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We aimed to determine the bone mineral status in patients with spondyloarthritis (SA), and to assess the impact of parameters associated with bone loss on bone mineral density (BMD). Seventy-five patients (62 men) with SA fulfilling the modified New York criteria were included in a cross-sectional study during one year. BMD was assessed in all patients using dual-energy X-ray absorptiometry. The patient’s average age was 36.8 years. Sixty-five patients (86.6%) had bone loss. The lumbar spine was the site most affected by osteoporosis (37%). Bone loss was significantly associated with low BMI, peripheral joint involvement, active disease (high ASDASESR and BASDAI), vitamin D insufficiency, elevated erythrocyte sedimentation rate (ESR) and c-reactive protein, as well as high BASRI, high BASMI, and with the use of csDMARDs or anti-TNF alpha therapy. The disease activity, biologic inflammation, low vitamin D level, peripheral joint involvement, and structural damage were the major factors that induce bone loss in SA patients. Multivariate analysis showed that only high ESR level (AOR 19.9, 95% CI) and peripheral arthritis (AOR 14.5, 95% IC) were independent risk factors of bone loss. Our study shows that bone loss was a multifactorial complication of SA.

Background: Intraosseous lipoma is a rare benign tumor representing 0.1% of all skeletal tumors. We report a new case of plantar heel pain revealing intraosseous lipoma of the calcaneus. Aim of the work: To increase clinical awareness of calcaneal lipoma and to highlight the contribution of imaging in the diagnosis of patients with persistent heel pain. Case report: A 67-years-old Tunisian man presented to the Rheumatology department, Kassab Orthopaedic Institute, Faculty of Medicine, University of Tunis el Manar with a four months history of persistent left heel pain. The pain became worse during walking and disappeared at rest. He had no history of trauma. The physical examination was normal, except for tenderness to palpation of the left heel. Radiography of the left heel showed a well-defined lesion in the neck of calcaneus. Magnetic resonance imaging (MRI) was performed and showed a large lesion in the left calcaneus, well demarcated (width: 30 mm, length: 33 mm and height: 18 mm), with high signal intensity on T1 and T2 weighted sequences and low signal in T2 sequences with fat saturation without enhancement after gadolinium injection. The diagnosis of calcaneal lipoma was established and the patient was put on symptomatic treatment and referred to surgery. Conclusion: Calcaneal lipoma should be mentioned as a forerunner among the differential diagnoses of persistent heel pain and promptly dealt with for a promising outcome. Keywords: Intraosseous lipoma, Heel pain, Bone tumor

Introduction The association of silicosis and RA is rare compared to pulmonary manifestations of rheumatoid arthritis (RA). A history of lung disease or a long exposure at work to silica and typical radiographic lesions on chest X-ray suggest the diagnosis of Caplan’s syndrome. We describe the case of an elderly Tunisian male RA patient with the Caplan’s syndrome diagnosed after prolonged exposure to silica. Case report A 62-year old patient was referred for exploration of a chronic symmetrical polyarthritis for 2 years involving the hands, elbows, forefeet, and knees and accompanied by prolonged morning stiffness. He had no history of lung disease but had worked in a ceramic plant for 20 years. He presented with arthritis of the wrists and knees with a rheumatoid nodule of the left elbow. Joint destruction was present in both hands and feet. Rheumatoid factor and anti-cyclic citrullinated peptide antibodies were highly positive (135 UI/L and 363 UI/L respectively). The patient was diagnosed as RA and the disease activity score (DAS-28) was up for 6.87. His breathing was normal, pulmonary auscultation and spirometry were normal. Chest X-rays revealed a multiple micro-nodules distributed throughout the lungs but predominantly in the upper and middle zones. Bronchoalveolar lavage showed a pauci-cellular liquid and chest CT scan showed bilateral, round, well-delimited small centri-lobular nodules which predominate the upper lobes. There was infra-centimetrical adenopathy with mediastinal calcification. Conclusion Prolonged exposure to silica dust has a remarkable influence on the development of RA with a suggested intricacy in to its pathogenesis.

Background Rheumatoid arthritis (RA)’s prognosis drastically improved with the introduction of TNF-blockers. However, reasons behind therapeutic failure in some patients remain unclear. Several factors might influence pharmacokinetics of these drugs by reducing their half-life and, consequently, their effectiveness. Considering Fc-containing biologics like infliximab (IFX) and adalimumab (ADL), Fc gamma receptors (FcgRs) polymorphism would be an interesting genetic candidate to focus on. Objectives The aim of our study was to determine the influence of low affinity allele FcgRIIA-131R on ADL and IFX bioavailability. Methods We enrolled RA patients treated with IFX and ADL for over six months. Blood samples were collected for each patient immediately prior to drug administration. Quantitative measurements of the residual drug concentration (DC) was carried out by a commercial enzyme-linked immunosorbent assay (ELISA) kit (Promonitor®). Then, we identified patients with DC above therapeutic cut-off (DC+) for each biologic. EULAR criteria were considered to determine treatment outcome. FcgRIIA H131R polymorphism was genotyped using PCR-SSP. Results Twenty-nine patients were included (13 treated with ADL and 16 with IFX). We identified 31.3% and 23.1% non-responders among patients treated with IFX and ADL respectively. Patients with DC+ were more frequent in ADL group (76.9%) than IFX group (43.75%). For IFX, DC+ was significantly correlated with the presence of FcgRIIA 131-R (p=0.033). In fact, none of the HH-genotyped patients had DC+. Furthermore, an association between FcgRIIA 131-R allele and poor response to IFX was noted (p=0.059) while all HH-genotyped patients responded to IFX. For ADL, no correlation was found with both of residual DC and response to treatment. Conclusion The presence of FcgIIA-131 R allele might be a predictive factor of non-responsiveness to TNF-blockers. It also appears to be associated to a higher residual DC. That might be explained by a reduced biologic clearance due to a lower binding affinity to Fc portion compared to wild allele FcgRIIA-131H. Therefore, FcgR polymorphism assessment in RA patients would be a decision-making parameter to consider, as part of the personalized medicine approach. References [1] Montes A, Perez-Pampin E, Narvaez J, et al. Association of FCGR2A with the response to infliximab treatment of patients with rheumatoid arthritis. Pharmacogenet Genomics. 2014;24(5):238-245 [2] DavilaaFajardo CL, van der Straaten T, Baak-Pablo R, et al. FcGR genetic polymorphisms and the response to adalimumab in patients with rheumatoid arthritis. Pharmacogenomics. 2015;16(4):373-381 [3] Canete JD, Suarez B, Hernandez MV, et al. Influence of variants of Fc gamma receptors IIA and IIIA on the American College of Rheumatology and European League Against Rheumatism responses to anti-tumour necrosis factor alpha therapy in rheumatoid arthritis. Ann Rheum Dis. 2009;68(10):1547-1552. Disclosure of Interests None declared

Background: The severity of Spondyloarthritis (SA) lies mainly in the progressive ankylosis of the axial skeleton and the deformations generated. The means of assessing the spinal static disorders in SA are currently subjective and difficult to reproduce. Multidisciplinary collaboration has led to the development of a new biplane low dose radiology technology named EOS. It allows a simultaneous acquisition of the axial skeleton and the lower limbs in a standard standing position. Objectives: We aimed to assess pelvic and spinal parameters and spinal stature in patients with SA using the EOS system. Methods: This is a prospective cross-sectional study conducted over a 10-month period (January-October 2018) involving 50 patients with SA meeting the criteria of Assessment of SpondyloArthritis International Society. An entire body EOS examination of the vertebral column in a standardized standing position was performed in all patients. Pelvic parameters measured by the EOS system were pelvic incidence (PI: normal value: 48-55°), sacral slope (SS: normal value: 36-42°) and lateral pelvic tilt (LPT: normal value: 12-18°). Spinal stature parameters were thoracic kyphosis (normal value: 41-48°), lumbar lordosis (normal value: 43-61°), sagittal vertical axis (SVA: normal value: Results: We enrolled 29 men (58%) and 21 women (42%) with an average age of 42.6 ± 11.09 years [20 -79]. The mean duration of SA was 12.4 ± 9.71 years [2-46]. SA was axial in 17 patients (34%), and axial and peripheral in 29 patients (58%). The median PI was 50.7 ± 11.81°. The median SS was 35.8 ± 11.64°. The median LPT was 14.9 ± 8.97°. The average value of thoracic kyphosis was 52.1± 12.1°. The average value of lumbar lordosis was 37.4 ± 16. The median SVA was 25.2 ± 55.88 mm and the median of SSA was 123.9 ± 16.64°. Thus, deformity of the thoracic spine was found in 40 patients (80%) with thoracic hypercyphosis type and thoracic rectitude in 12% and 68% of cases respectively. The deformity of the lumbar spine was found in 40 patients (80%) with lumbar hyperlordosis type and lumbar rectitude in 74% and 6% of cases respectively. From this construction and segmenting the SS values, we were able to classify the type of back according to Roussouly : the type 2 back was the most frequently found (40%), followed by type 3 back (34%), type 4 back (24%), and type 1 back (2%). Spinal deformities were more frequent in women (p=0.004) and associated with a longer duration of the disease (p Conclusion: Our study showed that the EOS system was a useful technique in assessing pelvic and spinal stature in patients with SA. Disclosure of Interests: None declared

Post-fracture osteolysis of the sacrum is a rare radiological entity mimicking a serious disease. We report the case of a female patient lost to follow-up after biopsy indication. She presented again after 4 months. During multi-stage bone registration prior to the biopsy, we noticed a change in the appearance of the lesion, associating a linear image (corresponding to the fracture line) with condensation at the edges. Patient’s evolution was good after a period of rest at 6-months follow-up. This study highlights the atypical imaging appearance and the diagnostic difficulties associated with post-fracture osteolysis of the sacrum. The particularity of our patient is that symptoms were masked by disc-related nerve root impingement with right L5 root and that the sacrum osteolysis was unexpectedly discovered on CT scan. Keywords : Post-fracture osteolysis, sacrum, pseudotumor

Aim of the work Tuberculosis is still one of the important health problems. Because of its insidious evolution, tuberculous (TB) tenosynovitis (TS) is usually misdiagnosed and undertreated. The aim of this study was to investigate clinical and therapeutic outcomes of TB TS. Patients and methods A retrospective study of 8 patients followed-up for TB TS was conducted. Clinical and therapeutic data were collected. Results The median age was 45 years (range 33–59 years), they were 5 females and 3 males with a median duration till diagnosis of 15 months. Fever, night sweats, and weight loss were reported by 3 patients. Physical examination showed swelling of the wrist and crepitation of the palmar side with affected fingers movements in 7 cases. A carpal tunnel syndrome was found in another case. The median erythrocyte sedimentation rate was 15 mm/1st hour and the C-reactive protein 5 mg/dl. Plain radiographies of the wrists were normal. Ultrasonography showed flexor TS in all cases. Since tuberculin skin tests were positive in all patients, TB TS was suspected. Surgical synovectomy was conducted and histological examination confirmed TB. In addition to surgical synovectomy, patients were treated with anti-TB drugs for 12 months. No relapse was noted for a mean follow-up duration of 2 years. Conclusions TB TS can be misdiagnosed because of its insidious evolution. Histological examination confirms the diagnosis. Surgical synovectomy could confirm the diagnosis rapidly by the histological examination and be part of the treatment. Medical treatment should be well-conducted and maintained to avoid relapse and future complications.

Background:Computed tomography (CT) of sacroiliac joints (SIJ) is usually considered as a third-line modality in the diagnosis of spondyloarthritis (SpA), as it shows only structural lesions. According to 2015 EULAR recommendations, CT may be helpful if conventional radiograph is inconclusive and MRI cannot be performed [1]. However, its contribution for the early assessment of sacroiliitis is still little-studied.Objectives:The purpose of this study was to assess the performance of CT scan for detecting sacroiliitis and the contribution of the different structural lesions to the early diagnosis of SpA.Methods:This cross-sectional prospective monocentric study included consecutive patients, aged over 16, consulting for symptoms suggestive of SpA between February 2014 and 2017. Patients with a pelvic radiograph showing a confirmed sacroiliitis (making CT unnecessary to confirm the diagnostic) were not included. Eligible patients underwent CT of SIJ and the images were reviewed by 2 experimented musculoskeletal radiologists blinded to clinical findings. Then, 2 experienced rheumatologists analyzed clinical, biological and radiological data and classified patients into 2 groups: confirmed non-radiographic spondyloarthritis (nr-SpA) or no SpA. This classification was considered as the gold standard of this study.Results:A total of 60 patients, 45 women and 15 men, were included in this study. Forty-six patients were assessed as confirmed nr-SpA (76.6%) and 14 patients as no SpA (23.4%). Mean age at the diagnosis was 39.5±10.8 years [17-59], and the disease duration from first symptoms was 48.6 ± 40 months [6.6-180]. Chronic back pain met the Calin criteria in 37 patients (61.7%), the Berlin criteria in 46 patients (76.7%) and the ASAS criteria in 32 patients (53.3%).Among the patients diagnosed as confirmed SpA, 71.7% were determined to have sacroiliitis at CT. As shown by the following table, the most sensitive lesion was subchondral bone sclerosis and the most specific one was new bone formation at entheses:TableConfirmed SpANo SpAPSe (%)Sp (%)PPV (%)NPV (%)Interruption of subchondral bone67.4%28.6%0.01 (S)67.471.488.640subchondral bone erosions65.2%35.7%0.05 (S)65.264.385.736Subchondral bone sclerosis78.3%28.6%0.001 (S)78.371.49050new bone formation at entheses10.9%7.14%0.68 (NS)10.992.983.324.1CT conclusion: sacroiliitis71.7%28.6%0.04 (S)71.771.489.243.5CT: computed tomography, SpA: Spondyloarthritis, Se: Sensitivity, Sp: Specificity, PPV: Positive Predictive Value, NPV: Negative Predictive ValueConclusion:The relatively limited place of SIJ CT can be explained by the lack of investigations evaluating its real contribution in detecting sacroiliitis. In this study, we found that the main SI structural lesions were significantly associated to the final diagnosis of SpA with a sensitivity up to 78.3% and a specificity up to 92.9%. The main limitation of this technique remains the large radiation dose delivered to the gonads, especially with the commonly used axial position for CT. However, recent studies found that oblique coronal CT imaging seems to be a very promising technique, since it allows visualization of the subtle radiologic signs of sacroiliitis while delivering less radiation dose [2].References:[1]Mandl P, Navarro-Compán V, Terslev L, et al (2015) EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 74:1327–1339.https://doi.org/10.1136/annrheumdis-2014-206971[2]Li SG, Liu X, Zhou H, Zhang Q (2018) Interrater reliability and radiation dosage of oblique coronal computed tomography. Br J Radiol 91:6.https://doi.org/10.1259/bjr.20150700Disclosure of Interests:None declared

Background:In view of the limited accuracy of clinical evaluation to recognize sacroiliitis, several imaging techniques such as conventional radiographs, scintigraphy, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) have been used to examine the sacroiliac joints (SIJ).Objectives:The aim of this study was to assess the performance of MRI for detecting sacroiliitis in early stages of spondyloarthritis (SpA).Methods:This cross-sectional prospective monocentric double-blind study included 57 patients consulting for symptoms suggestive of SpA during more than 3 months between February 2014 and February 2017. Patients with conventional radiograph showing a confirmed sacroiliitis (grade 3 or 4) were not included. After clinical examination and blood sampling, eligible patients underwent MRI of SIJ. MR images were interpreted by 2 experimented musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists’ conclusions, analyzed clinical data, laboratory tests, HLA typing, X-rays and MRI images and divided the patients into 2 groups: confirmed non radiographic SpA (nr-SpA) or no SpA. This classification was considered as the gold standard when analyzing the results.Results:Fifteen men and 42 women were enrolled. The mean age at inclusion was 39.75 ± 11 years [17-59]. The mean duration from the first symptom was 47 ± 39 months [6.6-180]. Forty-three patients were assessed as nr-SpA (75.4%) and 14 patients as no SpA (24.6%). Thirty-three percent of patients were HLA B27 positive. Totally 22 patients had sacroiliitis at MRI, all of them classified as confirmed nr-SpA. Among the nr-SpA group, MRI showed bone marrow edema (BME) in 34.9% of patients and erosions in 44.2% of patients. Among the patients in whom the diagnosis of SpA was excluded, MRI showed bone marrow edema (BME) in 7% of patients and erosions in 7% of patients. A statistically significant association was observed between the presence of sacroiliitis at MRI and rheumatologists’ diagnosis of SpA (p=0.001). The diagnostic value of MRI lesions is presented in the following table:Sensitivity (%)Specificity (%)Positive Predictive Value (%)Positive Predictive Value (%)BME34.992.993.731.7Erosions44.292.99535.1MRI conclusion: sacroiliitis51.210010040Conclusion:SIJ MRI had an excellent specificity for the diagnosis of SpA but a moderate sensitivity. Consequently, some patients in early stages of SpA might be missed by MRI. In addition, we found that diagnostic based solely on BME lacked sensitivity. Detection of erosions in addition to BME enhanced sensitivity (from 34.9% to 44.9%) without changing specificity. Indeed, many recent studies have pointed out the importance of considering structural lesions of SIJ in addition to inflammatory lesions [1, 2].References:[1]Weber U, Lambert RGW, Pedersen SJ, et al (2010) Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res 62:1763–1771.https://doi.org/10.1002/acr.20312[2]Weber U, Jurik AG, Lambert RGW, Maksymowych WP (2016) Imaging in Spondyloarthritis: Controversies in Recognition of Early Disease. Curr Rheumatol Rep 18:58.https://doi.org/10.1007/s11926-016-0607-7Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are disabling and common chronic inflammatory rheumatic diseases.Objectives:The aim of our study was to evaluate the socio-professional impact of RA and AS.Methods:Using the Biological National Registry (BINAR) data, which includes ten tunisian rheumatology centers,we identified patients≥18 years with AS and RA according to the ACR and EULAR 2010 criteria(RA) and ASAS 2009 (AS), receiving biotherapy for less than two years.Results:298 patients were included in the study. The percentage of patients with RA was 58.7 % and those with AS 41.3%. The sex ratio was 0.6. The average age of the onset of the disease was 49.1 years ± 14.1 years [18–79]. For marital status, 72% were married, single (25%), widowed (2.6%) and divorced (0.4%). 22.4% of patients were illiterate, 32.7 % (primary), 28.3% (secondary) and 16.6% had an university level. For the RA population, a high disease activity (DAS28-ESR >5.1) was detected in 36% of patients, an erosive arthritis in 73.1% and 7.2% had a coxitis. In the AS group, an elevate BASDAI (BASDAI≥4) was detected in 56.9% of patients and 39% had coxitis. All patients have received Biological therapy concomitant with corticosteroids (59.1%), methotrexate (42.6%), salazopirine (20.8%) and leflunomide (4.7%). 54% of patients had a comorbidity, of which 1.7% was depression. More than half of our patients (54.3%) were unemployed, 40 % were professionally active, and 5.7% were retired due to the rheumatic condition. Absence from work was observed in 15.1% of cases with a total duration exceeding three months in 55.5% of cases. 37.9 % of patients were physically active: regularly (9.8%), irregularly (28.1%) and (62.1%) were sedentary. For the functional impact, HAQ score was 1.31± 0.7 for RA and BASFI was 5.2 ± 4.8 for AS. The working abandonment is significantly associated to: marital status (p=0.039), low level of education (p=0.04),depression (p4 (p=0,001).Conclusion:RA or AS requiring biotherapy have a high socio-economic impact and are responsible for absenteeism at work and even for early working abandonment. Early therapeutic management and a global assessment are essential in order to improve quality of life and working conditions. Longitudinal studies are needed to assess the effect of biological therapy on the socio-professional impact of these chronic inflammatory rheumatic disease.Disclosure of Interests:None declared

Background:The utility of structural lesions of sacroiliac joints (SIJ) for the early diagnosis of spondyloarthritis (SpA) has been well established by previous reports [1]. Computed tomography (CT) is usually the preferred modality to assess structural changes.Objectives:The aim of this study was to evaluate the performance of magnetic resonance imaging (MRI) for detecting subchondral bone erosions of SIJ in patients with suspected SpA. SIJ CT findings were considered as the gold standard when interpreting results.Methods:A cross-sectional prospective monocentric study included consecutive patients aged over 16 and consulting for symptoms suggestive of SpA from February 2014 to February 2017. Patients with a confirmed sacroiliitis on pelvic radiograph were not included. Eligible patients underwent CT and MRI of SIJ. Imaging findings were assessed consensually by 2 experimented musculoskeletal radiologists, blinded to the clinical and laboratory data. Erosion was defined as resorption or destruction of the subchondral bone. The sensitivity, specificity, positive and negative predictive values of MRI for detecting SIJ erosions were determined with CT results as gold standard.Results:Fifty-four patients were enrolled: 13 men and 41 women. The average age at inclusion was 39.4 ± 11 years [17-59], and the average age at onset of symptoms was 35.6 ± 10.6 years [16-55]. Cervical, thoracic, lumbar and buttock pain were noted respectively in 46.3%,37%, 92.6%, and 57.4% of the studied patients. Sacroiliac compression test, distraction provocative test, sacral thrust test, Gaenslen’s test, Faber’s test (Patrick) and Mennel’s test were respectively positive in 23, 18, 24, 12, 28, and 17 patients. HLA B27 typing was positive in 23.4% of patients. Erosions were detected by CT scan in 30 patients. MRI showed erosions in 18 of them. A significant association was found between CT and MRI results (p=0.000), and between the presence of erosions and the diagnosis of SpA (p= 0.05 for CT and p= 0.012 for MRI). Sensitivity, specificity, positive and negative predictive values of MRI for detecting subchondral erosions were respectively estimated at 60%, 100%, 100% and 66.7%.Conclusion:Erosions of SIJ appear in early stages of SpA and have been reported in 60-90% of patients with axial SpA after mean symptom duration of 2.5 years[2, 3], hence the importance of the detection of these structural lesions. In our study, despite its moderate sensitivity, MRI showed an excellent specificity for detecting subchondral bone erosions.References:[1]Weber U, Lambert RGW, Pedersen SJ, et al (2010) Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res 62:1763–1771.https://doi.org/10.1002/acr.20312[2]Althoff CE, Sieper J, Song I-H, et al (2013) Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis 72:967–973.https://doi.org/10.1136/annrheumdis-2012-201545[3]Weber U, Lambert RGW, Østergaard M, et al (2010) The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. ArthritisRheum 62:3048–3058.https://doi.org/10.1002/art.27571Disclosure of Interests:None declared

Background:In the recent decades, biological disease-modifying antirheumatic drugs (bDMARDs) have significantly improved management and quality of life in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).However, bDMARDs have also a strong influence on the immune system, leading to a risk of serious infection. Reactivation of hepatitis B (HBV) and C (HCV) virus is one of the most redoubtable complications of these immunosuppressive agents.Objectives:The aims of this study were to determine the screening rate for hepatitis B and C before starting a biological treatment and to examine the prevalence of their markers in patients with RA or SpA.Methods:Our study evaluated all patients included in the Tunisian registry BINAR (Biologic National Registry) since 2018 who had RA (ACR/EULAR 2010) or SpA (ASAS criteria) aged with more than eighteen years old and receiving their first bDMARDs during the two past years.The following information were retrieved from the registry: demographic data on the patients, disease parameters, medication, HBV surface antigen (HBs Ag), antibody to HBs Ag (Anti HBs), antibody to HBV core antigen (Anti HBc), HBV-DNA, antibody to HCV (anti HCV) status and liver function tests (AST: aspartate aminotransferase; ALT:alanine aminotransferase).Results:A total of 298 patients was included, 111 men and 178 women, with a mean age of 49.2 ± 14.1 years old [18-79]. Among them, 58.7% were diagnosed with RA and 41.3% were diagnosed with SpA. The mean disease duration was 6.7±3.5 years [1-12] in patients with RA and 6.5±3 [1-12] in patients with SpA. The mean Disease Activity Score (DAS28) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were respectively of 4.9±1.5 [1-8] and 4.1±1.8 [0-9].Therapeutically, 167 patients (56%) were on Prednisone at a mean daily posology of 8.2±5.4 mg [4-60] and 70.3% on conventional synthetic disease modifying antirheumatic drug (csDMARD) in association with bDMARDs. It was about Tumor Necrosis Factor alpha antibodies (anti TNF a) in 87.9% of cases, Tocilizumab in 10.4% of cases and Rituximab in 5% of cases.A screening of HBV was performed in 286 patients (96%). Ag HBs was positive in two cases (0.7%), and anti-HBc was positive in 16 cases (6.4%) which indicate a prior HBV infection. Fifteen patients (6%) were immunized with positive anti HBs. HBV-DNA was measured in 177 cases (66.8%) and was positive in 15 patients (6%).HCV infection was searched in 282 patients (94.6%) and anti-HCV was negative in all cases.AST and ALT mean rates were respectively of 18.3 [2-108] and 17.9 UI/l [2-74]. A perturbation of these liver function tests was observed in 13 patients (4.4%).Conclusion:Screening for hepatitis B and C were performed respectively in 96% and 94% of our Tunisian patients before receiving any bDMARDs. This should be systematic to avoid HBV reactivation which can lead to fulminant hepatic failure with a severe prognosis.Disclosure of Interests:None declared

Background:Magnetic resonance imaging (MRI) of sacroiliac joints (SIJ) can assess early inflammatory changes, thus allowing an early diagnosis of spondyloarthritis (SpA). However, its use in clinical practice may be limited by its cost, its duration and its limited availability. In this sense, ultrasound (US) has been suggested as a feasible and easy-to-apply alternative.Objectives:The objective of this study was to evaluate the validity of Color Doppler Ultrasound (CDUS) in early assessment of sacroiliitis, compared to MRI findings as the gold standard.Methods:A cross-sectional prospective monocentric study included patients attending the rheumatology department with suggestive signs of SpA between February 2014 and February 2017. Patients with pelvic radiography showing a confirmed sacroiliitis (grade 3 or 4) were not included. Eligible patients underwent US and MRI of SIJ. US examinations were performed by an experimented musculoskeletal radiologist blinded to MRI results. Vascularization within the SIJs was explored by the presence of a CDUS. When an artery was found, the resistive index (RI) was measured. The values of the RI ranged between 0 and 1. Doppler of each SIJ was considered as positive when RI was Results:Forty-three patients were included: 10 men and 33 women, with an average age at inclusion of 40.2 ± 11.1 years [17-59]. The mean duration of symptoms was 46±37.5 months [6.6-180]. A personal history of uveitis was noted in 3 patients and of chronic diarrhea in 3 patients. Morning stiffness was noted in 72% (n=31) of patients. Good response to nonsteroidal anti-inflammatory drugs (NSAIDs) and to physical activity were respectively reported by 41.8% (n=18) and 58% (n=25) of patients. Sacroiliac compression test, distraction provocative test, sacral thrust test, Gaenslen’s test, Faber’s test (Patrick) and Mennel’s test were respectively positive in 39.5%, 32.5%, 48.8%, 23.2%, 32.5%, and 51.2% of the patients. Twenty-seven per cent of the patients were HLA-B27+. The MRI showed a confirmed sacroiliitis in 14 patients. Doppler signal was detected in 44 SIJ of 25 patients, of whom 14 SIJ of 8 patients showed bone marrow edema at MRI (p=0.054). At the joint level, considering MRI-proven sacroiliitis as the diagnostic standard, CDUS had a sensitivity of 70%, a specificity of 54.5%, a positive predictive value of 31.8%, and a negative predictive value of 85.7%. The spectral Doppler RI, averagely estimated at 0.74±0.12 [0.48-0.87], was not associated with the presence of sacroiliitis on MRI (p=0.747).Conclusion:US, an imaging technique increasingly used in the assessment of musculoskeletal diseases, has been suggested to detect active sacroiliitis [1, 2]. Our study revealed that in early SpA, CDUS may be useful to assess active inflammatory changes of SIJ since it had a sensitivity of 70%, despite a relatively reduced specificity. However, RI values, which are expected to be low in patients with active inflammation [3], were unrelated to the presence of sacroiliitis. Future studies on larger numbers of patients might be conducted to complete previous data.References:[1]Mohammadi A, Ghasemi-rad M, Aghdashi M, et al (2013) Evaluation of disease activity in ankylosing spondylitis; diagnostic value of color Doppler ultrasonography. Skeletal Radiol 42:219–224.https://doi.org/10.1007/s00256-012-1412-7[2]Hu Z, Xu M, Wang Q, et al (2015) Colour Doppler ultrasonography can be used to detect the changes of sacroiliitis and peripheral enthesitis in patients with ankylosing spondylitis during adalimumab treatment. Clin Exp Rheumatol 33:844–850[3]Arslan H, Sakarya ME, Adak B, et al (1999) Duplex and color Doppler sonographic findings in active sacroiliitis. AJR Am J Roentgenol 173:677–680.https://doi.org/10.2214/ajr.173.3.10470902Disclosure of Interests:None declared

Background The enthesitis screening is critical for the diagnosis and for monitoring the disease activity in axial spondyloarthritis(AS). Several indices have been developed for the clinical evaluation of enthesitis, including the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) in 2003 and the Spondyloarthritis Research Consortium of Canada (SPARCC) in 2008. Each of them has advantages and limitations, but could they be complementary? Objectives The objective of our study was to compare the abilities of MASES and SPARCC in detecting enthesitis and to look for possible correlations between these two scores. Methods We designed this prospective study in 60 patients meeting modified New York criteria for AS and seen at the rheumatology department. All patients underwent a clinical evaluation, in which scores of MASES (range 0–13) SPARCC (range 0–16) and visual analogue scale (VAS) for entheseal pain were recorded. Ultrasound scans were taken for five entheses sites on both sides in lower limbs (proximal and distal insertions of the patellar tendon, patellar insertion of the quadriceps tendon, and calcaneal insertions of the Achilles tendon and superficial plantar fascia). Results Sixty AS patients were enrolled (48 men and 12 women) with a mean age of 36 years20–74 and mean disease duration of 8.8 years [0.5–25]. Biological inflammation was detected in 51 patients with mean erythrocyte sedimentation rate (ESR) of 332–98 and mean C reactive protein of 16.9 mg/L [0–240]. Physical examination found 77/600 painful entheses sites(12.8%), of which quadriceps and calcaneum entheses were the most painful in 16% and 15.8% cases respectively. The mean MASES was 3.4 [0–13] and the mean SPARCC was 2.98 [0–16]. A null MASES and SPARCC scores were recorded in 18 (30%) and 23 (38%) patients respectively. US imaging of the entheses showed peritendinous oedema and bursitis mainly at distal insertions of the patellar tendon in 51% and 55% respectively. Erosions were more likely detected at Achilles tendon site (95.8%). MASES and SPARCC scores were both significantly correlated with VAS for entheseal pain (r=0.52; r=0.46; p Conclusions Good correlations were found between the 2 enthesitis indices in AS with special sonographic featuresfor each, attesting their complementary relationship. Disclosure of Interest None declared

Background Mood disorders are frequently associated to chronic diseases. They are reported in inflammatory diseases as well as in mechanical rheumatologic disorders but they are not systematically recognised and assessed by clinicians. It is necessary to identify the frequency of moods disorders in order to reduce their impact on patient’s compliance to treatment. Objectives The aim of this study was to assess the impact of chronicrheumatologic diseases on the mood of patients by comparing inflammatory and mechanical diseases and to identify factors correlated with anxiety and depression. Methods We conducted a cross-sectional study during 1 year including Tunisian patients with chronic inflammatory rheumatism (rheumatoid arthritis: RA according to the criteria ACR 1987 and axial spondyloarthritis: AS according to modified NEW YORK criteria)and patients with mechanical disorders (chronic low back pain and primitive knee osteoarthritis). Anxiety and depression were assessed by the BAI (Beck anxiety index) and the BDI (Beck depression index), respectively. Results We included 120 patients with chronic inflammatory rheumatism (group 1) and 80 patients with mechanical disease (group2). Group 1 was composed of 70 patients with RA and 50 patients with AS including 65 women and 55 men. Their average age was 46.95 [18.75]. Group 2 was composed of 40patients with chronic low back pain and 40 patients with knee osteoarthritis including 48 women and 32 men. Their average age was 51.95 [18.82]. Anxiety was significantly more frequent in group 1 than group 2: 15.52% vs 9.37% (p=0.000). Depression was significantly more noted in group 1 than group 2:16.29%vs 7.16% (p=0.009). The risk factors for anxiety and depression were respectively in the rheumatoid arthritis:tender and swollen joint count, DAS 28, the HAQ and the sharp erosion score. In AS, factors associated to mood disorders were the visual scale of pain, BASFI, BASDAI, ASDASESR and CRP. In the chronic low back pain mood disorders are associated to functional impairment assessed by the Eiffel questionnaire and the reduced mobility of the lumbar spine assessed by the distance finger-soil. Finally knee in osteoarthritis moods disorders were associated to Lequesne index and the reduction of knee extension. Conclusions Patients with chronic rheumatologic diseases suffer very often from anxiety and depression which was related in majority of cases to functional impairment, hence the need for multidisciplinary management. Disclosure of Interest None declared

Background The prevalence of Infectious spondylodiscitis (SPD) has decreased recentlywith the development of effective means of prevention. Multifocal forms are more common in immunocompromised persons, but may be seen in immunocompetent ones. They are severe, and fortunately remain rare. Objectives The aim of our study was to report the clinical, biological, radiological and therapeutic features of multifocal SPD in immunocompetent patients. Methods A retrospective study was performed including patients hospitalised in the department of rheumatology between January 2007 and December 2017. Clinical data, laboratory findings and radiologic features were evaluated. Results Six patients were included. Theirmean age was 53 years.34–81 No comorbidities were found in all patients. The interval between the beginning of the symptomatology and the diagnosis was 3 to 6 months. Fever was noticed in 4 cases. All the patients had inflammatory spinal pain. Two patients had neurologic deficiency: one spinal compression and one root compression. The localization of the infection was lumbar and thoracic in 3 cases, cervical in 1 case and lumbar in 2 cases. MRI showed epiduritis in 3cases and paravertebral abscess in 1 case. The infectious agent was identified by blood cultures in 1 case (Staphylococcus Aureus), by disco vertebral biopsy in 3 cases (tuberculosis) and by brucella serology in 2 cases. All patients underwent antibiotic therapy and immobilisation with a goodoutcome, only one patient needed surgery aiming to decompress the spinal cord. Investigation for immunodeficiency was negative in all patients. Conclusions Multifocal SPD in immunocompetent patients remains rare. Its etiology is dominated by tuberculosis. The most frequent localizations are lumbar and thoracic spine. Disclosure of Interest None declared

Background Fatigue is frequently reported by patients with inflammatory chronic diseases as well as in mechanical rheumatologic disorders. But it’s not recognised and treated as priority by clinicians. It is necessary toidentify the frequency of this symptom and to determinate it’s impact on the quality of life of patient. Objectives We aimed to assess andto compare the frequency and the intensity of fatiguebetween inflammatory and degenerative chronic rheumatologic diseases, and to identify the factors correlated with fatigue in these diseases. Methods We conducted a cross-sectional study during 1 year including Tunisian patients with chronic inflammatory rheumatism (rheumatoid arthritis: RA according to the criteria ACR 1987 and axial spondyloarthritis: AS according to modified NEW YORK criteria)and patients with mechanical disorders (chronic low back pain and primitive knee osteoarthritis). Fatigue was assessed by the chalder questionnaire including physical and mental fatigue. Results We collected 120 patients with chronic inflammatory rheumatism (group 1) and 80 patients withmechanical disease (group2). Group 1 was composed of 70 RA and 50 AS including 65 women and 55 men. The average age was 46.95 [18.75]. Group 2 was composed of 40 chronic low back pain and 40 knee osteoarthritis including 48 women and 32 men. The average age was 51.95 [18.82]. Fatigue was more significantly observed in group 1 than in group 2: 8.40% vs 5.54% (p=0.000). Mental and physical fatigue was noted in 2.1% and 6.25% in group 1% and 1.0% and 4.49% in group 2, respectively. The risk factors for fatigue were in theRA thetender and swollen joint count, the DAS 28 and the HAQ. In AS, factors associated to fatigue were the visual scale of pain, BASFI, BASDAI, ASDAS ESR and CRP. In the chronic low back pain fatigue was associated by the functional impairment assessed by the Eiffel questionnaire. Finally knee in osteoarthritis fatigue was associated to Lequesne index and radiological stage. Conclusions Fatigue seems to be a frequent symptom in rheumatic diseases and mostly associated to severity and activity of the disease. Disclosure of Interest None declared

Background Bone loss leading to osteoporosis (OP) is a well-known feature of axial spondyloarthritis (AS) although this disease is characterised by calcification in extra osseous tissues and new bone formation. In fact, dual-energy X-ray absorptiometry (DEXA) is the most common imaging method used to measure the bone mineral density (BMD). However, many studies have shown an inferiority of the postero-anterior (PA) spine measurements in reflecting the bone loss compared to lateral spine measurements because of the bridging syndesmophytes which may overestimate the BMD. Objectives Our aim is to evaluate the Lateral spine BMD (L-BMD) in AS and to assess its association with the disease features. Methods Seventy-five patients who met the Modified New York Classification criteria for AS were enrolled in this cross-sectional study. BMD was measured using DEXA at PA lumbar, lateral lumbar and hip regions. Results Sixty-two men and 13 women were enrolled with an average age of 36.8±11.8 years. Bone loss (osteopenia or OP) was noted in 65% of the patients (n=46) in PA lumbar and in 63% in lateral lumber (n=45). In L-BMD, BMD was correlated with early menopause and vitamin D level (p=0.01 and p=0.04 respectively). T-score in lateral spine was correlated with coffee consumption (p=0.02), physical inactivity (p=0.037), sexual hormones disorders (p=0.02), hip arthritis (p=0.017), BASMI (p=0.001), BASFI (p=0.03) and ASDASVS (p=0.03) scores, ESR (p=0.003) and CRP (p=0.03) levels, and hip (p=0.004), spine (p=0.007) and total (p=0.001) BASRI. Conclusions L-BMD seems to be a reliable measurement in AS, and may avoid the overestimation of the BMD values and allows consequently to detect spinal osteoporosis and prevent fractures in AS. References [1] El Maghraou A, Borderie D, Cherruau B, Edouard R, Roux C, Dougados M (1999) Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol26:2205–2209 [2] Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology39:85–89 Disclosure of Interest None declared

Background: The role of ultrasound imaging (US) in rheumatoid arthritis (RA) management is fundamental by sharpen diagnosis, predicting prognosis, monitoring disease activity and identifying remission. The detection of subclinical synovitis and articular inflammatory changes represent the real advantages of this technology. However, joint US is time-consuming, thus identifying the area of subclinical synovitis should be useful to overcome this difficulty. Objectives: We aimed to assess the most profitable joint locations in detecting subclinical synovitis in RA. Methods: We performed a cross-sectional study of one hundred patients with inflammatory joint pain or synovitis for more than 6 weeks and less than 2 years. All patients were free of conventional or biological DMARD’s at inclusion. An experienced radiologist performed the MSUS scan of 22 joints (2 wrists, 10 metacarpophalangeal joints MCP and 10 proximal interphalangeal joints PIP) unaware of clinical and biological findings. MSUS was performed using a Philips HD11. The used frequency ranged from 15 to 17 MHz and we used a Power Doppler (PD). After US assessment, patients were classified as having RA according to ACR/EULAR 2010 criteria. Results: We enrolled 100 patients (77 women and 23 men) with a mean age of 51.8 years [16–77]. Fifty-five patients (55%) fulfilled the ACR/EULAR 2010 criteria for the diagnosis of RA. The mean disease duration was 10.96 months [2–24]. Rheumatoid factor and ACPA were positive in 53% and 25% cases respectively. The mean disease activity score at the time of study was 5.36 [1.36–8.61]. A clinical wrist synovitis was found in 92 cases (46%). In the 54 wrists with no clinical synovitis, a total number of US wrist synovitis was detected at 30 (15%) radioulnar (of which half was Doppler +), 91 (45.5%) radiocarpal (of which 60% was Doppler +) and 105 (52.5%) intercarpal joints (of which 67% was Doppler +). Concerning the MCP and PIP joints, the most frequent location of subclinical synovitis were 1st MCP in 51 cases (25.5%), 4th MCP in 49 cases (24.5%), 5th MCP in 50 of cases (25%),1st PIP in 24 cases (12%) and 5th PIP in 22 cases (11%). Conclusions: Our study highlighted the low sensitivity of physical examination of synovitis in hand and wrist joints, especially in some locations. We showed the most frequent location for detecting subclinical synovitis were radiocarpal and intercarpal joint, 1st-4th -5th MCP and 1st-5th PIP. About half of those subclinical synovitis were Doppler +. Disclosure of Interest: None declared

Background Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease that affects the axial skeleton. It typically occurs in the late teens or early twenties and rarely in childhood, defining the juvenile onset (JoAS). The adult-onset AS (AoAS) and Juvenile-onset (JoAS) may share many common features including hip involvement. But their impact on function and quality of life may differ. Objectives To compare demographic, clinic and functional outcome of patients with hip involvement in JoAS, with that of patients with AoAS Methods Cross-sectional study including patients with AS according to the ,ASAS criteria of 2009 with hip involvement. The juvenile onset of coxitis was defined by an onset before 16 years of age. An analysis of demographic and clinical comparisons between the two groups was performed including HLA B27 status. Mobility spine outcomes were assessed by the Bath AS Metrology Index (BASMI) and radiographic disease severity by the Bath AS Radiology Index (BASRI). Results There were 100 AS aged on average 36.4±12,2 years old.16–69 The sex ratio was 4.6. The mean duration of progression of AS was 10.93±9,89 years [0.5–24]. It was a JoAS in 15 cases. All patients had a hip involvement. The juvenile onset of hip arthritis was associated with male gender (p=0,042), younger age of patient with AS at the time of recruitment (p=0,007), less severe clinical spinal involvement assessed by schober index (p=0,029) and more frequent and severe enthesitis assessed by MASES (p=0,024). Extra-articular manifestations were significantly more frequent in patients with juvenile onset of hip arthritis (p=0,008). Otherwise the comparison of the two groups showed no difference in the presence of uveitis (p=0,407) and pulmonary involvement (p=0,097). HLAB27 antigen was significantly more common in JoAS (p=0,037). BASRI and BASMI as well as ESR and CRP, were comparable between the two groups (p=0,976, p=0, 626, p=1,000, respectively) Conclusions Hip involvement is common in the AS, particularly in JoAS. Our study showed that juvenile onset hip arthritis was associated with male gender, less severe spine involvement, enthesitis and the presence of HLA B27. This would help physicians to identify patients at higher risk of developing hip involvement, to enable early diagnosis. References [1] Gensler LS, Ward MM, Reveille JD, Learch TJ, Weisman MH, Davis JC, Jr. Clinical, radiographic and functional differences between juvenile-onset and adult-onset ankylosing spondylitis: results from the PSOAS cohort. Ann Rheum Dis. 2008;67(2):233–7. [2] Stone M, Warren RW, Bruckel J, Cooper D, Cortinovis D, Inman RD. Juvenile-onset ankylosing spondylitis is associated with worse functional outcomes than adult-onset ankylosing spondylitis. Arthritis Rheum. 2005;53(3):445–51. Disclosure of Interest None declared

Background Axial spondyloarthritis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton. Hip involvement is common in AS patient. The reported prevalence of clinical hip involvement in AS ranges from 24% to 36% and prevalence of radiographic hip arthritis ranges from 9% to 22%.1, 2 Several radio-anatomic feature are described with often significant clinical impact. Objectives To assess for an association between the radio-anatomic feature of hip arthritis and its clinical impact in patients with AS. Methods Cross-sectional study including patients with AS according to the ,ASAS criteria of 2009 with hip arthritis. All patients had pelvic X-rays. This one allowed to distribute the patients according to five radio-anatomic feature of the hip arthritis: destructive, protrusive, ankylosing, mimicking osteoarthritis and early hip arthritis. To evaluate the functional impairement, two clinical indices were calculated: Lequesne index and Intermalleolar distance between the two medial malleoli in centimetre. The comparison of qualitative variables was performed with the Chi square test and the comparison of qualitative variable and quantitative ones was performed with the Student’s test. The significance level was set at 0.05. Results One hundred patients were included with 176 hips arthritis. The delay between onset of AS and hip arthritis was on average 5.6 years [0–34]. The distribution of coxitis according to the radio-anatomic feature was as following: destructive (110 cases), protrusive (10 cases), mimicking osteoarthritis (29 cases), ankylosing (7 cases) and early hip arthritis (20 cases). According to the Larsen classification for destructive hip arthritis: a grade 4 was found in 41 cases, a grade 2 in 33 cases, a grade 3 in 33cases and a grade 1 in 3 cases. The destructive form had the most important functional impairment with the highest Lequesne index in comparison with other forms (13,05 vs 9,7, p=0,000) and the smallest intermalleolar distance (74,40 vs 87,29, p=0,010). The early hip arthritis and protrusive forms had the least important functional impact in with the following scores: Lequesne index (8,83 vs 12,29, p=0,015) and (10,78 vs 11, 96, p=0,000) and the intermalleolar distance (76,36 vs 65,00 p=0,015) and (105,56 vs 70,22, p=0,002) respectively. Scores were comparables for osteoarthritis and ankylosing forms. Conclusions Our study showed that radio-anatomic feature of hip arthritis could influence functional impairment. Distinguishing these forms may allow the rheumatologist to select the hip arthritis that deserves more attention because of the highest risk of functional impairement. References [1] Jeong H, Eun YH, Kim IY, Kim H, Lee J, Koh EM, et al. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea. Korean J Intern Med. 2017;32(1):158–64. [2] Zhao J, Zheng W, Zhang C, Li J, Liu D, Xu W. Radiographic hip involvement in ankylosing spondylitis: factors associated with severe hip diseases. J Rheumatol. 2015;42(1):106–10. Disclosure of Interest None declared

Background Sleep disorders are frequent feature of chronic rheumatologic diseases. They are reported in inflammatory diseases as well as in mechanical disorders but they are not systematically assessed by clinicians. It is necessary to identify the frequency and factors associated to sleep problems in order to reduce their impact on patient’s quality of life. Objectives We aim to describe the sleep pattern in inflammatory and mechanical chronic rheumatologic diseases and to assess factors associated with sleep disorders. Methods We conducted a cross-sectional study during 1 year including Tunisian patients with chronic inflammatory rheumatism (rheumatoid arthritis: RA according to the criteria ACR 1987 and axial spondyloarthritis: AS according to modified NEW YORK criteria) and patients with mechanical disorders (chronic low back pain and primitive knee osteoarthritis). Sleep has been evaluated by the MOS-SS questionnary. For each group specific disease parameters were assessed at the same time of the administration of the questionnary. Results We collected 120 patients with chronic inflammatory rheumatism (group 1) and 80 patients with mechanical disorder (group2). Group 1 was composed of 70 RA and 50 SPA including 65 women and 55 men. The average age was 46.95 [18.75]. Group 2 was composed of 40 chronic low back pain and 40 primitive knee osteoarthritis including 48 women and 32 men. The average age was 51.95 [18.82]. Sleep disorders were frequent in both groups, but they were more noticeable in Group 1 patients than Group 2 patients 53.68% vs 26.38% (p=0.00). Risk factors for sleep disorders in rheumatoid arthritis were disease activity (p=0.00) and functional impairment (p=0.00). In patients with spondyloarthritis, risk factors for sleep impairment were disease activity (BASDAI (p=0.00), ASDAS vs (p=0.00) et ASDAS CRP (p=0.00)) and impaired quality of life (p=0.00). The factors involved in sleep disorders in chronic low back pain was the reduced lumbar spine mobility assessed by the finger-to-ground distance (p=0.00) and the schober index (p=0.01) and functional impairment assessed by Eiffel questionnaire (p=0.00). In patients with knee osteoarthritis the Lequesne index (p=0.008), the knee extension limitation (p=0.00) and the radiological damage (p=0.004) were associated to sleep impairment. Conclusions Our results illustrate the frequency of sleep disorders in chronic rheumatic diseases. They should not be under estimated in patients with mechanical disorders. A better control of the factors associated to sleep impairment for each disease should help promoting a better sleep quality in patients with chronic rheumatologic diseases. Disclosure of Interest None declared

Background Ultrasound imaging (US) is actually considered as a crucial element of the diagnostic process in rheumatic diseases and could be the method of choice in imaging peripheral synovitis, typical feature during rheumatoid arthritis (RA). The 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria focused on early-stage RA, and were designed to remedy the deficiencies in the 1987 ACR criteria, but still lacking sensitivity. Objectives We undertook this study to investigate whether including the ultra-sonographic data in calculating the 1987 ACR and 2010 ACR/EULAR criteria is useful in diagnosing RA. Methods We performed a cross-sectional study of one hundred patients with inflammatory joint pain or synovitis for more than 6 weeks and less than 2 years. An experienced radiologist performed the MSUS scan of 22 joints (2 wrists, 10 metacarpophalangeal joints MCP and 10 proximal interphalangeal joints PIP) unaware of clinical and biological findings. After US assessment, patients were classified as having RA according to ACR/ EULAR 2010 criteria using clinical, biologic and radiographic data (clinical ACR87 or clinical ACR/EULAR2010). Then we calculate those criteria using US data: US-ACR87 including erosion detected in US as a criterion and US-ACR/EULAR2010 including the number of synovitis detected in US as a criterion. Results One hundred RA patients were included (77 women and 23 men) with a mean age of 51.8 years.16–77 The mean disease duration was 10.96.2 24 Rheumatoid factor and antibodies against cyclic citrullinated peptides were positive in 53% and 25% cases respectively. Sixty-five patients (65%) accomplished the clinical ACR87 criteria and 55 patients (55%) fulfilled the clinical ACR/EULAR2010 criteria for the diagnosis of RA. Using US data eighty patients (80%) accomplished the US-ACR87 criteria and 68 patients (68%) fulfilled the US-ACR/EULAR2010 criteria for the diagnosis of RA. A good correlation was found between clinical and US ACR/EULAR criteria (k=0,684, p=0,000). US score showed a very good sensitivity of 100%, specificity of 67,5%, positive predictive value of 76,9% and negative predictive value of 100% compared to clinical score. In table 1 we summarise correlation between clinical and US ACR/EULAR criteria. Conclusions Our study showed that including US data in the classification criteria of RA, will improve diagnostic impact of those criteria during RA management. Disclosure of Interest None declared

Background Chronic hepatitis C (CHC) is assimilated to a systemic disease because of his multiple extrahepatic manifestations notably rheumatological. Objectives The aim of this study was to determinate the prevalence and the characteristics of rheumatological manifestations (RM) associated with CHC. Methods A retrospective study including all patients suffering from CHC followed over a period of 11 years (2002–2012). Were excluded all patients co-infected by hepatitis B virus or by human immunodefficiency virus and those having decompensated cirrhosis. Different RM were collected and analysed according to the epidemiological, clinico-biological, immunological, virological and histological data of the CHC. Results Two hundred and four patients affected by CHC were included, meanly aged by 52 years [22–66 years]. The sex-ratio was 0,46. MR were noted in 76 patients (37,25%) dominated by inflammatory polyarthralgia of big joints (88,25%). Non erosive arthritis was observed in a woman and was localised to the proximal interphalangeal articulation of the index. Myalgia were noted in 11 cases (14,47%) among them, 2 appeared under antiviral treatment. Sicca Syndrome was observed in 17 cases (22,36%). RM were associated to other extrahepatic manifestations of CHC in 69,7% of cases, notably to mixed cryoglobulinemia (MC) (60%) and to antinuclear antibodies (21,6%). Anti DNA, anti SSA, anti SSB, rheumatoid factor and anti CCP were absent in all cases. A partial to total amelioration of RM was noted in almost patients under antiviral treatment and sometimes associated to symptomatic measures. In univariate analyse, only feminal sexe and presence of MC were significatly correlated to the presence of MR. Conclusions During CHC, MR are frequent, dominated by arthralgia, myalgia and sicca syndrome. Authentic arthritis are rare and constitute a diagnostic problem essentially when they inaugurate the disease. MC is the immunological factor the most associated with RM. Treatment of MR still antiviral. Disclosure of Interest None declared

Background The hip disease is a serious complication of spondyloarthritis (SpA), engaging the functional prognosis of patients. TNF alpha inhibitors are a breakthrough for the treatment of SpA and the management of this complication. Objectives To assess the efficacy of TNF alpha inhibitors on hip involvement in SpA by evaluating the use of intra-articular corticosteroid infiltrations. Methods Observational cohort study that included 94 SpA patients with hip disease (ASAS2009). Two groups were studied. Group 1 (G1): patients under anti-TNF alpha therapy and Group 2 (G2): TNF alpha inhibitors naive patients. Clinical (BASDAI, BASFI, hip (pain/mobility), index of severity for osteoarthritis for the hip (ISH)), biological (CRP) data were assessed and the use of corticosteroid hip joint infiltration was compared. Evaluations were performed and compared between the 2 groups at baseline (T0), two years (T2) and Tn (greater than or equal to 3 years). The correlation study was made by Pearson test. A correlation was considered statistically significant if p Results Group 1 and 2 included 48 and 46 patients respectively. The socio demographic and clinical characteristics of the disease were comparable between the two groups. Biological and radiological assessments of the two groups were comparable at T0. Group 1 had however a more active disease and a greater functional impairment. NSAIDs were prescribed in 40% of patients in G1 and 86% in G2 (p Conclusions Hip involvement is a marker of severity of spondyloarthritis. Anti-TNF alpha treatment is effective on hip disease. It reduces the use of intra articular injections of corticosteroids. Disclosure of Interest None declared

Background Biological therapies had greatly improved the treatment of rheumatoid arthritis (RA). The response to biologics may be influenced by many factors. Little is known about the impact of body composition inRA biologics. Objectives We aimed to investigate the impact of obesity (BMI≥30) andbody composition (lean mass/ fat mass)on response to biotherapy in RA. Methods A retrospective study was performed over a period of 11 years (2006–2016). Patients diagnosed RA (according to the ACR 1987 criteria) and treated by biologics were enrolled. Body composition (lean mass/ fat mass) was measured by X-ray biphotonic absorption (DXA). The threshold of signification was set for a value of p Results Fifty patients were enrolled, including 5 men and 45 women (sex ratio=0.11). The mean age was 66 years [38–79]. The mean duration of RA was 5 years [1–30]. The mean duration of treatment with biologics was 38 months [6–120]. Thirty nine patients were treated by TNF alpha inhibitors (25 etanercept, 7 adalimumab, 6 infliximab and 1 certolizumabpegol), 6 rituximab and 5 tocilizumab. Nine patients had a normal weight (18%), 17 had overweight (34%) and 24 had obesity (49%). The average percentage of fat mass was 44.8 [23–54], with a median of 46. While comparing obese patients with others, we did not notice a significant difference in the mean variation of the DAS28 at 6 months for TNF alpha inhibitors nor for all biotherapies combined (respectively p=0.6 and p=0.9). The same result was observed while comparing the DAS28 according to the body composition (relative to the median of the percentage of the fat mass: for TNF alpha inhibitors (p=0,6) and for all biotherapies combined (p=0,09)). Conclusions In our study, there was no change in response to biologics in patients with RA. Further prospective studies with a larger size will be required to confirm or reverse these results. References Iannone F, Lopalco G and al. Impact of obesity on the clinical outcome of rheumatologic patients in biotherapy. Autoimmun Rev. 2016 May;15(5):447–50. doi: 10.1016. Gardette A, Ottaviani S. Body mass index and response to tocilizumab in rheumatoid arthritis: a real life study. Clin Rheumatol. 2016 Apr;35(4):857–61. doi: 10.1007. Disclosure of Interest None declared

Background spondyloarthritis (SpA) is characterized by inflammation of spine and sacroiliac joints. Hip involvement is the most frequent extra spinal arthritic manifestation of SpA and may lead to a worse functional outcome. Objectives The objective of this study was to assess clinical, biological and radiological characteristics of SpA patients with hip disease. Methods This is a transversal multicenter study, including SpAs patients (satisfying ASAS criteria2009) with hip disease Demographic, clinical, radiographic, and laboratory data were collected and analyzed. Radiographic forms of hip disease were assessed according to Netter classification (early, condensing, destructive, combined and synostosante forms). Radiographic severity was assessed by the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) and BASRI (Bath Ankylosing Spondylitis Radiologic Index). Results ninety four patients were evaluated (77men). The mean age was 41.53±11.97 years. The median age at disease onset was 26.23±10.29 years.The mean diagnostic delay was 6.48 years. 46% of patients were smoker. HLA B27 was positive in 50% of cases. A peripheral joint involvement was found in 33% of cases. Extra-articular manifestation was seen in 57% of patients: osteoporosis (16 patients), uveitis (15 patients), psoraisis (10 patients), chronic inflammatory bowel disease (12 patients). 78 patients had bilateral hip involvement and 147 hips were evaluated. The median BASDAI and BASFI scores were respectively 5,4 and 5,5. The mean index of severity for osteoarthritis for the hip (ISH) was 12.24 (±6.84). Patients had an early form of hip disease in 22% of cases, Condensing form in 3% of cases, combined forms in 22% of cases and destructive form in 53% of cases. BASRI-hip score was 1 in 24%, 2 in 49%, 3 in 19% and 4 in 8% of hips. Sacoiliac joint grade was 2 in 17%, 3 in 37% and 4 in 46% of cases. The mean mSASSS score was 15.34±16.22. TNF inhibitors were indicated in 49% of patients (infliximab 23, Adalimumab 7 and Etanercept 18).31 patients received csDMARDs and 46 NSAID. Conclusions Our finding confirm previous observation that clinical and radiological hip involvement is associated with a more severe disease with a high activity and pronounced functional impairments. Disclosure of Interest None declared

Background One of the major goals of treatment of spondyloarthrites (SpA) is to prevent or slow the radiographic damage.The results of clinical trials raised expectations that TNFi are effective not only on clinical and biological parameters of the disease but may also have structural effect. Objectives We assessed whether the baseline Bath Ankylosing Spondylitis Radiology (BASRI) hip index had effect on structural hip progression under TNFα blockers in SpA patients with hip disease. Methods This was a multicentric longitudinal study including SpA patients (ASAS2009) with hip disease under TNF α blockers. Anteroposterior X-rays of the pelvis obtained at baseline were compared with X-rays obtained after 5 years [3–10] of continuous TNF α blockers treatment. Radiographic progression of the hip was evaluated by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h), scoring system (min 0 = no change, 1 = focal joint space narrowing, 2 = circumferential joint space narrowing >2 mm, 3 = circumferential joint space narrowing ≤2 mm or bone-on-bone apposition of 0.3mm (RH-). Results 48 patients were included (81% male). The average age was 40.7±11years. The mean age at the onset of the disease was 25.8±10 years. Hip involvement was bilateral in 77% of cases. At baseline, the mean BASRI hip index was 2±0.8. The BASRI hip score was 1 in 26%, 2 in 51%, 3 in 18% and 4 in 5% of patients. The average of hip joint space width at baseline was 3.4±1.2mm. Infliximab was the most prescribed TNFα blocker (48%) followed by Etanercept (37.5%) and Adalimumab (14.5%).After 5years, the mean BASRI hip index remained stable 2±0.8, the BASRI hip score was 1 in 23%, 2 in 50%, 3 in 14% and 4 in 13% (p=ns). The variation of hip joint space width was-0.294 mm (p=ns). 29 patients were RH+. The BASRI hip index 2±0.8 and 2.1±0.9 in RH+ and RH- patients respectively with no statistically significant difference. Conclusions According to our study the structural hip joint progression under TNFα blockers is not influenced by the baseline BASRI hip index. References Konsta M,Sfikakis PP, Bournia VK, Karras D, Iliopoulos A.Clin Rheumatol (2013) 32:1229–1232. Disclosure of Interest None declared

Background The link between Coeliac disease (CD) and low bone mass has been established in several large international studies. Objectives To determinate the prevalence and risk factors of osteopenia and osteoporosis in a Tunisian population of coeliac patients. Methods We carried a retrospective study from January 1991 to December 2015 including all cases of CD diagnosed in the departement of Gastroenterology B in Rabta9s Hospital. We retained all patients having a bone mineral density (BMD). We used the WHO criteria for the diagnosis of osteoporosis and osteopenia. Results During the period of the study, 78 cases of CD were included. Thirty among them, performed a BMD: 25 women and 5 men with an average age of 35.8 years. Malnutrtion was found in 14 patients with a BMI Conclusions Our study showed that approximately ¾ of coeliac patients had a low bone mass. Osteoporosis was found in 33% of our patients and was associated to a marked villous atrophy. Disclosure of Interest None declared

Background Fortunately, management of RA at the early stage has become possible thanks to both the emergence of new biotherapies and the strategy treat to target. Musculoskeletal ultrasound (US) is a potent tool for the detection of synovitis, effusion and bone erosion in RA. Objectives The aim of this study was to assess the contribution of US in diagnosing RA at the early stage of the disease. Methods A cross-sectional study was performed during 2 years. Patients with a history of inflammatory joint pain for ≥6 weeks and ≤2 years with synovitis of at least one joint were enrolled in this study. All patients underwent clinical assessement, laboratory tests and plain radiography of hands and feet.US was assessed within one week of clinical examination. Synovitis and erosion were defined according to the OMERACT. Results One hundred patients were included in this study with an average age of 51,8±14,6 years-old. Female outnumbered male with a sex ratio of 3,8. The mean duration of the disease was 10,9±7,4 months. When admitted to our department and after clinical examination it was found that 31% of patients presented polyarthritis, 4% had oligoarthritis and 7% suffered from monoarthritis. US findings: US was found to be more sensitive than clinical examination to detect synovitis. Among the 2200 joints assessed by US, a synovitis was detected in 81% patients, an intra-articular effusion in 36% patients and PD signals in 51% patients. Also, flexor tenosynovitis were present in 55% patients and extensor tenosynovitis in 59% patients. Erosions were more detected in plain radiography (70%) than in US (41%). Clinical parameters (VAS, duration of morning stiffness, number of night awakens, TJC) were not correlated with most US findings. Nevertheless, correlation was detected for US effusion (r=0,250, p=0,028) and for US Doppler (r=0,289, p=0,011) with SJC. PDUS examination correlated with CRP results (r=0,302, p=0,023) but not with ESR results. A significant, positive correlation was observed between erosions in X-rays or US assessment (r=0,342, p=0,002). The US detected synovitis in 25% of patients who had no swollen joint at the clinical examination when admitted to our department and had detected erosions in 9% of patients having negative plain X rays. Conclusions Ultrasound appears as a sensitive tool to detect subclinical synovitis (25%) and infra- radiological erosions (9%). It helps us to make an early diagnosis and start appropriate treatment before the onset of irreversible joint destruction. Disclosure of Interest None declared

Key Clinical Message We report here a case of hyperparathyroidism with disseminated brown tumors mimicking malignancy. The important clinical teaching of our case is that hyperparathyroidism can take various aspects. Plasma parathyroid hormone concentration should be measured in all patients with multiple bone lesions.

Introduction Choosing between the different indices of activity evaluation in RA is often difficult considering the very heterogeneous clinical expression of the disease. The objective of our study was to evaluate the level of similarity between SDAI, CDAI, DAS28-ESR and DAS28-CRP indices in the evaluation of RA activity. Patients and methods In this transversal study, a total of 100 patients with RA responding to the ACR 87 criteria were followed up for a period of 20 months. The correlations between the four indices were studied through the Pearson's correlation coefficient (r). The similarity between these tools was evaluated through Kendall's (K) “tau” similarity coefficient. Results The 87 female and 13 male patients (sex ratio: 6.7F/1M) were of a mean age of 52.9 ± 11.6 years (17–77) and have been living with RA for a mean of 8.3 ± 9 years (2 months–41 years). The DAS28-ESR mean score was 5.53 ± 1.46 [1.25–8.05]. The DAS28-CRP mean score was 5.01 ± 1.44 [1.68–7.81]. The CDAI mean score was 30.72 ± 15.04 [2–62] and that of SDAI was 28.86 ± 15.86 [2.3–71.3]. A positive, statistically significant correlation was noted between the four indices of RA activity. The level of similarity between the different indices was good (K variation between 0.758 and 0.943). DAS28-ESR allowed classifying the patients in the same category of disease activity than DAS28-CRP in a proportion of 85%. This proportion was 88% when comparing DAS28-ESR to CDAI and SDAI, respectively. Regarding DAS28-CRP and CDAI, these two indices classified the patients in the same category in a proportion of 80%, compared to 87% regarding DAS28-CRP and SDAI. Finally, CDAI and SDAI classified the patients in the same category in a proportion of 92% with an excellent level of similarity. Conclusion Different evaluation indices of RA activity are currently available. DAS28 is the most used. CDAI and especially SDAI have a good level of similarity with DAS28. Their advantage is to be simple and quick, and seem therefore well adapted to the follow-up of outpatients.

Objectives To look for correlations among clinical, radiographic, and sonographic scores for enthesitis in patients with ankylosing spondylitis (AS). Methods Prospective study of 60 patients meeting modified New York criteria for AS. The clinical evaluation relied on the BASDAI, BASFI, and ASQoL and on a visual analog scale (VAS) for entheseal pain, as well as on two specific enthesitis indices, the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and the Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Radiographs and ultrasound scans were taken of five entheses on both sides (patellar insertion of the quadriceps tendon, proximal and distal insertions of the patellar tendon, and calcaneal insertions of the Achilles tendon and superficial plantar fascia). Ultrasound scans were obtained using a Philips HD 11™ machine with a high-frequency linear probe. Results We studied 48 men and 12 women with a mean age of 36 ± 11 years. The radiographic score correlated with the VAS pain score, BASDAI, and BASFI. The sonographic score for acute enthesitis correlated only with the MASES, and the sonographic score for chronic enthesitis correlated with none of the clinical scores. The Doppler score correlated with the VAS pain score, BASDAI, BASFI, and ASQoL. The overall sonographic score correlated with the MASES and SPARCC. Conclusion Good correlations were found between the clinical and sonographic scores for enthesitis. The radiographic score seemed correlated with the general AS parameters rather than with the clinical scores. Larger studies are needed to better define the role for radiographs and sonography of the entheses in the diagnosis of AS and follow-up of treated AS patients.

Resume Objectifs Rechercher les correlations entre les scores cliniques, radiographiques et echographiques d’enthesite au cours de la spondylarthrite ankylosante (SA). Methodes Etude prospective portant sur 60 patients, atteints de SA, repondant aux criteres de New York modifies. Nous avons utilise le BASDAI, le BASFI, l’ASQoL et l’echelle visuelle analogique (Eva) au niveau des entheses pour l’evaluation clinique de la SA, ainsi que les indices specifiques d’enthesite : le Maastrich Ankylosing spondylitis Enthesitis Score (MASES) et le Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Cinq sites enthesiques ont ete explores de facon bilaterale par des radiographies et par des echographies-Doppler (insertion rotulienne du quadriceps, insertions proximale et distale du tendon rotulien, insertion du tendon d’Achille et de l’aponevrose plantaire superficielle), a l’aide d’un echographe Philips HD 11TM utilisant une sonde a balayage lineaire de haute frequence. Resultats Cette etude a porte sur 48 hommes et 12 femmes, leur âge moyen etait de 36 ± 11ans. L’etude des correlations entre les scores cliniques, radiographique et echographiques a montre que le score radiographique etait correle avec l’Eva douleur des entheses, le BASDAI et le BASFI. Le score echographique d’enthesite aigue etait correle uniquement avec le MASES. Le score echographique d’enthesite chronique n’etait correle avec aucun score clinique. Le score Doppler etait correle avec l’Eva douleur, le BASDAI, le BASFI et l’ASQoL. Enfin, le score echographique global etait correle avec le MASES et le SPARCC. Conclusion Une bonne concordance a ete notee entre les scores cliniques et echographiques d’enthesite alors que le score radiographique semble plus lie aux parametres generaux de la SA. Des etudes de plus grande envergure sont necessaires pour mieux apprecier la place des radiographies et de l’echographie des entheses dans la demarche diagnostique et le suivi des malades sous traitement.

Purpose of the study Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting axial skeleton, occurring in young and active patients and often condition their professional prospects. Objectives To describe the social and occupational characteristics of patients affected by AS, to estimate the impact of the disease on their professional activity and to determine factors exposing to elevated risk of premature withdrawal from the labor force. Methods We had performed a cross-sectional study of 103 patients with AS recruited during 2 years (2005–2007) at the Department of Rheumatology, fulfilling the modified criteria of New York. Demographic, social and professional characteristics were determinated and some disease-specific instruments: BASDAI, BASFI, BASMI, BASG-s, BASRI, as well as an indicator of quality of life: the Short Form Survey-36 (SF-36). Results It is about 88 man and 15 women, the average age is 37.6 years ± 11.7 (18–59 years). Seventy percent of patients live in urban zone and 17% have an educational level superior to 13 years. The disease duration is on average of 11.2 ± 9.6 years. The mean score of BASFI is 45.5 ± 27.5 (7–100), the mean score of BASDAI is 45.9 ± 22.4 (9–100), the mean score of BASG-s is 53.8 ± 21.2, the mean score of BASMI is of 4.4 ± 2.2 (3–10), the mean score of BASRI is 8.4 ± 3.5 (2–16). Among these patients 95 (92%) are eligible to a professional activity (aged between 18 and 65 years and having ended their studies or vocational training). The global unemployment rate is 25.3%, that's attributed to the disease is 20.6%. Some factors are associated with high risk of work withdrawal: female gender ( p = 0.0005), low educational level ( p = 0.02), living in rural zone ( p = 0.028), manual labor ( p = 0.038), cold exposing in work place ( p = 0.006), high work time a week ( p = 0.02) and the absence of colleague help ( p = 0.001). For the specific disease indexes, high risk of withdrawal is correlated with high scores of BASFI ( p = 0.00002), BASDAI ( p = 0.044), BAS-Gs ( p = 0.0005) and BASMI (0.0000). Concerning the SF-36, only the item of physical activity is more significantly altered in patient's having stopped their work. Conclusion Several factors are identified to be associated to a high risk of premature working withdrawal in patients affected by AS. Prevention of this risk needs an early diagnosis and treatment of the disease, a vocational guidance, work preliminary training and eventually professional redeployment.

Osseous hydatidosis is reported in only 0.5-2.5% of the cases. The scapulohumeral localization is extremely rare. A 39-year-old woman, born in a rural area of Tunisia, presented swelling and tenderness of the left shoulder with limited motion 7 days after a minor trauma. Plain radiographs, CT and MRI showed osteolytic scapulohumeral lesions, cortical rupture and multiple cysts in the muscles, which were suggestive of hydatidosis. Indirect haemagglutination test using hydatid antigen was positive (1/280). The patient refused radical surgery and underwent resection of axillary cysts. Albendazole was given in the recommended dose but was stopped immediately due to hepatic toxicity. Scapulohumeral hydatidosis is extremely rare, often invasive and behaves like a locally malignant bone tumour. Its treatment is also difficult.

Piriformis syndrome (PS) is an uncommon cause of sciatica-like pain with buttock pain referred to the leg and caused by extraspinal compression of the sciatic nerve by the piriformis muscle.1 Diagnosis is often difficult. Piriformis syndrome is frequently posttraumatic or in relation with anatomic a

Objectives: The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.Methods: A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.Results: This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.Conclusion: Impairment in the quality of life can be significantwhen suffering from AS, affecting mental health more than physicalhealth. Among disease parameters, functional impairment,disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 5 juillet 2011

To assess the performance of ultrasound in detecting erosion, swelling, and new bone comparing to radiographs in five lower limb entheses in patients with ankylosing spondylitis (AS). Prospective study of 60 patients meeting modified New York criteria for AS. Lateral radiographs of both knees and ankles followed by a high-resolution Doppler ultrasound examination with a high-frequency (15 MHz) linear probe were performed. Ultrasound had an excellent sensitivity, but specificity was very weak compared to radiographs for erosion, swelling, and new bone formation. Negative and positive predictive values were good only for erosion. Ultrasound seems to be a performant instrument in detecting signs of chronic enthesitis particularly when radiograph is normal.

The authors report a case of a 37 years old man with Behcet's disease since 7 years who develops a destructive chronic polyarthritis involving wrists, hands and one knee. The parallel evolution between recurrent orogenital ulceration and arthritis added to the absence of other associated destructive rheumatism permit to link this polyarthritis to Behcet disease. In spite of the few reports, the occurrence of destructive arthritis can't exclude absolutely the diagnosis of this affection.

The objective of the study is to assess the distribution of HLA-B genes, HLA-B27 subtypes, HLA-DRB1 and HLA-DQB1 alleles in patients with ankylosing spondylitis (AS) and in control subjects in the Tunisian population and to compare their distribution with that found in other countries. This is a case-control study that included 100 consecutive patients (85 males/15 females) with AS according to the modified New York criteria and 100 control individuals. HLA-B, B27 subtypes and class II (DR and DQ) typing of all subjects was performed by polymerase chain reaction amplification with sequence-specific primers (PCR-SSP). HLA-B27 was found in 62% of patients against 3% in controls (P = 0.0000, OR = 52.6, 15.6 < CI < 166.7). On the other hand, B*07 and B*51 were significantly decreased in comparison with controls (P = 0.01, OR = 0.3, 0.1 < CI < 0.8 and P = 0.0000, OR = 0.2, 0.1 < CI < 0.4, respectively). Eight B*27 subtypes were identified in the AS group, but the most frequent ones were B*2702 (32%) and B*2705 (24%). Among HLA-DRB1 alleles, a significant increase in DRB1*11 was found in comparison with controls (P = 0.01, OR = 2.2, 1.2 < CI < 4.5). However, DRB1*13 had a negative association with AS (P = 0.01, OR = 0.4, 0.2 < CI < 0.8). For HLA-DQB1 alleles, a significant positive association with DQB1*03 was observed in AS group (P = 0.03, OR = 1.8, 1.0 < CI < 3.4). Multivariate analysis by logistic regression revealed that DRB1*11 and DQB1*03 had no direct links with the disease, but were dependent on the presence of HLA-B27. Moreover, B*07 and B*51 seemed to have independently a negative correlation with AS, but DRB1*13 seemed to depend on B*51. Haplotypes carrying B27 were significantly associated with AS and those carrying B*07 or B*51 were negatively correlated with the disease. In conclusion, our study confirms that B27 predisposes to AS while B*07 and B*51 are negatively correlated with the disease.

Background Tuberculous infection of the musculoskeletal system count 10% of all extrapulmonary cases of tuberculosis (TB). In musculoskeletal tuberculous infections, the involvement of TB in peripheral joints and tendons is rare. In this report we will describe 8 cases of flexor tuberculous tenosynovitis (FTT). Objectives The aim of our work is to analyze the diagnostical, therapeutical and evolutionary aspects of this disease through a series of 8 cases of FTT patients treated. Methods A retrospective study was conducted selecting patients followed-up for FTT. Patients hospitalized during the period from 2008 till December 2014 were recruited. Previous history of TB or exposure to TB was searched. All patients underwent hands plain radiographies and ultrasounds, chests radiographies, tuberculin skin test (TST), sputum smears and cultures; then to surgical synovectomy with histological and bacterial examination. Results Eight patients were included (5 females, 3 males), with a mean age of 45 years-old [33 – 59]. All patients were immunocompetent and without a past medical history of TB. A local steroid injection preceding the infectious episode was noted in one case and a cow bite was revealed in another case. The mean period before consulting was 15 months [3-23]. Fever, night sweats and weight loss was noted in 3 patients. First symptom of illness was swelling of the palmar side in 4 cases, of the left 4th finger in 2 cases, of the right 5th finger in one case and a carpal tunnel syndrome in an another case. Hands plain radiographies weren9t contributive for the diagnosis, however ultrasound showed flexor tenosynovitis in all cases. Chest radiography revealed squeal of tuberculosis in one patient. TST was always positive but sputum smears and cultures were negatives in all cases. Histological examinations and bacterial culture confirm the diagnosis of FTT in all patients. Combination of anti-tuberculosis antibiotics was well conducted and evolution was good for all patients. Conclusions Although rarely seen, FTT should be kept in mind if we found chronic flexor tenosynovitis; a detailed medical history and careful clinical examination should be taken to prevent misdiagnosis. Histological examinations and bacterial culture are very important to confirm the diagnosis. Disclosure of Interest None declared

Background Brucellar spondylitis is rare. It is also the most prevalent clinical form of osteoarticular involvement in adults infected by Brucella. Objectives The aim of this study was to report the clinical, biological, radiological and therapeutic features of brucellar spondylodiscitis. Methods Retrospective study including 6 patients followed up in our department between 2006 and 2014. Results We studied 6 cases (5 of them are male) with a mean age of 55.3 years old [20 - 83]. 3 patients were consumers of unpasteurized milk. The median delay of consultation was 6 months. All patients had fever, night sweats and generalized weakness. Lumbar spine was affected in 4 cases and cervical spine in 2 cases. Neurologic examination was normal in 5 cases, 1 patient had neurologic deficiency. Plain radiographs revealed narrowing of disc spaces in 5 cases and erosion of the antero-upper corner of the body of vertebra in 1 case. MRI was performed in all cases and revealed features suggesting spondylodiscitis in all patients. Epidural inflammation was found in 4 cases. Disco vertebral biopsy was performed in 1 patient revealing a nonspecific histological appearance and an inconclusive bacteriological study. Laboratory tests including CRP, sedimentation rate and leucocytes were increased in all cases. Rose-Bengale test and Wright test were positive in all of them. They were treated with double antibiotics (Rifadine and Cycline), during an average of 4 months in all cases. All of them had in immobilisation and also had a favourable development. Conclusions Brucellar spondylodiscitis may be difficult to diagnose and have an acute or chronic course. Only rapid and correct management may prevent irreversible neurologic deficits and spinal deformities. Disclosure of Interest None declared

Background Spondylodiscitis is a quite rare disease characterized by insidious onset and non-specific symptoms such as back pain and fever. Consequently, early diagnosis is difficult and is often missed despite repeated warnings in the medical journals and better access to imaging techniques such as magnetic resonance imaging (MRI). Spondylodiscitis may take acute, subacute or chronic course. Objectives We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis. Methods Retrospective study including patients diagnosed as spondylodiscitis and hospitalized in our department between 2006 and 2014. Results Sixteen patients were included. Ten patients (62,5%) were male. The mean age of our patients was 57 years [20 – 83]. Predisposing factors were found in 7 patients (43%): diabetes in 5 cases, chronic renal failure in 1 case and a patient with sickle cell disease. The lumbar spine was most affected (75%), the dorsal spine was affected in (12,5%) as the cervical spine (12,5%). A-multi stage spondylodiscitis was found in 3 cases. A neurological deficit was noted in 2 patients. Inflammation tests were disturbed in 87,5% of them. Radiographs of the spine were abnormal in all cases. Fourteen patients had MRI exam, showed epiduritis in 6 patients and paravertebral abscess in 7 patients. The causative microorganism was identified in 14 cases (87,5%): brucella in 6 patients, mycobacterium tuberculosis in 5 patients, staphylococcus in 1 case, Gram-negative germs in 1 case and streptococcus in 1 case. Multi-bacterial spondylodiscitis was found in 1 patient. All of them received initially adapted antibiotics. Two patients have not been followed, and most of the rest showed good response (78%). Neurological complication occurred in 1 case and sepsis occurred in 1 other case. Disturbance of liver function due to treatment occurred in two cases with good subsequent evolution. Conclusions Spondylodiscitis is an emergency which must be diagnosed on time to avoid life threatening complications, neurological sequelae and spinal deformities. Disclosure of Interest None declared