed in 11 patients, was positive in nine cases. However, the blood cultures, carried out in 13 patients and the disco-vertebral biopsy, carried out in 9 patients, did not find the causal agent.

Conclusion

The diagnosis of brucellar spondylodiscitis must be based on epidemiological, clinical arguments and biological examinations. Immunological examinations, however, seem to be more contributory and should be performed in case of diagnostic doubt and negative bacteriological investigation.

Disclosure of Interests

None declared

POS0612 COMORBIDITIES IN RHEUMATOID ARTHRITIS DO NOT INFLUENCE BIOLOGICS DRUG RETENTION: DATA FROM THE NATIONAL HEALTH INSURANCE FUND OF TUNIS

Background

The advent of biologics in the late 1990s radically changed the profile of inflammatory diseases, in particular rheumatoid arthritis (RA). The survival of these innovative therapies is an indicator, in clinical practice, of their long-term efficiency in patients with RA.

Objectives

To study the influence of comorbidities on biologics drugs retention rates.

Methods

We conducted a cross-sectional, observational study. Data were identified from the files of the National Health Insurance Fund of Tunis. It included patients with RA on biologics. Epidemiological characteristics such as age, sex, and comorbidities, were collected. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The therapeutic maintenance rate at 12, 24, 36, and 48 months as well as the biologics survival were analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.

Results

Three hundred and seventy-four files were selected. The average age of our cohort was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41].First biogics prescription was: etanercept 54%, adalimumab 14%, certolizumab pegol 13%, infliximab 6%, tocilizumab 6% and rituximab 7%. First-line survival rates at 12, 24, 36, and 48 months were 85.8; 69.9; 60.6, and 55.9% respectively. Biologics drug survival was, on average, 41.7 months [39.47-43.91]. Comorbidities were assessed by the CCI in 373 patients (99.7%). Ninety patients had an ICC of 0 and 103 patients had an ICC of 1. Only one patient had an ICC of 8. The median value of this score was equal to 1, the mean was 1.64 ± 1.48. Osteoporosis was the most observed comorbidity with 78 patients (20.9%). The study of drug survival according to the ICC did not show any significant difference between the different curves (p=0.809). The Hazard Ratio was 0.999. Similarly, we did not find a discriminating threshold for the Charlson score, allowing it to be decisive for the survival of biologic drugs.

Conclusion

This study did not identify the influence of comorbidities on the biologics survival during RA. Comorbidities can have an impact not only on our therapeutic choice but also on the efficacy and maintenance of biomedicines as well as the quality of life of patients and consequently the prognosis of RA (1). The few studies that have looked at this subject have produced variable results.

References

[1]Estíbaliz Loza, Cristina Lajas, Jose Luis Andreu, Alejandro Balsa, et al. Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis. Rheumatol Int 2015 Mar;35(3):445-58.

Disclosure of Interests

None declared

AB0191 OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS: IMPACT ON BIOLOGIC DRUGS TOLERANCE AND SURVIVAL

Background

Osteoporosis is one of the main comorbidity of RA and leads to an increased risk for fragility fractures, which further impair functional ability, quality of life, and life expectancy. The influence of this condition on the maintenance and survival of biotherapies has rarely been studied.

Objectives

To assess the influence of osteoporosis on efficacy, tolerance, and biologic drugs survival.

Methods

We conducted a cross-sectional and observational study. Files of patients with RA on biologics drugs (archived from the files of patients on the National Health Insurance Fund of Tunis) were studied. Epidemiological characteristics such as age, sex, and comorbidities, were collected. All patients had a bone mineral density measurement. The patients were divided into two groups (a group with G1 osteoporosis and a group without osteoporosis G2). The therapeutic maintenance rate at 12, 24, 36, and 48 months as well as the biologic survival were analyzed using Kaplan-Meier survival curves and compared using the Log-Rank test.

Results

Three hundred and seventy-four files were selected. The average age of our cohort was 55±12.54 years [20-90]. A female predominance was noted with a sex ratio M/F=0.147. The average duration of RA was 11.7±6.76 years [2-41]. Osteoporosis was observed in 78 patients (20.9%). First biogics prescription was: tocilizumab 6% and rituximab 7%, etanercept 54%, adalimumab 14%, certolizumab pegol 13%, infliximab 6%.The maintenance of the first biotherapy was 40.53 [35.64-45.43] in G1 and 41.44 [39.01-43.86] in G2. The biologic survival curve study did not find any significant difference between the two group p= 0.598.

The presence of osteoporosis would increase the risk of stopping biotherapy without being a statistically significant factor (HR = 1.109, p = 0.602)

The therapeutic maintenance of the 1st biotherapy, in the presence of osteoporosis, was on average 40.53 months [35.64-45.43].

Conclusion

Osteoporosis has not hitherto been retained as a determining factor in therapeutic maintenance (1), as was indeed the case in our study. Nevertheless, screening and early management of osteoporosis are necessary since it alone constitutes a risk factor for mortality.

References

[1]Leon L, Rodriguez-Rodriguez L, Rosales Z, Gomez A, Lamas JR, Pato E, et al. Long-term drug survival of biological agents in patients with rheumatoid arthritis in clinical practice. Scand J Rheumatol. 2016;45(6):456-60.

Disclosure of Interests

None declared

AB0490 IMPACT OF SPONDYLOARTHRITIS ON WORK PRODUCTIVITY: A REAL LIFE STUDY

Background:

Work productivity of patients with spondyloarthritis is frequently affected by their disease.

Objectives:

We aim to identify disease-related factors associated with poor work productivity in patients with spondyloarthritis.

Methods:

A cross-sectional study was performed in patients with spondyloarthritis. Data on disease characteristics were collected as well as specific indices: Visual analogue scale (VAS) for fatigue and pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP), Bath Ankylosing Spondylitis Functionnel Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI). EuroQol-5D (EQ5D) was used to assess health-related quality of life. Work productivity was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). Factors associated with presenteeism, absenteeism and work productivity loss were evaluated.

Results:

One hundred patients were enrolled (73 men and 27 women); mean age was 43.68 ± 10.3 years. Fifty nine percent of patients were employed, 26% were off work and 15% were retired of which 8% were in early retirement. Sixty seven percent of patients had ankylosing spondylitis, 17% had rheumatism associated with inflammatory bowel disease and 16% had psoriatic rheumatism. The average disease duration was 12.24 ± 8.73 years. Mean age at onset was 33.2 ± 10 years [18-59]. The average diagnostic delay was 2.41 ± 3 years; it was more than five years in 17% of cases. Sacroiliac pain has been noted in 69 patients, lumbar or cervical stiffness in 78 patients and peripheral joint involvement in 18 cases. Thirty one percent of patients had hip joint involvement and 49% had extra-articular manifestation. Fifty percent had inflammatory biological syndrome, 63% were treated with anti-TNFα and 58% needed symptomatic treatment regularly. The mean fatigue and pain VAS was respectively 5.58 ± 2.5 and 5.56 ± 2.9. The mean BASDAI was 4.4 ± 2.4, the average BASFI was 4.6 ± 2.7 and the average ASDAS-CRP was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. The mean EQ5D score was 0.485 ± 0.378. Among employed patients, mean absenteeism, presenteeism and work productivity loss was 21.8 ± 33.13%, 42 ± 32% and 46.5 ± 35.31%, respectively. These work outcomes were correlated to diagnostic delay ≥ 2 years (p<0.03), peripheral joint involvement (p=0.006), psoriasis (p=0.02), inflammatory biological syndrome (p<0.001), need of symptomatic treatment (p=0.001), fatigue and pain VAS ≥ 4 (p<0.001), BASDAI ≥ 4 (p<0.001), ASDAS-CRP ≥ 2.1 (p<0.001), BASFI ≥ 4 (p<0.001), BASMI ≥ 4 (p=0.002) and low EQ5D score (p<0.001). Work productivity loss was in addition correlated to age at onset < 25 years (p=0.03).

Conclusion:

Active disease, reduced physical function and poorer quality of life are associated with reduced work productivity. Early diagnosis and good disease management especially fatigue and pain can potentially improve work outcomes in patients with spondyloarthritis.

Disclosure of Interests:

None declared.

POS1280 SPINAL LOCATION OF TUBERCULOSIS: WHAT HAS CHANGED OVER THE LAST YEARS?

Background:

Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. It can affect the different parts of the spine.

Objectives:

The aim of this study was to determine the preferred spinal location of TB.

Methods:

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with tuberculous spondylodiscitis (TS).

Results:

Fifty-two patients were included (37F/15M). Their mean age was 55.21 years ± 17.79 [19-91]. TS was more frequently unifocal (75%) than multifocal (25%). Lumbar spine involvement was the most common (57.7%) and more frequent in women (63.3%) but with no statistically significant difference (p = 0.2). Other localizations were described such as: dorso-lumbar (21.2%), dorsal (15.4%), lumbosacral (3.8%) and cervical (1.9%). Lumbar pain was present in 34 patients (65.4%) and 29 patients (55.8%) suffered from segmental lumbar stiffness. Imaging was contributive by showing the vertebral location using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively).

Conclusion:

TS is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. Spinal involvement is often unifocal and mostly diagnosed with lumbar pain or stiffness. Multifocal forms, touching several parts of the spine, however remain rare. Our findings remain consistent with those of the literature.

Disclosure of Interests:

None declared

AB0793 CONTRIBUTION OF INVESTIGATIONS FOR THE QUEST OF PRIMITIVE CANCER IN FRONT OF BONE METASTASIS

Background:

Bone metastases (OM) or secondary cancers bones are bony locations of tumor cells, away from a primary malignant tumor. The Bone metastases are the most common metastases. They can be revealing in 20 to 30% cases or complicate the course of a known cancer. The bone metastases are a pejorative prognostic factor.

Objectives:

The aim of this study was to identify the Contribution of diagnostic methods for the quest of primitive cancer in presence of bone metastasis.

Methods:

We conduct a retrospective study of 35 files of patients who were hospitalized in the rheumatology department. All patients underwent a questionnaire and a clinical examination. Additional radiological assessment, bone biopsies, biopsies of other sites, bone scintigraphy and tumor markers were carried out on a case-by-case basis.

Results:

Thirty-five cases (25 men and 10 women) were analysed. The average age was 61 years [45-85]. Seven patients had a known history of neoplasia. One or more bone biopsies were performed in 8 cases. The vertebrae were the most biopsied bone site (6 cases). The bone biopsies were in favour of carcinoma (3 cases), adenocarcinoma (2 cases), squamous cell carcinoma (1 case) and inconclusive (2 cases). Non bony biopsies (2 pulmonary, 2 prostatic, 1 mammary) concluded to an adenocarcinoma (3 cases) and a carcinoma (2 cases). Bone scintigraphy was carried out in 7 cases and showed in all cases diffuse or localized hyperfixation. The localized value of tumor markers appeared relatively low except for Prostate Specific Antigen (PSA). Other metastatic localisations were identified: hepatic (6 cases) and pulmonary (1 case). The primary cancer identified was pulmonary for 11 patients, prostatic for 7, gynaecological for 4 and digestive for 3. One patient had Otorhinolaryngological cancer and another had bone cancer. Bone biopsy allowed the diagnosis in 6 cases (17%). The primary cancer was discovered by a biopsy of other non-bone sites in 5 cases (14%). Neoplastic antecedents and clinical context were considered sufficient in 16 cases (45%). Primary cancer remained undetermined in 8 cases (22%).

Conclusion:

Bone biopsy, as well as non-bone biopsy, remains an essential tool in the etiological diagnosis of bone metastases. They are very contributive in the same proportions. PSA is a major diagnostic asset in the search for primary cancer.

Disclosure of Interests:

None declared

POS1288 TUBERCULOUS SPONDYLODISCITIS IN ELDERLY: EPIDEMIOLOGY, CLINICAL, FEATURES, TREATMENT AND OUTCOMES

Background:

Tuberculosis is still endemic all over the world. The incidence of tuberculous spondylodiscitis (TS) is steadily increasing. Clinical features and outcomes of this affection are various and depending on various parameters, including age.

Objectives:

Our objective was to explore the differences in presentation and the results of further investigations and the prognosis of TS between young and elderly subjects.

Methods:

We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with TS. We carried out a comparative study concerning the clinical biological, imaging features and outcomes between young subjects and subjects aged over 65 years.

Results:

Fifty-two cases of TS were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). Young subjects was more frequently vaccinated (88.9%) by Bacillus Calmette–Guérin (BCG) (p < 0.001). A delayed diagnosis was noted in both groups (p = 0.24). Lumbar spine involvement was the most common (57.7%). In the two age ranges, the onset of the disease was progressive (p = 0.22), characterized by segmental spine stiffness (p = 0.57) and lumbar pain with general signs (p = 0.27), such as: impaired general condition, fever, night sweats and weight loss. Biological inflammatory syndrome and normochrome normocytic anemia were encountered in both cases (p = 0.08 and p = 0.2, respectively). Standard X-rays and Computed tomography were more performed in young subjects (94.4% and 69.4%, respectively; p < 0.001), unlike magnetic resonance imaging which was more common in elderly subjects but with no statistically significant difference (p = 0.22). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively). Clinical, biological and imaging arguments contributed to positive diagnosis in both groups (p = 0.24). Common medical treatment was anti-tuberculosis: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E) and physical treatment such as immobilization witch was more common in the eldery (56.3%, p = 0.16). The evolution of the disease was characterized by a clear improvement of young subjects during the second week of treatment (p < 0.001). A more frequent clinical improvement in older subjects was during the fourth week but with no statistically significant difference (p = 0.13). The occurrence of immediate complications was more frequent in the elderly (p = 0.23) with a predominance for drug complications (56.3%) such as: hepatic cytolysis (12.5%), hyperuricemia (18.8%) and major intolerance to anti-tuberculosis (18.8%).

Conclusion:

TS is a frequent condition that needs to be treated rapidly. the clinical presentation of TS in the elderly is less noisy which leads to more frequent complications and mortality.

Disclosure of Interests:

None declared

POS0155-HPR DIAPHRAGMATIC BREATHING RELAXATION TECHNIQUE TO DECREASE ANXIETY DURING JOINT INFILTRATION: A RANDOMIZED CONTROLLED TRIAL

Background:

Joint infiltration is the injection of therapeutic substances directly into a joint. It may be a stressful experience for patients as imagined different from other usual injections. Several techniques are used to manage anxiety and pain during such a procedure.

Objectives:

To evaluate the effectiveness of diaphragmatic breathing relaxation on reducing anxiety and pain during joint infiltration.

Methods:

Patients scheduled for a joint infiltration at the rheumatology department’s daycare unit were recruited. All infiltrations were performed using steroids without anesthetic therapy except for the hip. Patients were randomized into two groups (cases=38, controls=34). Cases learned from a trained health agent diaphragmatic breathing relaxation technique to perform it immediately before and during the procedure while controls received the usual procedure. We used the Visual Analogue Scale (VAS) to assess self-estimated both anxiety (VAS-Anx) and pain (VAS-Pain) as evaluated on pre and post-joint infiltration. VAS-Pain was evaluated as expected then as experienced respectively on pre and post-infiltration. We also assessed heart rate and blood pressure on pre and post-procedure.

Results:

Seventy-two participants were included with a mean age of 55.48 ± 12.39 years (39-78), treated for an inflammatory rheumatic or degenerative disease (21, 51 respectively), and receiving joint infiltration for the first time among 37. Sites of infiltrations were: wrist=7, elbow=10, shoulder=17, hip=1, knee=22, epidural=6, plantar heel=9. There were no significant differences in pre-procedural

VAS-Anx, VAS-pain, or physiological parameters between cases and controls. Cases had a significant decrease in VAS-Anx from pre to post-infiltration (Mean post-VAS-Anx=23.33/100, p=0,017) but not significant compared with controls (p=0.297). Patients who have performed the breathing technique had no significant decrease in VAS-Pain from pre- to post-infiltration (p=0.083) and compared with controls (p=0.662). Physiological parameters showed a significant decrease in heart rate of cases from pre to post-infiltration (p<0,0001) and compared with controls (p=0,036), but no significant decrease in systolic or diastolic blood pressure from pre to post-infiltration and compared with controls. There were no correlations between all participants’ VAS-Anx/VAS-Pain and age, gender, infiltration site or history and joint pain causes.

Conclusion:

This study suggests that diaphragmatic breathing relaxation is an effective nonpharmacological intervention that could be used in controlling anxiety and experienced pain during joint infiltration.

Disclosure of Interests:

None declared

AB0139 RHEUMATOID ARTHRITIS AND SLEEP QUALITY

Background:

Consequences of rheumatoid arthritis (RA) are many and varied: physical, psycho-affective and financial.

Objectives:

The objective of our study is to evaluate the impact of RA on sleep quality.

Methods:

We conducted a cross-sectional study including 49 RA patients. An evaluation of sleep quality using the MOS-Sleep Scale was performed.

Results:

The mean age of patients was 54.1 years, with a female predominance (89.8%). The mean duration of RA was 11.43 ± 7.32 years with a mean time to diagnosis of 2.35 years. Rheumatoid factor was positive in 77.6% of cases. A atlanto-axial dislocation was found in 4.1% of cases and coxitis in 8.2% of cases. All patients were on symptomatic treatment, 57.1% of whom were on corticosteroid therapy. 83.67% of patients were on cs-DMARDs and 14.2% were on biologics. At inclusion, sleep was optimal in 63.2% of cases and the mean Sleep Problem Index was 26.19 ± 22.77.

The index of sleep problems was higher in older subjects and in those with long diagnostic delays. The presence of co-morbidities and atlanto-axial dislocation and/or coxitis was associated with impaired sleep quality. Also, VAS pain and EGP were associated with an increase in the sleep problem index. In the multivariate study, EGP, the presence of co-morbidities and atlanto-axial dislocation and/or coxitis were the independent factors affecting sleep quality.

Conclusion:

The impact of RA on the patient’s quality of life and especially the quality of sleep is confirmed by several studies in the literature. A global management of the patient is necessary in order to adapt well to his disease.

Disclosure of Interests:

None declared

AB0244 INFLUENCE OF BIOLOGICAL DRUGS ON HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The level of the Health-related quality of life (HRQL) in patients with rheumatoid arthritis (RA) is often negleglected in their medical care. While, theese patients are suffering from a precarious quality of life, resulting from pain, impaired physical function and fatigue. The use of biological agents for treating this disease is then a challenge, leading to the possibility of reducing the consequences of the disease.

Objectives:

The main purpose of this study was to compare the level of HRQL in patients with rheumatoid arthritis (RA) during therapy applying disease-modifying antirheumatic drugs (DMARDs) with conventional synthetics (csDMARDs) or with csDMARDs in combination with biological drugs (bDMARDs).

Methods:

The study involved 120 patients with RA, divided into two groups: group I –treated using csDMARDs (combination therapy: methotrexate and salazopyrine), group II – using csDMARDs in association with bDMARDs which included TNF inhibitors (etanercept and adalimumab). All the studied patients were surveyed with the use of the following questionnaires: the short-form health survey (SF-36) for HRQL that assesses eight domains: functional capacity (ten items), physical aspects (four items), pain (two items), general health (five items), vitality (four items), social aspects (two items), emotional issues (three items) and mental health (five items), in addiction to one item to compare current health status and that of the previous year, The AIMS2-SF, and Health Assessment Questionnaire (HAQ). The questionnaires were filled out at the consultation after patient’s consent.The 28-Joint Disease Activity Score (DAS-28) was calculated.

Results:

Group I consisted of 72 persons including 55 women and 17 men with a mean age of 58.4 years. Group II contaned 48 patients where females predominated (sex ratio: 0.3), the mean age was 52.4 years. The majority of patients (53.3%) had been diagnosed with RA for more than five years. Most of the SF-36 domains showed significant improvement in the second group (p<0.01), highlighting the social aspects, pain, physical functioning, emotional issues, vitality and physical aspects. The mean score of HAQ II decreased from 1.97 up to 1.23 with biological therapy (p<0.01). The highest AIMS scores were comparatively in the two groups (I vs II): in social activity (6.49±1.93 vs 6.23±1.56), pain (4.70±2.04 vs 4.01±2), depression (4.70±2.23 vs 4.66±2.03), and physical activity (4.03±2.10 vs 4.01±2.08). The DAS-28 value, the number of swollen joints, and the duration of morning stiffness were significantly smaller among patients from group II (P=0.04). After logistical regression,treatement with biotherapy was isolated as a fundamental independent factor influencing the mentel component of SF-36 scale with an OR of 1.59.

Conclusion:

we conclude that the use of biologic therapy in patients with RA proved to be an important pharmacological strategy for improving HRQL and functional capacity as assessed by the HAQ II and SF-36 instruments.The intensity of the activity of RA as well as experiencing pain and the duration of morning stiffness were smaller among patients applying csDMARDs plus bDMARDs compared with patients treated only with csDMARDs.

References:

[1]Blair, H. A., & Deeks, E. D. (2016). Infliximab Biosimilar (CT-P13; Infliximab-dyyb): A Review in Autoimmune Inflammatory Diseases. BioDrugs, 30(5), 469–480.

[2]Araújo, F., Gonçalves, J., & Fonseca, J. E. (2016). Biosimilar DMARDs: What Does the Future Hold? Drugs, 76(6), 629–637.

Disclosure of Interests:

None declared

AB0123 ANXIETY AND DEPRESSION DURING RHEUMATOID ARTHRITIS

Background:

Although the management of rheumatoid arthritis (RA) has been booming since the advent of biological treatments, the consequences of this disease remain multiple, both physical and psychological.

Objectives:

The aim of our work was to investigate the factors influencing anxiety and depression in RA.

Methods:

This was a cross-sectional study of 49 RA patients. We used the Hospital Anxiety and Depression scale (HAD) to assess anxiety disorders.

Results:

We included 24 women and 5 men with an average age of 54.1 years. Sixty-nine percent of patients were unemployed and 81% had health insurance coverage. RA had been evolving for an average of 11.43 ± 7.32 years and the mean time to diagnosis was 2.35 years. It was erosive in 93.8% of cases. An atlanto-axial dislocation was found in 4.1% of cases and coxitis in 8.2% of cases. Eighty-three percent of patients were on cs-DMARDs and 14.2% were on biotherapy. Most patients had low active disease (53%) with a mean DAS28CRP score of 2.74 ± 0.81. Twelve percent of patients had a probable anxiety and 18% had a probable depression.

A long delay in diagnosis was associated with a higher risk of anxiety disorders. Working patients had a lower risk of depression while patients from rural areas had a higher risk. The risk of anxiety and depression disorders was associated with increased VAS pain, EGP, and DAS28. In the multivariate study, EGP was the independent risk factor for the development of anxiety and depression disorders.

Conclusion:

Anxiety and depression disorders are a frequent yet underestimated consequence in RA. Appropriate care in psychiatry is required as soon as the diagnosis is announced.

Disclosure of Interests:

None declared

POS0294 PROFILE OF SPINAL TUMORS IN RHEUMATOLOGY DEPARTMENTS

Background:

Spine tumors remain a hot topic because of their associated morbidity by affecting motor and sensory function. Contrary to metastatic spine disease (MSD), extremely prevalent, rise within or surrounding the spinal cord and/or vertebral column, primary spinal tumors are rare, 5% of all primary skeletal tumors and frequently benign (20%). The diagnostic delay of these tumors, even when benign, is associated with a poor prognosis. Establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation.

Objectives:

to provide an overview of the epidemiology, radiological and histopathological of spinal tumors diagnosed in a rheumatology department.

Methods:

A retrospective study consisting of clinical characteristics analysis, laboratory and x-ray examinations, was performed on 40 patients who were hospitalised for a spinal tumor, in a rheumatology department, over 5-year period from 2015 to 2020.

Results:

A total of 40 patients with a mean age of 66 ± 13.5 years [18-93] and a sex-ratio of 1.1, were included. The most common initial complaints were inflammatory back pain (67.5%) and fatigue (52.5%), with a median duration of 5 months. Physical examination abnormalities included lumbar stiffness (32.5%), radicular signs (18.7%), hepatomegaly (12.5%), and lymphadenopathy (17.5%). Neurological deficit was found in only 3 patients (7.5%). Hypercalcemia (corrected serum calcium > 105 mg/l), and anemia (hemoglobin (Hb) < 100 g/l in female, Hb <110g/l in male) were present initially in respectively 47.5% and 46.3% patients, while biological inflammatory syndrome was present in 89.7% patients (median C-reactive protein of 44.7). Tumor markers were performed in 12 patients and they were positive in 9 of them.

Plain radiographs findings were vertebral compression fractures (43.6%), osteolytic lesions (30.8%) and osteoblastic lesions (12.5%). Lumbar spine was the most affected (57.5%), followed by the dorsal spine (45%). Magnetic resonance imaging (MRI) was performed in 55%, and the most common lesion was low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences (68.1%).

In our study, only one patient was diagnosed for a myxopapillary ependymoma, a benign primary spinal tumor characterised by a metastatic dissemination risk. For the rest (39 patients), the diagnosis of bone metastasis, multiple myeloma (57.7%), and of solid tumor cancers (40%), were established. Primary cancers were mainly prostate cancer (37.5%), lung cancer (18.7%) and kidney cancer (18.7%). By a median follow-up time of 25 months, overall survival rate was 30%.

Conclusion:

Extradural lesions are the most common, and are typically metastatic. Special attention should be pain to the patient’s medical history and laboratory abnormalities. In fact, an early diagnosis requires a high index of clinical suspicion.

Disclosure of Interests:

None declared

AB0238 SECOND BIOLOGICAL DMARD THERAPY IN RHEUMATOID ARTHRITIS: A RETROSPECTIVE COHORT ANALYSIS

Background:

The development of biologic disease modifying antirheumatic drugs (bDMARD) has dramatically improved the management of rheumatoid arthritis (RA). However, some patients did not respond or partially respond to biologic agents. Management of first bDMARD failure may involve another biotherapy.

Objectives:

The aim of our study is to assess the efficacy of second line biologic as well as survival rates of 2nd line biotherapy in RA.

Methods:

This is a retrospective study based on Tunisian data including 374 RA patients treated with biologic agent from 2014 and followed until December 2018.

Results:

Tumor necrosis factor inhibitor (TNFi) was the most prescribed class as first-line therapy with 86.4% patients (Etanercept: ETA 54%; adalimumab: ADA 13.6%; certolizumab pegol: CZP 12.8% and infliximab: IFX 5.9%), IL-6 inhibitor (Tociluzimab: TCZ) and anti-CD 20 (Rituximab: RTX) were given respectively to 6.4% and 7.2% cases. The first biotherapy was discontinued for 146 patients (39%). Of these, 79 patients (21.1%) received a second bDMARD (mean age 52.6 ± 11.8; sex ratio = 0.12; ETA 17.7%, ADA 7.6%, CZP 41.8%, IFX 1.3%, TCZ 24.1% and RTX 7.6%). Average DAS28 at second line biotherapy initiation was 5.93 ± 0.96. Overall survival rates of 2nd line bDMARD at 12, 24 and 36 months was respectively 91%, 76.4% and 72.1%. Among the patients receiving second biologic agent, 30.4% patients (24 cases) achieved either low disease activity (LDA) or remission. On average 38 weeks [14 – 96] were needed to reach that therapeutic target. In fact, 27.8% of the TNFi vs. 40% of the non TNFi patients achieved LDA (p = 0.277). Second biotherapy was withdrawn in 16.7% of the cases of TNFi group vs. 20% of the non TNFi group (p = 0.718). Moreover, no significant difference has emerged between the TNFi and the non-TNFi patients when comparing time to biotherapy discontinuation (15.8 months vs. 20.9; p = 0.11).

Conclusion:

In our study, no significant difference was found between TNFi and non-TNFi switcher in RA. But, treatment strategy after first bDMARD failure is still controversial. Further studies have to be done to get the most beneficial strategy in RA.

Disclosure of Interests:

None declared

AB0240 PREDICTORS OF RESPONSE TO BIOLOGIC AGENTS IN RHEUMATOID ARTHRITIS

Background:

In rheumatoid arthritis (RA), the ‘treat-to-target’ therapeutic approach imposes rigorous control of disease activity. Although biological agents have been shown to be effective, these therapies fail sometimes to achieve therapeutic goals.

Objectives:

In this study we tried to determine predictive factors of good therapeutic response to biologic disease-modifying antirheumatic drugs (bDMARD).

Methods:

This is a retrospective study including 374 Tunisian patients who received their first biotherapy between 2014 and 2016. Categorical variables were reported in numbers and percentages, while quantitative variables were expressed by mean with standard deviations. The univariate analysis was performed using the student t-test or the Chi2 test. Multivariate analysis was performed by binary logistic regression.

Results:

Average age of our cohort was 55 ± 12.5 years with a female predominance of 87.2%. The average duration of RA was 11.7 ± 6.7 years. Rheumatoid factors were positive in 79% and ACPA were positive in 72% of cases. After the introduction of biotherapy, low disease activity (LDA) or remission was achieved in 55% of cases (206 patients).

No statistically significant difference between biotherapy responder and non-responder groups for age (55.7 vs. 54.7 years; p = 0.44), gender (Female: 86.5% vs. 88.7%; p = 0.08) and disease duration (12 years vs. 11.4 years; p = 0.41). A significant difference between the two groups was found for the positivity of rheumatoid factors (76.4% vs. 88.9%; p = 0.004), methotrexate’s association (65% vs. 53.4%; p = 0.02) and corticosteroids’ use (50% vs. 66.5%; p < 0.001).

Positive predictive factors of remission or LDA by biotherapy were female sex (Odds Ratio = 2.2; p = 0.026), presence of rheumatoid factors (Odds Ratio = 2.64; p = 0.001), association with methotrexate (Odds Ratio = 1.69; p = 0.028). Whereas, corticosteroid use (OR = 0.41; p < 10-3) was a negative predictor of disease control by bDMARDs.

Conclusion:

Achieving LDA low level or even remission is currently achievable with biological treatments. Certain factors need to be studied in order to optimize RA treatment and adapt the right bDMARD for each patient.

Disclosure of Interests:

None declared

AB0492 DETERMINING FACTORS RELATED TO POOR QUALITY OF LIFE IN PATIENTS WITH SPONDYLOARTHRITIS: A REAL LIFE STUDY

Background:

When treating people with spondyloarthritis (SA), rheumatologists are focused on reducing disease activity based on activity measurement scores; but there may be other factors not directly captured by these tools, which impact on quality of life.

Objectives:

We aim to identify factors associated with poor quality of life in patients with spondyloarthritis.

Methods:

A cross-sectional study was performed in 100 patients with spondyloarthritis. Data on sociodemographic and disease characteristics were collected as well as specific scores: Visual analogue scale (VAS) for fatigue and pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP), Bath Ankylosing Spondylitis Functionnel Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI). EuroQol-5D (EQ5D) was used to assess health-related quality of life.

Results:

A total of 100 Patients were enrolled (73 men and 27 women); the mean age was 43.68 ± 10.3 years. Thirteen percent of patients had high level of education (> 12 years), 47% had BMI ≥ 25 and 47% were smoking. Sixty seven percent of patients had ankylosing spondylitis, 17% had rheumatism associated with inflammatory bowel disease and 16% had psoriatic rheumatism. The average disease duration was 12.24 ± 8.73 years. Mean age at onset was 33.2 ± 10 years. The average diagnostic delay was 2.41 ± 3 years. Sacroiliac pain has been noted in 69 patients, lumbar or cervical stiffness in 78 patients and peripheral joint involvement in 18 cases. Thirty one percent of patients had hip joint involvement and 49% had extra-articular manifestation. Fifty percent had inflammatory biological syndrome, 63% were treated with anti-TNFα and 58% needed symptomatic treatment regularly. The mean fatigue and pain VAS was respectively 5.58 ± 2.5 and 5.56 ± 2.9. The mean BASDAI was 4.4 ± 2.4, the average BASFI was 4.6 ± 2.7 and the average ASDAS-CRP was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. EQ5D questionnaire showed that: 37 patients had no problems with mobility, 61 had some problems and two had extreme problems; 39 patients had no problems with self-care, 55 had some problems and six had extreme problems; 35 patients had no problems with performing usual activities, 60 had some problems and five had extreme problems; 13 patients had no pain or discomfort, 61 had moderate pain or discomfort and 26 had important pain or discomfort; 42 patients had no anxiety or depression, 46 had moderate anxiety or depression and 12 had extreme anxiety or depression. The mean EQ5D score was 0.485 ± 0.378 [-0,448-1] and the mean general health EQ5D VAS was 59 ± 25% [7-100]. Poor quality of life was associated with smoking (p=0.03), physical inactivity (p<0.001), cervical and lumbar stiffness (p=0.001), peripheral joint involvement (p=0.006), inflammatory biological syndrome (p<0.001), need of symptomatic treatment (p<0.001), BASDAI > 4 (p<0.001), ASDAS > 2.1 (p<0.001), BASFI > 4 (p<0.001) and BASMI > 4 (p<0.001).

Conclusion:

Active disease and reduced physical function are the main causes of poor quality of life in patients with spondyloarthritis. Good disease management, smoking cessation and encouragement of physical activity can potentially improve patients’ quality of life.

Disclosure of Interests:

None declared.

[Dobutamine speckle tracking imaging for evaluation of microvascular dysfunction in a patient with exertion dyspnea]

Microcirculatory dysfunction despite the absence of angiographically obvious significant coronary artery disease may potentially generate symptomatic myocardial ischemia; comprehensive assessment both noninvasive and invasive could prove to be of critical interest. We report the case of a 54-year old patient referred for an exertion dyspnea that proved to be caused by both micro and microvascular dysfunction. We present key elements for diagnosis, functional evaluation and management and demonstrate the potential role of speckle tracking imaging in that setting.

[Cardiac metastasis of a lung adenocarcinoma mimicking atrial myxoma]

Les tumeurs cardiaques secondaires demeurent une pathologie sévère et assez rare et sont typiquement associées à un stade évolué de la tumeur primitive et, de fait, à un pronostic péjoratif. Les présentations cliniques sont variables et potentiellement déroutantes. Nous rapportons les cas d’une patiente de 76 ans chez laquelle la présentation échocardiographique évoquait, en premier lieu, un myxome de l’oreillette gauche, mais le diagnostic définitif était celui d’un envahissement par un adénocarcinome pulmonaire. Nous abordons le tableau clinique, le résumé de la littérature et la prise charge.