La place du dosage de l'interleukine 6 chez les patients hospitalisés dans une unité COVID (en dehors du milieu de la réanimation)

Introduction

Le développement d'une forme grave de COVID-19 pourrait être causé par la survenue d'un syndrome de libération de cytokines pro-inflammatoires. L‘interleukine 6 (IL-6) est une cytokine qui joue un rôle clé dans la mobilisation et la coordination de la réponse immunitaire pour contenir l'infection par le SARS-CoV-2. L'objectif de notre étude est d'évaluer les niveaux d'IL-6 chez les patients atteints de COVID-19 admis en dehors du milieu de réanimation et leur corrélation avec la forme clinique.

Matériels et méthodes

Il s'agit d'une étude rétrospective descriptive analytique mené à l'unité COVID-19 durant 12 mois [2020-2021]. Tous les patients ayant eu un dosage de l'IL-6 à l'admission.

Résultats

Ils s'agissaient de 81 patients, 53 hommes et 28 femmes (sex-ratio H/F=1,9), âgés en moyenne de 58,4 ans [20-93 ans]. Le délai moyen d'hospitalisation était de 8 jours [2-21 jours]. La forme clinique à l'admission était sévère dans 91 % et modérée dans 9 % des cas. La symptomatologie était dominée par l'asthénie (79 %), la toux (74,1 %), la dyspnée (63 %), l'arthromyalgie (59,3 %) et la fièvre (58 %). Au moins une comorbidité était présente chez 88 % des patients. Les plus fréquentes étaient l'hypertension artérielle (40 %), le diabète (30,9 %), les pathologies cardio-vasculaires (13,6 %) et les maladies respiratoires chroniques (7,5 %). une TDM thoracique réalisée chez 80 patients avait objectivé des lésions évocatrices avec une étendue entre 50 et 75 % (34,6 %), 25 et 50 % (28,4 %) et 10 et 25 % (18,5 %). La valeur moyenne des globules blancs est de 7122 ± 3564 éléments/mm³, celle de CRP de 104,6 ± 59,6 mg/l, de la ferritinémie de 412 pg/l [188 -643pg/L] et des D-dimères de 743 µg/l (481 – 1729µg/l). Le taux de l'IL6 était augmenté chez tous les patients avec une valeur moyenne de 42pg/ml +/- 54 pg/ml [2 et 580 pg/ml]. Le taux d'IL-6 était significativement plus élevée dans les formes sévères que dans les formes modérées (p=0,01). La valeur moyenne de l'IL-6 était de 20,2pg/ml et de 58,6 pg/ml respectivement dans la forme modérée et la forme sévère. L'évolution était favorable dans 92,6 % des cas. Six patients (7,4 %) sont décédés. Le modèle multivarié de Cox a montré que le taux d'IL-6 pouvait être utilisé comme facteur indépendant pour prédire la gravité de la COVID-19 (p <0,001).

Conclusion

Les taux sériques d'IL-6 sont significativement plus élevés dans les formes sévères que dans les formes modérées de COVID-19 et peuvent être considérés comme critère de gravité. Son taux sanguin est un bon marqueur de l'évolution.

Aucun lien d'intérêt

Interleukine-6 chez les patients COVID-19 hospitalisés en dehors du milieu de réanimation

Introduction

Patients et méthodes

Résultats

Conclusion

P047 Musculoskeletal symptoms as first clinical presentation of juvenile-onset systemic lupus erythematosus: Experience from a military internal medicine department

Background

Juvenile-onset systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder occurring before the age of sixteen. The clinical manifestations are variable and the management of the disease at this age may be different. The aim of our study was to investigate first clinical presentation of juvenile-onset SLE.

Methods

We conducted a retrospective study in a military internal medicine department. We accessed medical records of 103 patients with SLE diagnosed according to the revised 1997 American College of Rheumatology (ACR) criteria or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. Only patients with an age of lupus-onset &lt; the age of sixteen were included. Clinical data were collected and analyzed. The statistical analysis was performed using SPSS 23.0 software.

Result

There were eight juvenile-onsets SLE: two males and six females. The median age at the diagnosis was 13.7 + 1.9 years-old (11–16). First clinical presentations are shown in table 1.

Arthritis and hematological involvement tended to be associated (p = 0.07). Hypocomplementemia and positive anti-DNA antibodies were detected in 50% of cases.

All patients received Hydroxychloroquine and most of them combined corticosteroids (7cases).

Conclusion

Our study showed that musculoskeletal manifestations especially arthritis were frequent at the diagnosis of juvenile-onset SLE. According to the aggressive pharmacological treatment, a multidisciplinary approach should be required

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

Background:

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

Objectives:

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

Methods:

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

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

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

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

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

Results:

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

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

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

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

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

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

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

Conclusion:

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

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

References:

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

Disclosure of Interests:

None declared

AB0725 FACTORS ASSOCIATED WITH RADIOGRAPHIC SPINAL INVOLVEMENT IN SPONDYLOARTHRITIS

Background:

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

Objectives:

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

Methods:

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

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

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

Results:

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

Forty-nine patients were smockers (43.8%).

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

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

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

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

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

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

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

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

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

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

Conclusion:

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

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

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

References:

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

Disclosure of Interests:

None declared

Changes in photosynthetic pigments and chlorophyll-a fluorescence attributes of sweet-forage and grain sorghum cultivars under salt stress

Water shortage leads to a low quality of water, especially saline water in most parts of agricultural regions. This experiment was designed to determine the effects of saline irrigation on sorghum as a moderately salt-tolerant crop. To study salinity effects on photosynthetic pigment attributes including the chlorophyll content and chlorophyll fluorescence, an experiment was performed in a climate-controlled greenhouse at two vegetative and reproductive stages. The experimental design was factorial based on a completely randomized design with five NaCl concentrations (control, 50, 100, 150, and 200 mM), two grain and sweet-forage sorghum cultivars (Kimia and Pegah, respectively) and four replications. According to the experimental data, there were no significant differences between two grain and sweet-forage cultivars. Except for 100 and 150 mM NaCl, salinity significantly decreased the chlorophyll index and pigment contents of the leaf, while it increased the chlorophyll-a fluorescence characteristics. Although salinity reduced photosynthetic pigments and the crop yield, either grain or sweet-forage cultivars could significantly control the effect of salinity between 100 and 150 mM NaCl at both developmental stages, showing the possibility of using saline water in sorghum cultivation up to 150 mM NaCl.

[SAPHO syndrome]

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare entity characterized by the association of heterogeneous osteoarticular and cutaneous manifestations that have for common denominator an aseptic inflammatory process. The etiopathogeny of this disease is still a matter of debate. Although it has been related to the spondylarthritis family, an infectious origin is suggested. Diagnosis is based on the presence of at least one of the three diagnostic criteria proposed by Kahn. The treatment includes NSAIDs, antibiotics, corticosteroids, methotrexate and more recently the bisphosphonates and the TNFα inhibitors.