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Background: Synovial chondromatosis is an uncommon benign condition characterized by synovial membrane proliferation and metaplasia. Synovial chondromatosis cases in patients with rheumatoid arthritis have been reported. However, involvement of the glenohumeral joint is rare. Case presentation: We herein report a case of a rare association of synovial chondromatosis involving the shoulder in a rheumatoid arthritis patient. The symptoms have improved with anti-tumor necrosis factor drugs. Consequently, there was no need for invasive therapy for treating synovial chondromatosis. Conclusions: Synovial chondromatosis can be aggressive and destructive. More trials are needed to establish a better clinical diagnostic strategy and pharmacological management.

Background: Knee osteoarthritis, a chronic degenerative disease, is becoming a public health problem around the world due to increasing life expectancy. Objectives: We aimed to assess the impact of knee osteoarthritis on the quality of life (QoL) of the patients and to identify factors associated with impaired QoL. Materials and Methods: We conducted a cross-sectional monocentric study including patients with knee osteoarthritis. The pain was evaluated by the Visual Analog Scale (VAS). The short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) was used to assess functional im-pact. QoL was assessed using the OsteoArthritis of Knee Hip Quality Of Life (OAKHQOL) ques-tionnaire. Results: Fifty patients were included. The mean age of patients was 59 ± 9 years. The sex ratio was 0.25. At least one comorbidity was noted in 77% of patients. The mean disease duration was 8.82 years. Mean VAS pain and KOOS-PS were 6.8 ± 1.1 and 54.7 ± 9.6/100; respectively. Assessment of the QoL by OAKHQOL showed impaired QoL in all domains; the worst scores concerned the areas of social functioning and pain. Factors associated with an altered QoL were age > 65 years, longer disease duration, higher pain intensity, comorbidities, and functional impairment. Conclusion: Our patients showed an impaired QoL in all domains, particularly in terms of physical activity and social functioning. Lower QoL scores were associated with age, comorbidities, pain, function, and disease duration. Factors associated with QoL should be considered in the manage-ment program of these patients. Screening and the treatment of comorbidities are also useful for the management of knee OA.

Backgroung: Fibromyalgia may be associated to Spondyloarthritis with which it shares some common symptoms such as sleep disorders, fatigue and diffuse pain, leading to diagnostic and treatment dilemmas. Objectives: We aimed to determine the prevalence of fibromyalgia in axial spondyloarthritis and to determine how fibromyalgia might influence the assessments of disease activity and how it might impact treatment. Methods: An observational cross-sectional study was conducted. The study included 100 patients with axial spondyloarthritis according to the Assessment of SpondyloArthritis international Society criteria. Fibromyalgia was diagnosed based on the 2010 American College of Rheumatology crite-ria. Demographics, disease characteristics, activity parameters and treatment were compared be-tween patients with and without fibromyalgia. Patients were recruited from the hospitalization unit and the outpatient clinic of rheumatology. Results: The mean age of patients was 44.65 ± 13.13 years, with a sex ratio equal to 2. The preva-lence of fibromyalgia was 20%. Fibromyalgia associated factors were advanced age and a late age at the onset of axial spondyloarthritis. Disease activity parameters such as global pain VAS, BASDAI, ASDAS-ESR, ASDAS-CRP, BASFI and BAS-G as well as MASES and BASMI were significantly higher in the presence of FM. Doses of paracetamol were significantly higher among FM+ patients. Also, treatment duration of the current anti-TNF alpha agent was significantly shorter among FM+ patients. Conclusion: Our study showed that fibromyalgia was associated with axial spondyloarthritis in 20% of patients. Its presence was associated with higher disease activity parameters and negative impact on the treatment.

We aimed to investigate the relationship between epicardial adipose tissue (EAT) thickness, flow-mediated dilation (FMD), and carotid intima-media thickness (cIMT) in spondyloarthritis (SpA) patients compared to healthy controls.We performed a cross-sectional study including SpA patients aged ≤ 50 years without traditional cardiovascular risk factors and healthy controls matched for age and gender. Baseline characteristics, laboratory data, and SpA-related parameters were recorded. All participants underwent ultrasound examination with measurement of EAT thickness, FMD, and cIMT by both an experienced cardiologist and radiologist blinded to clinical data. The relationships between the ultrasound measurements were analyzed using Spearman's correlation coefficient and Person correlation.The study included 94 subjects (47 SpA and 47 healthy controls). The sex-ratio was 2.35; the median age of patients was 36 years (IQR: 28-46), and the median disease duration was 11 years (IQR: 5-16). Compared to the control group, SpA patients had significantly higher values of EAT thickness (p = 0.001) and cIMT (p 0.0001). FMD values were significantly lower in SpA patients compared to controls (p = 0.008). The univariate analysis detected a significant negative association between EAT thickness and FMD (p = 0.026; r = - 0.325), and between left cIMT and FMD (p = 0.027; r = - 0.322). No association was found between EAT thickness and cIMT.EAT thickness, FMD, and cIMT were significantly impaired in SpA patients compared with healthy controls supporting evidence of accelerated atherosclerosis in SpA. EAT thickness was correlated to endothelial dysfunction suggesting the role of EAT in predicting the early reversible stages of atherosclerosis. Key Points • Spondyloarthritis is associated with impaired subclinical atherosclerosis markers accurately increased epicardial fat and carotid intima-media thickness and endothelial dysfunction. • Increased epicardial fat thickness is correlated with impaired endothelial function in spondyloarthritis patients.

The objective of the study was to assess clinical and imaging features of rheumatoid arthritis associated with atlantoaxial dislocation (RA-AAD) in comparison to RA without AAD (RA-C) and to identify the associated factors to AAD.This was a retrospective comparative study including RA patients over 18 years old. The control group of RA-C was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, AAD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of AAD.A total of 120 patients were included (78 RA-AAD and 42 RA-C); sex-ratio was 0.15. Mean age was 58.55 ± 9.14 years (RA-AAD) versus 60.43 ± 10.78 years (RA-C), (p = 0.31). Regarding RA features, RA-AAD patients have significantly a higher rheumatoid factor (RF) rate (p = 0.002), extra-articular manifestations (p = 0.009) especially osteoporosis (p 10Our results confirmed that predictive factors of AAD were related to higher disease activity and structural damage. These modifiable factors may be prevented by tight control, early treatment, and educating RA patients to improve treatment adherence.

Foot function is usually assessed using self-reported outcome measures which remain subjective in patients with rheumatoid arthritis (RA). Physical performance tests were recommended for functional assessment in lower limb osteoarthritis. However, foot function assessment's guidelines in RA are lacking. We aimed to investigate the correlation between a self-reported outcome measure and two performance-based physical tests for assessing foot function in RA patients.A cross-sectional study was performed over 7 months' period including RA patients. We used Rheumatoid and Arthritis Outcome score (RAOS) as a self-reported functional tool. Physical performance tests were 4-min walk test (4-MWT) and Timed up and go test (TUGT).Fifty RA patients were included with 96% females and a mean age of 54.7 ± 10.4 years. Foot involvement occurred since the diagnosis of RA in 36% of patients. Foot pain was reported by 68% of patients (48% forefoot), and foot stiffness in 46% of patients. Skin lesions of the feet were found in 78% of patients, 90% had foot deformities and 56% had inflammatory disorders of feet. Radiographic lesions were found in 94% of patients. The most impaired RAOS subscales were Sports and Recreation and Quality of life. Poor physical-based performance was found in 34% of RA patients according to 4-MWT, in 42% of RA patients according TUGT, and in 46% of patients based on at least one performance test. RAOS was negatively correlated to the 4-MWT and positively correlated in the subscales pain, other symptoms, activities of daily living, and Sport/Rec of the RAOS. Poor performance-based physical tests were significantly associated with advanced age, sedentary lifestyle, higher disease activity score and impaired functional status. Foot-related parameters significantly associated with poor performance-based physical tests were: foot pain, foot deformity and inflammatory disorders. Multivariate analysis identified foot deformities and higher functional impairment as predictive factors for lower gait speed (4-MWT) and older age and higher functional impairment for higher duration of TUGT.RAOS was significantly associated with performance-based physical function. In the era of connected technologies, these results encourage the regular assessment of rheumatoid foot function by the RAOS score through a connected programme using wearable trackers.

Sarcopenia is a syndrome defined by generalized and progressive loss of skeletal muscle mass, strength, and function. Besides affecting elderly population, it is actually common among inflammatory rheumatic diseases (IRD) patients. We performed a systematic literature review with a meta-analysis to investigate the influence of biologic and target synthetic disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) on sarcopenia in IRD. A systematic search has been performed on Pubmed, Scopus, and Web of science. Studies characteristics were collected. Assessment tools were body composition (total lean mass (TLM) and percentage, appendicular skeletal mass (ASM), fat-free mass and index (FFM and FFMI), skeletal mass index (SMI) and segmental lean mass (SLM)), and muscle strength and physical performance tests. Treatment effect defined the difference in change from baseline to the end of follow-up treatment was divided by the pooled SD of the difference. Twenty-two studies on 778 patients receiving bDMARDs/tsDMARDs and 157 controls were reviewed. They investigated rheumatoid arthritis (RA) (N = 14), spondyloarthritis (SpA) (N = 6), psoriatic arthritis (N = 1), and both RA and SpA (N = 1). tsDMARDs were used in one study with no effect on sarcopenia. Ten studies demonstrated that bDMARDs increased significantly muscle measures in 347 patients (44.6%) with a significant increase in TLM (6/15 studies; 57.4%), FFMI (4/6 studies; 59.9%), ASM (2/5 studies; 17.6%), SMI (2/5 studies; 18.1%), and SLM (2/2 studies; 3.6%). bDMARDs showed also a positive effect on handgrip strength in 1/3 of studies (45.2%) and on physical performance in 1/2 of studies (61%). In 1/5 of comparative studies, IRD patients on bDMARDs showed significantly higher increase of TLM in comparison to controls naïve bDMARDs. Regarding diagnosis, positive effect of bDMARDs was seen in 67.4% in SpA versus 49.3% in RA, with a significant increase of TLM, ASM and FFMI in 59.4%, 100%, and 65.2% in SpA versus 54.9%, 24.1%, and 54.8% in RA, respectively. Meta-analysis assessed the effect of bDMARD on TLM in 10 studies. There was no statistically significant difference [SMD - 0.10 (95% Confidence Interval - 0.26 - 0.06; tau

Gitelman syndrome represents the clinical manifestations of inactivation of the Slc12a3 genes encoding the thiazide-sensitive sodium chloride cotransporter and the Trpm6-Mg genes encoding the magnesium transporters in the distal convoluted tubule. In fact, the biochemical findings resemble those with thiazide diuretics such as hypokalemia, hypomagnesaemia, hypocalciuria, metabolic alkalosis, and low normal blood pressure. He is usually associated with calcium pyrophosphate deposition. Serum uricemia level is rarely affected in Gitelman syndrome. We aimed to report a rare association of chronic gout with Gitelman syndrome, hence the interest of our case. We describe a 29-year-old male patient with a history of Gitelman syndrome associated with articular gout including pelvic localization. We provided pictorial evidence of extensive and diffuse monosodium urate deposition in articular and periarticular structures to confirm the gout origin. A literature review illustrates 4 reported cases of Gitelman syndrome associated with gout. The gender distribution was equal with a mean age of 40 years.

Objectives: The aim of this study was to evaluate the prevalence of neuropathic pain components of knee osteoarthritis (OA) patients and to identify the relation between associated neuropathic pain and comorbidities, pain intensity, function, and radiographic severity of knee OA. Methods: This cross-sectional study enrolled patients with knee OA (ACR criteria 1986). Visual Analog Scale (VAS), DN4 questionnaires were performed for each patient. A score of DN4≥4/10 was classified as diagnostic for neuropathic pain. Functional impairment was estimated using the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) ad radiographs were rated using the Kellgren Lawrence (KL). Results: We recruited 101 patients with a sex ratio was 0.1. The mean age was 65.5±10.8 years [41-95]. The mean duration of symptoms was 3.5 years. At least one comorbidity was revealed for 88.1% of patients. Mean VAS pain was 6.5±1.69. The mean DN4 score was 4.8± 2.4. The prevalence of NP (DN4≥4) was detected in 68.3%. The most frequently described NP characteristic was the sensation of burning (74%). The mean KOOS-PS score was 46.4±19.2. Based on KL grading, 78.2% of OA were classified grade III-IV. Female gender, number of comorbidities, bilateral knee OA, mean VAS pain, and mean KOOS-PS score were significantly higher in the neuropathic pain group when compared to the group without neuropathic (respectively: p=0.01,p=0.04, p=0.017, p=0.00, p=0.00). In multivariate regression, KOOS-PS and bilateral knee OA were independently associated with NP. Conclusion: Our results highlight the frequent NP in patients with knee OA (68.3%) and its relation with function and comorbidities.

BackgroundThe aim of our study was to assess subclinical atherosclerosis in spondyloarthritis (SpA) by combining three ultrasound methods (flow-mediated dilation (FMD), carotid intima–media thickness (cIMT) and Ankle Brachial Index (ABI)) and to determine the predictive factors of theses parameters.MethodsThis was a case control study conducted over 12 months including 47 patients with SpA-free-cardiovascular (CV) disease in comparison with age and sex matched 47 healthy controls. Sociodemographic, clinical and biological features as well as therapeutic modalities were recorded in our patients. All subjects had Doppler ultrasound with measurement of cIMT, FMD and ABI. Ultrasound measurements were compared between patients and controls. Linear regression was performed and assessed by machine learning to determine the predictive models of markers of subclinical atherosclerosis.ResultsWe found higher cIMT (pConclusionOur study supported the accelerated subclinical atherosclerosis in patients with SpA. This subclinical atherosclerosis was mainly mediated by traditional CV risk factors.

Objectives This study aims to assess the prevalence of joint surgery in Tunisian patients with rheumatoid arthritis (RA) and to determine the risk factors of surgical treatment. Patients and methods This retrospective cross-sectional study was performed over a period of 15 years between January 2000 and December 2014 and included 500 Tunisian patients with RA (78 males, 422 females; mean age 53.4 years; range, 21 to 83 years). The prevalence of joint surgery indication was evaluated. Clinical, paraclinical and therapeutic characteristics of RA were compared according to the need of surgery. Results Female to male ratio was 5. The indication of joint surgery was noted in 59 patients (12%). Knee joint surgery was the most performed surgical procedure (56% of surgical treatment). A decrease in surgery prevalence from 30% in 2004 to 4% in 2013 was noted. Statistical study showed that factors associated with joint surgery were: delayed diagnosis (p=0.037), long RA duration (p=0.017), young onset of RA (p

The aim of this study was to evaluate the variation of homocysteine (Hcy) levels in patients with rheumatoid arthritis (RA) and to analyze the relationship to inflammatory parameters, cardiovascular risk, and methotrexate (MTX).This cross-sectional study assessed disease activity and treatment in RA patients. The European League Against Rheumatism (EULAR) 2015 HeartSCORE was performed for cardiovascular (CV) risk estimation and levels of plasma Hcy, serum folate concentrations, vitamin B12, and erythrocyte sedimentation rate (ESR) were measured.A total of 103 participants with mean age 53 ± 10 years and mean disease duration 10.55 ± 7.34 years were included. Patients were treated with MTX in 69.9% of cases and corticosteroid in 80.5% of cases. Of all patients, 13% had a cardiovascular inheritance, 25% were hypertensive, and 18% had diabetes. The EULAR 2015 HeartSCORE was high and very high (≥5%) in 35% of cases. Mean Hcy level was 12.54 ± 4.2 µmol/L [6.89-32.92] and hyperhomocysteinemia was noted in 20.4% of patients. Analytic study demonstrated that hyperhomocysteinemia was associated with male gender (p = 0.01), MTX use (p = 0.01), smoking (p = 0.008), renal failure (p = 0.04), and high disease activity (p = 0.05), but there was no association with the HeartSCORE (p = 0.23). Hcy level was negatively correlated with folate (p = 0.009) and vitamin B12 level (p = 0.02) and positively with age (p = 0.01), C‑reactive protein (CRP; p = 0.05), and Simplified Disease Activity Index (SDAI; p = 0.03). In multivariate logistic regression analysis, current MTX use, levels of vitamin B12 and creatine, and Clinical Disease Activity Index (CDAI) appeared to be independent factors associated with hyperhomocysteinemia.MTX use, CDAI, and the levels of vitamin B12 and creatine are independent factors associated with hyperhomocysteinemia.HINTERGRUND: Ziel der vorliegenden Studie war es, Unterschiede in den Werten für Homocystein (Hcy) bei Patienten mit rheumatoider Arthritis (RA) und den Zusammenhang mit Entzündungsparametern, Herz-Kreislauf-Risiko und Methotrexat (MTX) zu untersuchen.In dieser Querschnittstudie wurden Krankheitsaktivität und Therapie von RA-Patienten analysiert. Zur Abschätzung des kardiovaskulären Risikos wurde The European League Against Rheumatism (EULAR) 2015 HeartSCORE eingesetzt und die Werte für Plasma-Hcy, Folsäurekonzentration im Serum, Vitamin B12 und Blutsenkungsgeschwindigkeit (BSG) bestimmt.Es wurden 103 Teilnehmer mit einem mittleren Alter von 53 ± 10 Jahren und einer mittleren Krankheitsdauer von 10,55 ± 7,34 Jahren in die Studie einbezogen. In 69,9% der Fälle wurden die Patienten mit MTX und in 80,5% mit Kortikosteroiden behandelt. Bei 13% der Patienten bestanden familiär kardiovaskuläre Erkrankungen, bei 25% Hypertonie und bei 18% Diabetes mellitus. In 35% der Fälle war der EULAR 2015 HeartSCORE hoch oder sehr hoch (5%). Im Mittel betrug der Hcy-Wert 12,54 ± 4,2 µmol/l [6,89–32,92], und eine Hyperhomocysteinämie lag bei 20,4% der Patienten vor. Die Auswertung ergab, dass eine Hyperhomocysteinämie mit männlichem Geschlecht (p = 0,01), MTX-Therapie (p = 0,01), Rauchen (p = 0,008), Niereninsuffizienz (p = 0,04) und hoher Krankheitsaktivität (p = 0,05) assoziiert war, aber es gab keinen Zusammenhang mit dem HeartSCORE (p = 0,23). Der Hcy-Wert war negativ mit den Werten für Folsäure (p = 0,009) und Vitamin B12 (p = 0,02) korreliert und positiv mit dem Alter (p = 0,01), C‑reaktivem Protein (CRP; p = 0,05) und dem Simplified Disease Activity Index (SDAI; p = 0,03). In der multivariaten logistischen Regressionsanalyse schienen eine derzeitige MTX-Therapie, Werte für Vitamin B12 und Kreatin sowie der Clinical Disease Activity Index (CDAI) unabhängige Faktoren zu sein, die mit Hyperhomocysteinämie assoziiert waren.MTX-Therapie, CDAI und die Werte für Vitamin B12 und Kreatin sind unabhängige, mit Hyperhomocysteinämie assoziierte Faktoren.

The shoulder may be affected in a large portion of patients with rheumatoid arthritis (RA) worldwide. However, this joint does not receive the attention required during follow-up. Indeed, although numerous clinical tests for diagnosis of a painful shoulder are available, differentiating articular from peri-articular lesions may be difficult in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA has benefited from a reliable imaging modality used to detect its exact origin—ultrasonography (US). This study was aimed at assessing the intra- and inter-observer reliability of ultrasonographic findings for patients with established RA with shoulder pain in a patient-based exercise as a clinical challenge among Maghrebian rheumatologist experts in US. A total of 7 operators examined 10 patients in two rounds independently and blindly of each other. Before beginning the session, all of the rheumatologists reached a consensus on sites and US settings by performing a brief exercise on a normal shoulder. Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions of US-detected pathologies were used. Each patient underwent US scanning of the painful shoulder in predefined sites based on US technical guidelines of the European Society of Musculoskeletal Radiology: long head of biceps (LHB), subscapularis recess, posterior recess and axillary recess. The presence of subdeltoid or subcoracoid bursitis or full rupture of the suprasupinatus was identified if present. Intra- and inter-observer reliability measures were calculated using the κ coefficient. Intra-observer reliability was good for gray-scale (GS) synovitis in subscapularis and posterior recesses (κ = 0.77 and 0.73, respectively). It was moderate in the presence of GS synovitis and effusion in LHB (κ =0.53 and 0.40, respectively), posterior and subscapularis recess effusion (κ = 0.56 and 0.60, respectively) and GS and power Doppler (PD) synovitis in axillary recesses (κ = 0.58 and 0.49, respectively). Inter-observer reliability was good for PD for LHB signals (κ = 0.78). It was moderate for GS for LHB synovitis (κ = 0.54). Inter-observer agreement was poor for effusion and GS synovitis for subscapularis, posterior and axillary recesses, and very poor for PD signals in these recesses. US was a reliable imaging tool for detecting tenosynovitis in the LHB. However, reliability was moderate to poor in detecting synovitis in subscapularis, posterior and axillary recesses. These findings could be optimized by standardization of sites to assess.

Background: Liver involvement is not considered a typical extra-articular manifestation and has rarely been studied in rheumatoid arthritis (RA). : We aimed to identify the prevalence and aetiologies of liver disease in RA patients. Methods: A cross-sectional study included 150 patients with RA enrolled over 5 years (2010- 2015). The clinical and paraclinical features of RA were analyzed. The clinical and biological characteristics of liver impairment and its aetiologies were collected. Results: One hundred and fifty RA patients (124 women) with a mean age of 57.09 years and a mean RA duration of 7.52 years were included. Liver involvement was diagnosed in 66 patients (44%). The liver disease was asymptomatic in 94% of the cases, revealed by increased gammaglutamyl transferase levels in 74% of the patients. The aetiologies of liver involvement were hepatotoxicity of medications in 38 cases (57%), hepatitis B and C in 14 patients (21%), fatty liver disease in 10 cases (15%), autoimmune liver disease in 2 patients (3%), hydatid cyst in 1 case (2%), and liver angiomas in 1 case (2%). Non-steroidal anti-inflammatory drugs and methotrexate were the drugs most often involved in the genesis of hepatotoxicity (21% and 20% of the cases, respectively). Conclusion: Liver involvement occurred in 44% of RA patients. Aetiologies were mainly hepatotoxicity and viral hepatitis B and C. Patients with RA should be systematically screened for liver disease, which is rarely symptomatic.

Background Fc gamma receptors (FcgR) type IIA IIIA and IIIB play an important role in the recognition of immune complexes (ICs) by binding their Ig-Fc portion. However, it has been demonstrated that FcgR single nucleotide polymorphisms (SNP) leads to low binding affinity alleles (FcgRIIA-131R, IIIA-158V and IIIB NA2). Therefore, we can make an assumption that the presence of these risk alleles could influence the outcome of immune mediated disease such as rheumatoid arthritis (RA). Objectives The aim of this study was to assess the relationship between functional SNP of FcgR IIA H13R, IIIA V158F and IIIB NA1/NA2 and disease severity scores in RA. Methods We assessed disease severity in RA patients based on the Health Assessment Questionnaire (HAQ) and Sharp/van der Heijde (mSharp) method. To reduce selection biais, all recruited patients were treated with conventional DMARDs.We considered patients with HAQ score ranged from 2 to 3 as having severe disability. For radiographic evaluation, since there is not validated threshold for joint damage severity, we took mSharp score median value of our population as a reference. Patients underwent FcgRIIA, FcgRIIIA and FcgRIIIB SNP study using PCR-SSP and direct sequencing process. Then, biallelic polymorphisms were examined for association with HAQ and mSharp score. Results Fifty-eight RA patients were enrolled. The mean duration of the disease was 11.77 years [0.5-24]. Among these patients, 34 (58.62%) had severe disability according to HAQ score. The mSharp median value was 43,5 [0-232] and 28 (48.28%) patients had a score above this value. Genotypic study showed that FcgR IIIB-NA2 was significantly associated with severe disability (p=0.021) (Table 1). Furthermore, FcgRIIIA-158F and IIA-131R carriers were more frequent in patients with severe disability but the association was not statistically significant. Finally, no correlation was found between radiographic evaluation and FcgR SNP study (table 2). Conclusion FcgR low affinity alleles seem to confer susceptibility to severe functional impairment in RA but not to structural damage. However further studies on larger population must be done to corroborate these findings. References [1] Brun JG, Madland TM, Vedeler CA. Immunoglobulin G Fc-receptor (FcgammaR) IIA, IIIA, and IIIB polymorphisms related to disease severity in rheumatoid arthritis. J Rheumatol. 2002;29:1135–40. [2] Kastbom A, Ahmadi A, Soderkvist P, Skogh T. The 158V polymorphism of Fc gamma receptor type IIIA in early rheumatoid arthritis: increased susceptibility and severity in male patients (the Swedish TIRA project) Rheumatology (Oxford)2005;44:1294–8. [3] Lee YH, Bae SC, Song GG. FCGR2A, FCGR3A, FCGR3B polymorphisms and susceptibility to rheumatoid arthritis: a meta-analysis.Clin Exp Rheumatol. 2015 Sep-Oct; 33 (5):647-54. Disclosure of Interests None declared

Background Rheumatoid arthritis (RA) is a common inflammatory disease developing within joints but extra-articular organs such as the lung could be involved. Objectives To determine the relationship between disease activity and lung involvement in rheumatoid arthritis (RA) Tunisian patients. Methods We performed a retrospective study of patients with RA diagnosed according to American College of Rheumatology-European League Against Rheumatism classification criteria for RA 2010 between 2014 and 2017 in a department of rheumatology in the north of Tunisia. The prevalence of pulmonary involvement was determined based on combined results from chest-X-ray, computed tomography of the chest and pulmonary functional tests. Disease activity was evaluated based on number of night waking, morning stiffness duration, painful joints number and swelling joints number, erythrocytes sedimentation rate (ESR) and C-reactive protein levels (CRP). Specific disease activity scores were also noted including the 28-joint Disease Activity Score Index (DAS28), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI). Results Sixty five patients were collected. Mean age was 56 years ± 12.8 years and mean age of disease onset was 46.4 ± 13.8 years ranging from 17 to 75 years. Mean disease duration was 9.6 ±10.1 year ranging from 1 to 38 years. Number of painful joints was 13.71 at mean and swelling joints number was 5.98. Morning stiffness duration was 1.03 hour at mean and number of night waking was 2.31. Concerning laboratory investigations, mean ESR was 49.7 mm ant mean CRP level was 13.6 mg/l. The average of DAS28 was 5.8. The overall frequency of lung involvement based on different lung investigations was 27.6% (18 patients). Interstitial lung disease was found in 7 cases, bronchiectasis was found in 5 cases, rheumatoid nodule in 4 cases and pleural disease in 2 cases. Patients with lung involvement had significantly higher painful joints number (p=0,034) and no difference was seen concerning swelling joints number. Number of night waking and morning stiffness duration had no impact in lung involvement (p=0,651, p=0,907 respectively). RA patients with lung involvement displayed higher ESR level (p=0,032) and no difference was seen concerning CRP level. No association was found between lung involvement and specific disease activity scores (DAS28, CDAI, SDAI). Conclusion Our study showed that only high level of ESR could be associated with lung involvement in RA Tunisian patients. References [1] Perez-Doramea R, Mejiaa M, Mateos-Toledoa H,Rojas-Serranob J.Rheumatoid arthritis-associated interstitial lung disease: Lung inflammation evaluated with high resolution computed tomography scan is correlated to rheumatoid arthritis disease activity. Clin Rheumatol. 2015;11(1):12-6. [2] Jearn LH, Kim TY. Level of anticitrullinated peptide/protein antibody is not associated with lung diseases in rheumatoid arthritis. J Rheumatol 2012;39:1493-4.2] Jearn LH, Kim TY. Level of anticitrullinated peptide/protein antibody is not associated with lung diseases in rheumatoid arthritis. J Rheumatol 2012;39:1493-4. Disclosure of Interests None declared

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 Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the axial skeleton and can lead to complete ankylosis of the involved joint. Unfortunately, involvement of the facet joints (FJ) is not evaluated by the available scoring methods that are supposed to quantify the structural damage of the spine. Aim of the work The aim of the present study we assessed is the involvement of FJ in Tunisian AS patients with low radiological score. Patients and methods Results of 8 AS patients (7 men; 1 woman) with FJ involvement and low radiological scores were retrospectively studied. Their median age was 36 years, age at onset 26 and disease duration of 10 years. The Bath AS Radiology Index (BASRI) and the Stoke AS Spinal Score (SASSS) were calculated in all patients from the radiographs of lateral cervical spine, anteroposterior and lateral lumbar spine. Results All patients had FJ ankylosis without involvement of the anterior part of the spine. Six patients (75%) had inflammatory back pain and 2 had bilateral hip pain with radiological involvement. Cervical spine limitation was noted in 4 patients. Limited lumbar spine mobility and bilateral sacroiliitis were present in all cases. The HLA-B27 typing was positive in 6/7 cases. Five patients had restrictive lung disease and 3 had osteoporosis. Conclusion Involvement of FJ in AS may be the only sign of spine damage and may be responsible for functional impairment, however, it is not evaluated by the available radiographic scores which is an important limitation to their use.

Neurofibromatosis (NF) type I is a genetic disorder caused by a mutation of the NF type I gene. This disease is associated with a variety of skeletal manifestations. In this article, we report a 33-year-old female patient with a known history of von Recklinghausen's disease and inflammatory right buttock pain. Diagnostic imaging pointed out unilateral sacroiliitis possibly of a septic origin. Sacroiliac biopsy showed histological patterns consistent with NF. This case report summarizes an exceptional localization of NF mimicking the imaging of infectious sacroiliitis.

Background Interleukin-17 (IL-17), a cytokine mainly secreted by Th17 cells, seems to play a significant role in the pathogenesis of rheumatoid arthritis (RA). Functional genetic polymorphisms in IL-17 and its receptor genes can influence either qualitatively or quantitatively their functions. Therefore, we aimed to study the impact of IL17-A and IL17RC polymorphisms on plasma level of IL-17 and RA susceptibility and severity. Methods In this context, IL-17A*rs2275913 and IL-17RC*rs708567 polymorphisms were investigated together with the quantification of IL17 plasma level in 115 RA patients and 91 healthy control subjects matched in age, sex and ethnic origin. Results There were no statistically significant associations between IL-17A and IL-17RC studied polymorphisms and RA susceptibility. In contrast, IL-17A plasma levels were significantly higher in patients (55.07 pg/ml) comparatively to controls (4.75 pg/ml), p

Trochanteric tuberculosis represents less than 2% of all musculo-squeletal tuberculosis. The diagnosis is difficult especially if abscess and fistula are missing. The authors report three cases of trochanteric tuberculosis. The diagnosis was established, respectively, 4, 9 months and 1 year after the beginning of the symptoms. The tuberculosis was plurifocal in all cases. Diagnosis was based on the presence of caseum granuloma in the first case, positive Lowenstein culture in the second case and on clinical and paraclinical arguments in the third one. Healing was obtained after medical treatment alone. The authors discuss the potential role of the newer imaging modalities in diagnosis of trochanteric tuberculosis and the indications of medical and surgical treatment.

Trochanteric tuberculosis represents less than 2% of all musculo-skeletal tuberculosis. The diagnosis is difficult especially if abscess and fistula are missing. The authors report 3 cases of trochanteric tuberculosis. The diagnosis was established, respectively, 4, 9 months and 1 year after the beginning of the symptoms. The tuberculosis was plurifocal in all cases. Diagnosis was based on the presence of caseum granuloma in the first case, positive Lowenstein culture in the second case and on clinical and paraclinical arguments in the third one. Healing was obtained after medical treatment alone. The authors discuss the potential role of the newer imaging modalities in diagnosis of trochanteric tuberculosis and the indications of medical and surgical treatment.

Nailfold video-capillaroscopy (VCP) is nowadays worldwide considered as one of the best diagnostic noninvasive imaging technique able to study microcirculation in vivo.To review the applications of VCP in the clinical practice and its results in rheumatic and non-rheumatic diseases.Review of literatureThe possibility of managing the imaging, by means of dedicated software able to characterize quantitative and qualitative data, represents another relevant property of VCP. This technique is very useful at the identification of microvascular involvement in many rheumatic diseases, particularly in systemic sclerosis and related disorders. At the same time, VCP has been showed valuable in many other extra-rheumatic diseases. The authors review the applications of VCP in the clinical practice and its results in rheumatic and non-rheumatic diseases.

Background Brucellosis incidence has declined in developped countries, nevertheless it remains endemic in certains regions. Spondylodiscitis is the most frequent localisation of brucellosis infections complications, ranging from 30% to 85% according to cases series. Objectives The aim of our study is to report the clinical and bacteriological features of this disease as well as its therapeutic profile. Methods Retrospective study witch included medical records of patients treated for brucellar spondylodiscitis during the fifteen past years (2000–2014). Results Nineteen cases were collected (12 males/ 7 females). Mean age was 52 years [rang 36 to 75]. All patients had at least a risk factor: exposed occupation in 6 cases, and unpastorized milk consumption in 12 cases). The following symtoms were observed: inflammatory back pain (14 cases), inflammatory dorsal pain (4 cases), raduculalgia with neurological signs were (1 cases), weight loss (13 cases), fever (14 cases), night sweating (4 cases), C Reactive protein was increased in 2 cases. Lymphopenia was noted in 1 case. Wright serology was positive in all cases. Standard X-ray showed narrowing in disc space in 5 cases, endplate destuction in 9 cases and bone condensation in 3 cases. MRI performed in 14 cases, showed Low signal on T1 weighted images and high signal on T2 weighted images of the vertebral bodies and intervertebral disc. Moreover it revealed epidural extension (5 cases) abcess formation (2 cases) and psoas abcess (6 cases). All patients were treated by association of antibiotics (doxycicline and rifampicin) for 2 to 3 months. Evolution was farorable with resolution of pain, normalization of biological inflammation and slow radiologic reconstruction in 10 cases. For one patient treatment was prolongated to one year due to the persistance of an epiduritis in the follow-up MRI. Conclusions Prognosis of brucellar spondylodiscitis seems good under appropriate treatment. Nevertheless primary prevention is still necessary especially in countries where brucellosis is endemic. Disclosure of Interest None declared

Background Work and socio economic related factors have a great impact on patient9s quality of life. Objectives To explore the effect of work-related and socio-economic factors on quality of sleep in patients with Axial Spondyloarthritis (AS). To explore the effect of work-related and socio-economic factors on quality of sleep in patients with Axial Spondyloarthritis (AS). Methods A cross sectional case-control study was conducted between August 2012 and August 2013 in the department of Rheumatology of Charles Nicolle Hospital. Only patients with Axial Spondyloarthritis according to the 2009 Eular criteria were included. The 100 age- and sex-matched healthy controls were included in this case-control study. The patients and controls who had malignancy, fibromyalgia, serious infections or systemic diseases, and other chronic diseases were excluded from the study. Demographic characteristics, disease specific variables, years of education, marital status, disease duration, occupation and absenteeism during the three last months were documented for each patient. They answered a self-assessing: sleep quality the Medical outcome study sleep scale (MOS-SS). Results One hundred patients with AS and 100 control group patients age and sex matched participated in this study. Patients were divided into 71 men and 29 women. Their average age is 41.72 years [16-74].The majority of patients belonged to an average socioeconomic class (70%). 16% had a higher education, 68% secondary education, and 16% were illiterate. One-half of patients were unemployed and 26% displayed a disability related to their disease. Absenteeism was noted in 23% cases. The duration of the disease is on average 11.7 years and the age of disease onset is 28.9 years on average. In the group of women through, there were many more disruption sleep (p=0.016), headache/breathlessness on waking (p=0.008), and a fewer sleep hours amount (p=0.037). There was no difference between the sexes in terms of adequacy, sleepiness, snoring and sleep index I and II. Age was significantly correlated with sleepiness and areas snoring (p=0.002, p=0.001). The age of onset of the disease was significantly correlated with the areas drowsiness (p=0.015) and snoring (p=0.01) Comparison of sleep disorders by socio economic level showed that sleep adequacy, headache and breathlessness are more observed in disadvantaged class (p=0.022). Workplace absenteeism was related to sleep disorders in the area sleep disturbance with p=0.002. Conclusions Socio economic and professional status affects greatly the quality of life of patients and especially their sleep quality. Disclosure of Interest None declared

Background The order of use of biologic agents after failing a TNF inhibitor is still a question for debate. Recent clinical practice guidelines recommend the use of Rituximab after previous failure of one anti-TNF. Objectives This study aims to compare the efficacy of first and second line of Rituximab and factors associated with, in patients with rheumatoid arthritis (RA). Methods Retrospective analysis of 40 Tunisian RA database was included. RA patients initiating a first line either anti-TNF (adalimumab (ADA), etanercept (ETA) or infliximab (INF)) or Rituximab (RTX) were identified and followed forward in time. Anti TNF was then switched with Rituximab, which has become the second line. Baseline demographics included age, disease duration, fatigue and pain visual analogical scale evaluations (VAS) and DAS 28 ESR. The therapeutic efficacy was assessed on the EULAR response criteria. Results The analyzed cohort comprised patients with average age of 53,85 years (80% female). 21 patients initiating a first line anti TNF (ADA (n=2), ETA (n=7), INF (n=10), ETA then ADA in one case and INF then ETA in another one case). The evolution marked by a primary therapy failure in 6 cases and a secondary therapy failure in 8 cases. Anti TNF was then switched to RTX. The reason for the switch was therapy failure (n=12) and adverse effects (n=8). In this group, the EULAR response criteria were positive in 57% (Good in 6 cases and moderate in 6 cases). For patients (n=19) who have started in a first line RTX, the EULAR response criteria were positive in 94% (Good in 8 cases and moderate in 10 cases). Seven patients had positive antinuclear antibodies whose 57% had positive EULAR response criteria (Good in 1 case and moderate in 3 cases) and whose 3 patients were under second line RTX therapy who have not developed therapy response. Total, 75% of patients developed positive EULAR response criteria under RTX, whose 50% were under Methotrexate, 43% received more than one course of RTX whose 53% maintained therapeutic efficacy at week 16. Conclusions As a first line agent, RTX demonstrates a better retention rate than in second line. Disclosure of Interest None declared

Background Tuberculous spondylodiscitis still frequent in our country. Biologic aspects can help diagnosis in some cases. Objectives Our objective is to describe laboratory features of tuberculous spondylodiscitis among monocentric experience. Methods This is a retrospective study which included medical records of patients treated for tuberculosis spondylodiscitis during the ten past years [2002-2012]. Biologic data were recorded and analysed. Results Fifty seven cases of 29 women and 28 men of tuberculous spondylitis were treated during the ten past years. The mean age was 56.6 years (range 20 to 86 years). A contact history of tuberculosis was reported by 2 patients. The predisposing conditions were present in the third of cases: diabetes mellitus (13 cases), hepatic cirrhosis (5 cases) and high-dose corticosteroid intake (2 cases). It was a progressive starting of disease in two thirds of cases with median duration from the onset of symptoms to the diagnosis about 5.4 months (0.7 range to 24 months). Fever was observed in 29% of cases. Night sweats were present in 40% of cases Anorexia and weight loss were present in 71.9% of cases. Stiffnes was noted in 70% of cases. Pulmonary tuberculosis was associated in 3 cases and cutaneous tuberculosis was noted in 1 case. Biological inflammatory tests were rised in 91% of cases with a mean erythrocyte sedimentation rate of 93mm (range 2 to 150) and an average value of c Reactive protein of 55mg/l (range 0,2 to 331). The blood count showed leukocytosis (15 cases), lymphocytosis (9 cases), leukopenia and anemia in one case each. Disturbance of liver function tests was noted in 5 cases: hepatic cholestasis (n=3), hepatic cytolisis (n=2). Hyerglycemia was noted in the 13 cases of diabetes mellitus. Identification of mycobacterium tuberculosis in sputum was positive in 1 case. Conclusions Inflammatory blood tests were rised in major of cases and leukocytosis was frequent among patients with tuberculous spondylodiscitis in this study. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2758

Background Joint and bone infections are a therapeutic emergency that may occurs at any age but is particular among elderly patients. Objectives The aim of this study is to identify different features of joint and bone infections in elderly patients. Methods We performed a retrospective study of medical records of patients hospitalized for management of osteoarticular infections and who were aged more than 65 years old between 2000 and 2012. Clinical, paraclinical and therapeutic characteristics were recorded and analysed. Results Forty four cases were collected (20 males/24 females). Mean age was 73.8 years (range 65 to 90). The predisposing factors were present in 54,4% of cases (n=24): diabetes mellitus (n=9), renal failure (n=5), cirrhosis (n=3), rheumatoid arthritis (n=2), psoriatic arthritis (n=1), high dose corticoid intake (n=4). Tuberculous and brucellar contage were reported by 4 and 2 patients respectively. Infectious gateway were found in 5 cases: pulmonary (n=2), cutaneous (n=2) and urinary (n=1). Pain was present in all cases. The following symptoms were observed: fever (n=25), impaired general condition (n=20), night sweat (n=13), radiculalgia with neurological signs (n=6). Inflammatory blood tests were rised in all cases with mean CRP of 113.2mg/l (range 4 to 331) and mean ESR of 101.3mm (range 2 to 195). Blood culture was positive in 2 cases and wright serology was positive in 2 cases. Radiological abnormalities were found in 38 of cases. It was an infectious spondylodiscitis in 25 cases, an association of spondylodiscitis and septic arthritis of sternocostal joint in 1 case and a septic arthritis in 18 cases. In the last cases, it was: polyarthritis (n=1), oligoarthritis (n=2) and monoarthritis (n=15). The arthritis involved the: Knee (n=12), elbow (n=2), shoulder (n=2), ankle (n=3) and hip (n=1). The germ was identified in 10 cases: Specific germ in 1 case (Mycobacterium Tuberculosis), and pyogenic germ in 9 cases: Staphylococus (n=3), Pseudomonas (n=1), Escherichia coli (n=1), Streptococcus (n=1), Serratia (n=1), Lactococcus (n=1) Enterobacter (n=1). All patients received antibiotics according to the bacterial agents. Complications were observed in 6 cases: endocarditis (n=1), cauda equina syndrome (n=1), medullar cord compression (n=1) and side therapy effects (n=3). Five patients died. Conclusions Osteoarticular infections in elderly patients were dominated by spondylodiscitis, characterised by blood inflammation and may cause several complications. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2755

Background The clinical and radiological diagnosis of osteoarticular brucellosis is not always easy owever essential for early and effective treatment. Objectives The aim of this study is to study radiological findings of osteoarticular brucellosis which were reported and confirmed in a rheumatological department. Methods This is a retrospective study which included medical records of patients treated for osteoarticular brucellosis during the ten past years [2002-2012]. Radiological data were recorded and analysed. Results Twelve cases of osteoarticular brucellosis were treated during the ten past years. All patients had spondylodiscitis. One patient had elbow bursitis associated. We had no case of peripheral arthritis or sacroiliitis. The mean age was 55 years (range 33 to 79 years) with a male to female ratio about 1. The predisposing conditions were present in 2 cases: diabetes mellitus and cirrhosis. Consumption of raw milk products was noted in 8 cases. The median duration from the onset of symptoms to the diagnosis was 3.6 months (range 1.5 to 6 months). The following symptoms were observed: inflammatory back pain (12 cases), sciatalgia with neurological signs (4 cases), weight loss (11 cases), fever (9 cases) and night sweating (n=7). One patient had symptom of spinal cord compression. C Reactive protein level was increased in 8 cases. Lymphopenia was noted in 4 cases. Wright serology was positive in all cases. Spondylodiscitis was uni-staged in all cases: the lumbar spine was the most commonly involved (8 cases). Standard X-ray showed narrowing of the intervertebral space (10 cases), endplate destruction (8 cases), bone condensation (1 case) and were normal in one case. MRI performed in all cases, had showed low signal intensity on T1-weighted images and high signal intensity on T2 weighted images of the vertebral bodies, endplates and intervertebral disc in all cases. Indeed the following findings were observed: paravertebral abcess formation (3 cases), epidural extension (8 cases), posterior longitudinal ligament elevation (1 case) and psoas abcess (2 cases). Conclusions MRIduring osteoarticular brucellosis and especially spondylodiscitis provides early diagnosis and well demonstration of paravertebral soft tissue spreading more than standard X-ray. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2759

Background Fatigue is reported to be a common complaint among patients with Ankylosing Spondylitis (AS). Previous studies have shown that fatigue is associated with inflammatory pain, stiffness and global wellbeing. Objectives Assess the symptom of fatigue in patients with AS regard to its prevalence and its relationship with demographic variables, inflammatory pain, disease activity and other variables covering anxiety depression and sleep disturbance in patients with AS. Methods A self-administered questionnaire, including visual analog scales to assess fatigue and the FACIT-F (functional assessment of chronic illness therapy of fatigue) score were completed by 70 patients with AS felling the criteria of AMOR. FACIT-F is a questionnaire with13 items; higher scores of FACIT-F indicated more important fatigue. The demographic and clinical characteristics of patients were also collected : The BASDAI (Bath ankylosing spondylitis disease activity index), the BASFI (Bath ankylosing spondylitis functional index), the BASMI (Bath ankylosing spondylitis metrological index), the BAS G (Bath ankylosing spondylitis Global index), the BASRI (bath ankylosing spondylitis radiology index). Depression and anxiety was evaluated by the HAD (hospital anxiety and depression scale), quality of life was assessed by the SF36 and sleep quality was evaluated by sleep scale from the medical outcomes Study. Results Seventy patients were included. 65% were men, sex ratio was 1,85. Age ranged from 16 to 74 years with an average of 40,6 years. Mean disease duration was 10,75±9 years. Mean Pain-VAS was 65 mm and mean Tiredness-VAS was 56 mm. Mean BASDAI score was 45%, mean BASFI score was 44,7% and mean BASG- score was 55%. The mean BASMI score was 4,76 and the mean BASRI score was 4,43. Mean HAD score was 15,9. Mean fatigue-VAS was 56,21 and mean FACIT-F score was 25,67 (8-52) Fatigue is significantly correlated with the VAS pain (p = 0.028), the BASFI (p=0,004) the BASDAI (p = 0.004), the BASG (p= 0.001), the BASMI (p=0,021) the HAD (p Conclusions Our findings suggests that Fatigue is a major symptom in the majority of patients with AS, in particular those with active disease. The physician needs to take into account this parameter in the global care of patients with AS. Disclosure of Interest None Declared

Background Etiologic diagnosis is important for treatment and consequently for the prognosis of the patient with infectious spondylodiscitis. Unfortunately, this diagnosis can be difficult and the need of a guided discovertebral biopsy (GDVB) could be helpful. Objectives The purpose of this retrospective study was to assess the performance of GDVB to determine the etiology of infectious spondylodiscitis. Methods Patients hospitalized in Rheumatology department, between 1999 to 2012, for suspected diagnosis of infectious spondilodiscitis has been collected. Only patients who had a GDVB for etiologic diagnosis of infectious spondylodiscitis were included in this study. Results 60 patients were included. The accurate arguments diagnosis was obtained in 32 %. Then GDVB was profitable for tuberculosis by: tuberculosis culture, necrosis caseum with giganted cells in 17 % of case; for pyogenes germs it was also profitable in 15% (four cases for staphylococcus aureus one case for brucellosis, one case for Klebsiella oxytoca, one case for Serratia Marcescens, two cases for E.coili ). In 40 % of case the results was no specific with an inflammatory involvement in histopathologic exam: with a definitive diagnosis of tuberculosis in 20 cases and brucellosis in 4 cases. In 28% of case the results was without particularity, non interpretable or non transmitted (major case for tuberculosis, and brucellosis and pyogenes germs for the rest). Conclusions Guided discovertebral biopsy is helpful for the diagnosis of infectious spondylodiscitis and should be done whenever this condition is suspected. The increased rates for no specific inflammatory involvement and no interpretable results could be reduced by respecting the guided discovertebral biopsy technical in order to biopsy the real lesions for different exams. Disclosure of Interest None Declared

Background Septic arthritis of the pubic symphysis is rare and causes many difficulties to get the diagnosis. The risk factors are in most cases pelvic surgery, sports or drug addiction. Its management is not well codified. We report four cases. Results : There were 2 men and 2 women. The mean age of the patients was 56 years (range 35 to 76 years). A predisposing condition was noted in 2 cases: pelvic surgery. Patients presented with hypogastric pain (3 cases) and pain in the gluteal region irradiating to the genitor-urinary organs miming sciatalgia. The fever was present in all cases. The symptoms evolved at mean since 2 months. The physical exam revealed a pain limitation of the hip and a pubic pain (4 cases). Inflammatory tests were rised in all cases. Pelvic radiography showed an irregular cortical with erosion of pubic symphysis and ischio-pubic branchs and enlarging of borders in all cases. Pelvic tomodensitometry was performed in all cases and confirmed these results in three cases and showed the presence of three collections around the pubic symphysis in one case. The bacteriological exams of these collections showed the presence of staphylococcus aureus. The anatomopathological exam, done in the other 3 cases, showed histopathologic signs of pyogenic infection in 2 cases and it was inconclusive in one case. Cytobacteriologic exam of urine revealed a Klebsiella pneumonia in one case. All the patients were treated by association of two antibiotics for 2 weeks, followed by one antibiotic for a total of 6 weeks. Evolution was excellent with resolution of pain, normalization of biologic inflammation and slow radiologic reconstructions, even for the patient with collections. Indeed, magnetic resonance imaging was perfomed a month after antibiotics beginning and has showed their clear regression. Conclusions Infectious symphysitis should be evocated even in the absence of predisposing factors in front of prolonged fever and pain in the pelvic region. Imaging allows positive diagnosis and guide biopsy. Prognosis seems good under appropriate treatment. Disclosure of Interest None Declared

Background Behcet’s disease is an inflammatory disorder of unknown aetiology, characterized by recurrent painful oral ulcer and genital ulcer, skin diseases and uveitis. It may involve cardiovascular, gastrointestinal and central nervous system, as well as joints Objectives To define the epidemiology and clinical features of Behcet’s disease, giving special attention to the rheumatic manifestations. Methods We retrospectively reviewed the medical records of the patients who met the International Study group criteria of Behcet disease and were treated during the last ten years [2002-2012]. Results Twenty three patients were treated. The mean age at the diagnosis was 41 years (range 20 to 58 years) with a female to male ratio of 1.5. Mean disease duration was about 4,4 years (range 6 to 14 years). Joint manifestations were present in 22 cases and were inaugural in 18 cases. Patients presented with inflammatory arthralgia (14 cases) and arthritis (8 cases). It was a monoarthritis in 4 cases, oligoarthritis in 3 cases and polyarthritis in one case. The knee and ankles were the joint most commonly affected. Oral Ulcers and genital ulcers were noted in all cases. Skin lesions were seen in 5 cases: including erythema nodosum-like eruption (2 cases) and pseudofoliculitis (3 cases). Ocular involvement was observed in 11 cases: anterior uveitis, posterior uveitis and retinal vasculitis. Deep venous thrombosis was noted in 3 cases and neurological involvement such (convulsion and cognitive impairement) in 2 cases. Biologic inflammatory syndrome was observed in 16 cases. HLA B51 was positive in 4 cases among the 7 tested. Conclusions This series confirms the heterogeneity of the Behcet disease in Mediterranean countries. Uveitis and joint manifestations were frequent and inaugural in most cases Disclosure of Interest None Declared

Background Septic arthritis may cause damage and inflammation in short period of time and may also be a serious cause of mortality. Only early diagnosis and treatment can allow good prognosis. Objectives Our objective is to describe the cases of non tuberculosis septic arthritis, which were reported and confirmed in our hospital. Methods This a retrospective study which included medical records of patients treated for non tuberculosis septic arthritis during the ten past years [2002-2012]. Epidemiologic, clinical, biologic and therapeutic data were recorded and analysed. Results Fifty one cases of non tuberculosis septic arthritis were treated during the ten past years. The mean age was 52,8 years (range 22 to 90 years) with a female to male ration 1.1. The predisposing conditions were present in 50% of cases: diabetes mellitus (8 cases), renal failure (8 cases), rheumatoid arthritis (2 cases), psoriatic arthritis (1 case), osteoarthritis (3 cases) and hepatic cirrhosis (2 cases), high-dose corticosteroid intake (1 case) and arthroscopy (1 case). The median duration from the onset of symptoms to the diagnosis of septic arthritis was 20 days (1 range to 75days). Fever was observed in 97% of cases an average value of 38,3(37,9-40,5). Anorexia and weight loss were present in 7 cases. Mono-arthritis were noted in 43 cases (84%), localized in knees (24 cases), hips (6 cases), elbow (5 cases), Shoulders (3 cases), ankles (2 cases), sternocostal joint (1 case), manubriosternal joint (1 case) and sternoclavicular joint (1 case). Oligo-arthritis were noted in 4 cases and polyarthritis in 6 cases. Biological inflammatory tests were rised in all cases. Hyperleucocytosis was noted in 43% of cases and leucopenia in 3 cases. Radiographies schowed soft tissueabnormalities (8 cases), joint narrowing (17 cases) and joint destructions (7 cases). The germ has been identified in 52% (26 cases) of the cases and recovered in the joint in 17.6% of cases. Staphylococcus was the most common (10 cases) . The other germs were: Streptococcus (4 cases), Pseudomonas (2 cases), Gonococcus (1 case), E.Coli (6 cases), Proteus mirabilis (2 cases) and a combination of two microorganisms in one case. The treatment associated parental use of two antibiotics for 6 weeks except for for gonococcal arthritis. Joint washing was indicated in all cases. Surgical treatment was performed in 5 cases. We noted a good outcome in most cases with only a flessum in 4 cases. Nevertheless, 3 patients with diabetes died. Conclusions Septic arthritis should be evocated in front of any arthritis, especially if it is acute, with fever and in presence of predisposing factors. The predominant germ is the staphylococcus and the treatment must be urgent to avoid complications. Disclosure of Interest None Declared

Background The prevalence of psychological disorders is greater in patients with rheumatologic conditions than among the general population. Objectives We aim in this study to determine the frequency of depression and anxiety disorders in spondylarthritis (SA) patients and to determine predictor disease parameters. Methods We performed a cross-sectional monocentric study in 70 SA Tunisian patients. Presence of anxiety or depression disorders was evaluated by the Hospital Anxiety and Depression Scale score (HADS). A certain anxious or depression state was defined by a HADS>10. Epidemiological factors of SA and different disease assessing measures were noted. For statistical analysis, we used Khi 2 -test for qualitative variables and Student-test for quantitative variables. A p value≤0,05 was considered significant. Results There were 65% men and 35% women. Age ranged from 16 to 74 years with an average of 40,6 years. Disease mean duration was 10,75±9 years. Mean HADS score was 15,9 and 49 patients had HADS score >10 (certain depression or anxious state) corresponding to a frequency of 70%. 63% of patients had peripheral joints involvement and 65% had hips involvement. Mean Pain-VAS was 65mm and mean Tirederness-VAS was 56mm. Mean BASDAI score was 45%, mean BASFI score 44,7% and mean BASG-s score 55%. The mean BASMI score was 4,76 and the mean BASRI score 4,43. Statistical analysis showed that presence of depression or anxious state was correlated best with BASG-s (p=0,00006), followed by BASFI (p=0,001). Depression and anxiety were significally higher in female (p=0,02) and in patients with active disease (BASDAI>40%) (p=0,009). Depression or anxious status was correlated with Tiredness-VAS (p=0,004) and not with Pain-VAS (p=0,171). Psychological status was independent of disease duration (p=0,959), spine mobility (BASMI) (p=0,567) and of the severity of radiologic involvement (BASRI) (p=0,237). No correlation was seen with peripheral joints involvement nor with hips involvement (respectively p=0,914 and 0,660). Conclusions Frequency of depression and anxiety disorders in SA is high. Female gender, general well- being, disease activity and functional impairment are predicting factors. Disclosure of Interest None Declared

Background Infectious Spondylodiscitis is rare among elderly people. Besides being life-threatening it has variable clinical presentations and insidious onset, leading to a delay in diagnosis and a difficulty in treating Objectives To analyse the characteristics of spondylodiscitis in the elderly patients focusing upon epidemiology, diagnosis, and treatment outcome. Methods A retrospective monocentric study was performed. All patients with spondylodiscitis admitted between 1999 and 2013 at the rheumatology department of the Charles Nicolles Hospital, and aged more than sixty-five years were included. Demographic characteristics, underlying diseases, imaging studies, isolated microorganisms, different treatments, complications, and outcome were recorded. Results Twenty two patients among seventy seven cases of spinal spondylodiscitis were more than sixty-five years old. Ten patients were male. Duration of symptoms before the diagnosis was 6.3 months (20 days-24 months). The presence of diabetes mellitus was found in five patients, underlying chronic comorbidities in three cases, high-dose ofcorticotherapy in one case and renal failure in one case. Inflammatory back pain was reported in 19 cases, stiffness in 14 cases, fever in only 5 cases with an average of 38.3°, impaired general condition in 16 cases and night sweat in 9 cases. Neurological involvement was found in 3 cases. The vertebral level involved was lumbar in 15 patients, thoracic in 5 patients, in the thoracolumbar junction in 2 patients, sacral in one patient and cervical in one other. Multifocal spondylodiscitis was found in 6 cases. Radiographies have shown anomalies in all patients. MRI has shown epiduritis in 9 cases, abscess of psoas in 8 patients, paravertebral abscess in 5 cases and medullar compression in 2 cases. Hyperleucocytose and leucopenia were noted in 4 cases each, whether increased erythrocyte sedimentation rate (ESR) were observed in all patients with a mean value of 96mm. The mean CRP was 70mg/l. In our study, we found 8 cases of pyogenic spondylodiscitis and 14 cases of specific spondylodiscitis. Among pyogenic spondylodiscitis patients’, blood cultures identified the microorganism in three cases: Serratia Marcescens in one case, Lactococcus cremoris in one case and association of Staphylococcus and Enterobacter cloacae in the last case. In the other 5 casesdiagnosis was madeonclinical features and the results of the punction biopsy of the intervertebral disc (PBID). Among specific spondylodiscitis, positive Wright serology yielded the diagnosis of brucellar spondylodiscitis in 3 cases, whether 11 cases of tuberculosis spondylodiscitis were confirmed by positive tuberculin skin test and specific lesions in the PBID. During treatment, 5 patients experienced different complications: renal failure in one case, medullar compression in another case, relapse in two cases, and death in one case. Conclusions Spondylodiscitis in elderly patients is characterized by a delayed diagnosis. A large spectrum of microorganism may be involved. In a significant number of cases, neurological impairment, relapse or fatal outcome may occur. Disclosure of Interest None Declared