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Background Immunodepressed patients are a high-risk group for tuberculosis. Objectives The aim is to study the differences in presentation, diagnosis and therapeutic management of tuberculosis according to the immune status of patients. Methods A retrospective study of the files of patients hospitalized in the internal department of military hospital of Tunisia for a Mycobacterium tuberculosis infection. Comparison of two populations: immunodepressed versus non immunodepressed. Results 129 patients aged 20 to 90 were included, 49 patients were considered immunodepressed and 80 non immunodepressed. The causes of immunodepression were: age ≥65years (n=27), diabetes (n=20), immunosuppressive drugs (n=16), chronic inflammatory diseases (n=9), chronic renal failure (n=7), neoplasia (n=8), chronic hepatopathy (n=4), and HIV infection (n=2). Comparison between the 2 populations revealed a more frequent history of absence of vaccination in the immunodepressed (p=0.0001), shorter duration of hospitalisation (p=0.01), greater frequency of disseminated forms (p=0.02), more frequent use of corticoids (p=0,007) and enhanced mortality (p=0.04). There was no difference in the 2 groups with regard to the clinical signs having evoked tuberculosis, the diagnostic method and the bacteriological results. Conclusions The severity and the frequency of tuberculosis in immunodepressed patients should incite clinicians to evoke tuberculosis and to initiate rapidly an efficient treatment. In case of alteration in immune defenses, prophylactic treatment Disclosure of Interest None declared

Objectives This study aimed to investigate EULAR 2003 recommandation application on a sample of 60 (KOA) patients. Methods Retrospective longitudinal study done on the department of Physical and Rehabilitation Medicine of the Principal Military Hospital of Tunis between January 2011 and December 2012, about 60 patients with knee OA. These patients were divided into two groups of 30 cases: patients aged 65 years and over (SA) and young adults 30 to 55 years (SJ). Results All patients received therapeutic management combiningpharmacologic and nonpharmacologic. This treatment was individualized, taking into account: clean Knee risk factors (obesity, mechanical, physical activity), general risk factors (age, comorbidity, polypharmacy), the intensity of pain and disability that it entails, to the presence of inflammatory signs (particularly effusions)? of the location and the degree of structural reached. The above-mentioned elements have been identified in interrogation and the initial review of our patients, further management was judged on these factors. However, the treatment received and appreciation of weight reduction have not mentioned in their records. All patients received an educational program focusing on the economy joint, the need for weight loss and self-rehabilitation. this program was initiated concomitantly with functional rehabilitation sessions. The use of assistive devices were limited to 13.3% of our patients, all of elderly. Weight loss could not be assessed (default data). Paracetamol is the most prescribed treatment in our series: 53.3% of our patients received paracetamol alone or in combination. The Topical NSAIDs are prescribed in 63.3% of patients in which 60.5% are of older group In 5 cases of patients with peptic ulcer documented, there has been use of Anti of H2 as gastric coverage during short periods of NSAID prescription. Analgesics II were used in 5 cases. The AASALs were used in 10 cases, especially in young patients. Infiltration of chondroprotectors using hyaluronic acid were found in 4 cases. Intra articular corticosteroid injections were performed in 8 patients. These findings were not influenced by age. Conclusions Application of recommadations depends greatly on socio-economic conditions of countries and their social security systems. In our study, several recommendations were insufficiently met. A study on a larger population should investigate the factors influencing the implementation of these recommendations and the opinion of various stakeholders (physicians, patients and physiotherapists) Disclosure of Interest None declared

Background Physical therapists provide a variety of interventions, such as manual therapy techniques, balance, coordination, and functional retraining techniques, knee taping techniques, electrical stimulation, and foot orthotics to assist in overcoming some of the barriers that make participation in exercise and physical activity difficult. Objectives This study aimed to assess the role of physical therapy in management of knee osteoarthritis on both levels pain and function. Methods Retrospective longitudinal study done on the department of Physical and Rehabilitation Medicine of the Principal Military Hospital of Tunis between January 2011 and December 2012, about 60 patients with knee OA. These patients were divided into two groups of 30 cases: patients aged 65 years and over (SA) and young adults 30 to 55 years (SJ). The evaluation protocol included clinical algofunctional before and after medical and rehabilitative treatment performed on an outpatient program with three sessions per week for two months. Results There were 35 women and 25 men with a mean age of 58±6.27 years. The average duration of knee OA was 63.74±38.62 months. The main characteristics of elderly subjects compared to young subjects, before rehabilitation, were the bilateral involvement of the knees (p=0.02), severity of pain (p=0.02), disability (p=0.006), stiffness (p=0.02), muscle weakness of the quadriceps (p=0.006), hamstrings (p=0.03), the retraction of the latter (p=0.04) and reducing the walking distance (p=0.04). 38 patients (19 and 19 SA SJ) adhered to the rehabilitation program. After rehabilitation, the main features were the reduction of pain by 60%, improving activities of daily life of 50%. The rehabilitative treatment was more effective in the elderly in terms of pain (p=0.03) and activities of daily living improvement (p=0.01). Patients in both groups improved their scores with no significant differences related to age. Considering respectively the VAS pain (p=0.48), WOMAC index (p=0.39) and LEQUESNE Index (p=0.75). At the end of the rehabilitation program, a reduction in pain intensity was observed in all AS (19 cases), 13 of them have lowered their VAS pain threshold of less than 50 mm. In young subjects, the pain remained stationary in 2 cases and was exacerbated in one case. Conclusions Physical therapy appears to be an important tool for KOA management. Future studies are needed to improve our understanding of factors that can influence the responsiveness of patients with knee osteoarthritis to exercise and physical activity programs. Disclosure of Interest None declared

Introduction L’hypercalcemie est frequente chez le sujet âge et elle est responsable d’une symptomatologie peu specifique et invalidante. Notre objectif etait de preciser les caracteristiques epidemiologiques, cliniques et etiologiques de l’hypercalcemie chez le sujet âge et de comparer nos resultats a la litterature. Patients et methodes Nous rapportons dans ce travail une etude retrospective colligeant 47 sujets âges de plus de 65 ans sur une periode de 27 ans (1986–2013). Resultats Il s’agissait de 23 hommes et de 24 femmes âges en moyenne de 71,9 ans (avec des extremes de 65 ans et 88 ans). Les signes generaux (asthenie, anorexie, amaigrissement) (73,3 %) avaient domines le tableau clinique suivi des douleurs osseuses (42,2 %). Les manifestations articulaires (arthralgies, rachialgies, chondrocalcinose) etaient trouvees dans 28,8 % des cas et l’HTA etait presente dans 31,1 % des cas. Ailleurs, il s’agissait de signes urinaires (lithiases, coliques nephretiques) dans 15,5 %, digestifs (douleurs abdominales, constipation) dans 13,3 % et musculaires dans 4 % des cas. La decouverte fortuite de l’hypercalcemie etait notee dans 3 cas. Une hypercalcemie moderee etait notee dans 68 % des cas, elle etait importante dans 28 % des cas et severe dans un cas. Les principales etiologies etaient les pathologies malignes dans 55,5 % des cas et l’hyperparathyroidie primaire dans 28,8 % des cas. L’iatrogenie etait notee dans 4,4 % des cas, l’hyperthyroidie dans 2 cas, la tuberculeuse dans 1 cas et l’hyperparathyroidie tertiaire dans 3 cas. L’hypercalcemie etait de cause indeterminee dans 4,4 % des cas. Discussion Nos resultats etaient globalement comparables a ceux de la litterature, en effet les pathologies neoplasique et l’hyperparathyroidie primaire etaient les etiologies les plus frequentes. Neanmoins la recherche d’une iatrogenie s’impose surtout que les patients âges sont souvent polymediques. Conclusion Le but de ce travail est de montrer l’interet de la pratique d’un bilan phosphocalcique systematique chez le sujet âge compte tenu de la frequence de la pathologie tumorale.

Background Brucellosis is the most common zoonotic infection worldwide. It is caused by intracellular gram-negative bacteria, Brucella spp. InTunisia, human brucellosis was reported in the first time in 1909. It represents a notifiable disease that occurs as an endemic evolution. The physical findings depend on the duration of illness, and the disease may be attended by various complications. Methods This is a retrospective study in the internal medicine department (from 2000 to 2013). The aim of this study was to evaluate the clinical, laboratory findings and therapeutic features of patients with brucellosis. Results We have studied 42 cases of brucellosis (29 men and 13 women9s), they were 46-year-old on an average (16-78 years). Most came from country areas, and only 7 came from the city. The source of infection was attributable to the consumption of contaminated milk or cheese, except in 3 cases of workplace exposure (veterinarian=1 case, laboratories=2 cases). Brucellosis is acute in 30 patients (71%) and focused in 12 patient cases (29%): (spondylodiscitis=8 cases, coxite=2 cases, sacroiliitis=3 cases, splenic abscess=1 case). The clinical profile was made of: fever (100%), articular and muscular pains (70%), sweats (50%) and spinal symptoms (19%). The clinical diagnosis of brucellosis was made by serology in 100% of patients (rose Bengal and/or Wright). The only organism identified was brucellosis melitensis in 18 cases (42%). All of patients had medical treatment (rifampicin and tetracycline) associated to corticosteroids in one case (spondylodiscitis with epiduritis). Conclusions Brucellosis presents with a wide clinical spectrum. Brucellosis melitensis is the species most incriminated. Eradication of the disease in humans can only be achieved by the control of the disease in animals. This necessitates a multidisciplinary approach involving both humans and animals. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5770

Background Interstitial lung disease (ILD) is a heterogeneous group of disorders that are classified together because of similar clinical and radiographic manifestations. However, prognosis and therapeutic response are influenced by the presence of an underlying cause. Objectives The aim is to study the etiologic profile of ILD in internal medicine. Methods A retrospective analysis of patients with ILD hospitalized in internal medicine department of military hospital from 2000 to 2013. Results We evaluated 44 patients (30 women, 14 men) with a mean age of 57 years. Among them, 32% were smokers. The most common symptom was progressive dyspnea occurring in 83% of cases. All the patients had abnormal chest radiographs, mainly confluent reticular infiltrates or diffuse reticulonodular shadowing. Pulmonary function tests were restrictive in pattern in 54% of the subjects. The most frequent disease was connective tissue disorders (CTD) - associated ILD (64% of all cases): Sjogren9s syndrome (20%), systemic sclerosis (16%), systemic lupus erythematosus (11%), rheumatoid arthritis (9%), antisynthetase syndrome (5%) and dermatomyositis in one case. The diagnostic of both CTD and ILD was made at the same time in 57% of cases. ILD induced by drugs was observed in 16% followed by sarcoidosis in 11% of cases. Idiopathic pulmonary fibrosis was observed in 3 cases and Churg–Strauss syndrome in one case. Corticosteroid therapy was prescribed in 68% of variable dosage depending on the cause and severity of lung disease. Immunosuppressive treatment with cyclophosphamide was indicated in only 4 cases. The response to therapy was favorable in 48% of cases and not satisfactory in 25% of the cases. Conclusions Collagen and vascular diseases are more common than previously appreciated. A multi-disciplinary evaluation of patients with DPLD can enhance diagnosis, improve prognosis and quality of care. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2378

Background Cardiac involvement in ankylosing spondylitis is uncommon. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis. Methods A retrospective study including 50 patients with ankylosing spondylitis. all patients underwent a complete physical examination with a heart and lung auscultation and an electro-cardiogram (ECG). Transthoracic ultrasound was performed whenever there was an abnormal physical examination and/or ECG. Results The study included 47 men and 3 women, the sex ratio is 15.6. The average age of onset was 26±7 years. The mode of onset is axial in 95% of cases (low back pain and/or buttock). The extra-articular manifestations are present in 54% of cases. Cardiac involvement is present in 9 cases (18% of cases). The reason for consultation is dyspnea in 2 patients. In other cases, cardiac involvement was discovered incidentally. Aortic regurgitation was noted in 4 patients. Mitral insufficiency was found in 3 cases. Two patients have predominantly septal hypertrophic cardiomyopathy and one patient presented an array of pulmonary insufficiency. The average time of onset of cardiac involvement was 8±5 years. All patients were put under special medical treatment of their heart, with good clinical outcome. Conclusions Cardiac involvement in ankylosing spondylitis is seen more frequently in men, especially in the old cases. A close relationship between time to onset of aortic insufficiency and duration of disease progression was found. It would be responsible for one third of deaths of patients. It was significantly more frequent in HLA B27 positive patients (especially complete atrioventricular block and aortic insufficiency). Cardiac involvement should be sought routinely in patients with APS because it presents a poor prognosis that can be life-threatening. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5835

Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease with a large clinical polymorphism. Many factors: genetic, endocrine, immunological and environment contribute to disease onset. SLE is characterized by the involvement of multiple viscera, particularly the kidney, the heart and the skin. Cardiac manifestations are relatively common and can involve life-threatening. Materials and methods This is a retrospective descriptive study out of ten years, on the records of patients admitted in our department of internal medicine for LES (final diagnosis according to the criteria of the American Rheumatology Association: ACR). We studied the case with cardiac events. Results In a series of 80 cases of SLE patients, cardiac involvement was retained in 70% of patients. It was dominated by pericarditis in 52% of cases and it was symptomatic in 30% of them. Ultrasound noted endocarditis in 44% of cases with lesions of the mitral valve in 74% of cases. Myocarditis with left ventricular failure was observed in six patients. These events had occurred at the beginning of the disease in 60% of patients. Indeed, patients had dyspnea in 30% of cases, chest pain in 25% of cases. At ECG, a micro-voltage was noted in 40% of cases (pericarditis). Echocardiography has contributed to the diagnosis of pericarditis, myocarditis and endocarditis. The treatment was the strengthening of corticosteroids. Conclusion Cardiac manifestations of SLE are severe and asymptomatic in most cases. Their research must be systematic in order to treat earlier. Ultrasound appears to be the first-line examination in the detection of cardiac involvement in SLE. The prognosis remains severe coronary insufficiency and rhythm disorders.

Background Cardiac involvement in ankylosing spondylitis is common. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis. Methods A retrospective study including 50 patients with ankylosing spondylitis. All patients underwent a complete physical examination with a heart and lung auscultation and an electro-cardiogram (ECG). Transthoracic ultrasound was performed whenever there was an abnormal physical examination and/or ECG. Results The study included 47 men and 3 women, the sex ratio is 15,6. The average age of onset was 26±7 years. The mode of onset is axial in 95% of cases (low back pain and/or buttock). The extra-articular manifestations are present in 54% of cases. Cardiac involvement is present in 9 cases (18% of cases). The reason for consultation is dyspnea in 2 patients. In other cases, cardiac involvement was discovered incidentally. Aortic regurgitation was noted in 4 patients. Mitral insufficiency was found in 3 cases. Two patients have predominantly septal hypertrophic cardiomyopathy and one patient presented an array of pulmonary insufficiency. The average time of onset of cardiac involvement was 8±5 years. All patients were put under special medical treatment of their heart, with good clinical outcome. Conclusion Cardiac involvement in ankylosing spondyllitis is seen more frequently in men, especially in the old cases. A close relationship between time to onset of aortic insufficiency and duration of disease progression was found. It would be responsible for one third of deaths of patients. It was significantly more frequent in HLA B27 positive patients (especially complete atrioventricular block and aortic insufficiency).

Introduction The pericarditis is an inflammation of the pericardium accompanied or not by a pericardial effusion. Its etiopathogeny is variable. Through this work we describe the clinical and paraclinical characteristics of the pericarditis. Materials and Methods it is a retrospective study including 15 patients hospitalized in our service over a period of seven years from 2006 to 2013, presenting a pericarditis. Results It was of 15 patients including 5 men and 10 women, with a sex ratio of 0.5. The average age of our patients was 49 years (26 to 83 years). The pericarditis was revealed by: dysphonia (86% of cases), a chest pain (20% of cases), a flu-like syndrome with a moderate fever (13% of cases) and edema of the lower limbs (26% of cases). All patients had ultrasound a pericardial effusion well tolerated (moderate to abundant) except four patients who were in tamponade. She was of viral origin in 4 cases. It was in relation to a systemic disease in 6 cases: a systemic lupus erythematosus isolated in 3 cases, a rheumatoid arthritis in one case and a Sjogren syndrome in one case. In three cases the pericarditis was of renal origin. In addition, the pericarditis was secondary to radiotherapy for thymom in one case. In a single patient no etiology has been found. The evolution under specific medical treatments was good except of three patients who needed a surgical treatment with transition to chronicity in two cases. Conclusion The pericarditis is often easy to diagnose. A complete etiological investigation allows an earlier and adapted therapeutic. A good collaboration between an internist and cardiologist would allow an effective prevention of the acute risk of tamponade and chronic evolution toward the constriction.

Objectives Intrathoracic manifestations other then vascular aneurysm and thrombosis are rare in the course of Behcet’s disease. Mediastinal fibrosis is also unusual. Methods Three cases of Behcet’s disease with initial mediastinal fibrosis are reported. Diagnosis means, pathogenic mechanisms and therapeutic modalities are also more precisely defined. Results Three male patients (21, 25 and 27 years of age, respectively) were hospitalized for progressive vena cava superior syndrome accompanied by mediastinal fibrosis demonstrated by MRI and/or CT scan which both showed infiltration of the mediastinal fat. Multiple calcifications were also present in one patient. Histology was performed in one case. Thrombosis of the vena cava superior and innominata veins was associated with fibrosis in all three cases. Thrombosis of venae subclavia and left jugularis was also present in one case. Other manifestations leading to the diagnosis of Behcet’s disease were demonstrated by the patient’s history and, in one case, occurred on the fourth day of hospitalization. After initiation of a treatment including corticoids, anticoagulants and colchicine, the outcome was favorable in two cases. The third patient died. Conclusions Mediastinal fibrosis combined with Behcet’s disease has rarely been described. However, it should be included in manifestations of the disease. The causative process which might be vasculitis has to be demonstrated. Disclosure of Interest None Declared

Background Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease. The frequency of neuropsychiatric manifestations in SLE studies varies widely, depending on the type of manifestations included and the methods used for evaluation. Neuropsychiatric (NP) manifestations may be considered primary if directly related to SLE activity, or secondary when related to treatment, infections, metabolic abnormalities or other systemic manifestations such as uremia and hypertension. Objectives To evaluate the prevalence and characteristics of different neurological and psychiatric presentations in patients admitted to the department of Internal Medicine of the Military Hospital of Tunis hospital with systemic lupus erythematosus (SLE). Methods In this retrospective hospital-based study, we examined the medical records of 80 patients with SLE from 2000 to 2010 in our department. All patients fulfilled the criteria of the American College of Rheumatology (ACR). Results Eighteen (80) SLE patients were included in the study. The prevalence of neuropsychiatric syndromes in our study was estimated to be 27% and the most frequent NP syndromes were headaches (28%), seizures (27%) and cognitive dysfunctions (21%). Meningitis, convulsions and cerebrovascular events were found respectively in: 16 cases (21%), 11 cases (16%) and 6 cases (7%). One patient had an optic neuropathy and onether extrapyramidal syndrome. No cases of plexopathy or Guillain-Barre syndrome were reported. MRI abnormalities were found in 21 cases (27%).Glucocorticoids and immunosuppressive therapy were indicated when NP manifestations were thought to reflect an inflammatory process in SLE(optic neuritis, refractory seizures, psychosis) and in the presence of generalized lupus activity. Antiplatelet and anticoagulation therapy were indicated when manifestations are related to antiphospholipid syndrome. Conclusions The prevalence and nature of different neurological presentations of SLE in Tunisian patients has some similarities to that reported in the literature. Differences are due to ethnic and environmental factors References Jennekens FG, Kater L. The central nervous system in systemic lupus erythematosus Part 1: Clinical syndromes: A literature investigation. Rheumatology 2002;41:605-18. [PUBMED] [FULLTEXT] Weiner SM, Peter NH. Neuropsychiatric involvement in systemic lupus erythematosus: Part 1: Clinical presentation and pathogenesis. Med Klin (Munich) 2002;97:730-7. Futrell N, Schultz LR, Millikan C. Central nervous system disease in patients with systemic lupus erythematosus. Neurology 1992;42:1649-57. Disclosure of Interest None Declared

Background Ocular complications of Behcet’s disease are considered one of the major criteria upon which the diagnosis is based. Objectives The purpose of this study is to analyze clinical manifestations, treatment and prognosis of ocular Behcet’s disease. Methods This retrospective study concerned 81 cases of Behcet’s disease followed by internal diseases department. An ophtalmologic examination was practiced in all cases including visual acuity, fluorescein angiography and use of slit lamp biomicroscopy. Results Ocular manifestations was observed in 23 patients (28%). There were 21 men and 2 women. The mean age at onset was 26,7 years. Ocular involvment was the first manifestation of Behcet’s disease in 11 cases (48%) but the mean Behcet’s disease duration before ocular manifestations onset was 4 years and 3 months. The most common ocular manifestation was panuveitis noted in 10 cases, followed by anterior uveitis in 2 cases (associated with hypopyon in 1 case) and retinal vasculitis in 17 cases (74%). Before treatment, ocular complications were observed in 30% of patients dominated by catarct in 3 cases, retinal atrophy in 2 cases and ocular hypertension in 2 other cases. All patients were treated with oral corticoids. An initial high dose intravenous corticosteroid were indicated in 82%, immunosuppressive drugs in 52% (Cyclophosphamide in 11 cases, Ciclosporine in 6 cases and Azathioprine in 1 case) and biotherapy in 21% of cases (Infliximab and Rituximab). A decline in the ocular involvment of Behcet’s disease was observed after a mean duration of 50,63 months. The incidence rate of ocular inflammatory attack was 1,5 per year and one case of death occured two months after the diagnosis. However, 16 affected eyes had an improvement of visual acuity with a mean of 5/10. Conclusions The ocular manifestations of Behcet’s disease are one of the major criteria of both diagnosis and prognosis. It usually requires systemic medications including corticosteroids and immunosuppressive drugs. Disclosure of Interest None Declared

Background Progressive pseudorheumatoid dysplasia is an inherited skeletal dysplasia with radiographic changes notably in the spine, similar to spondyloepiphyseal dysplasia tarda. There is also articular cartilage involvement which gives it some clinical resemblance to juvenile rheumatoid arthritis. Results We report a case of fifteen year old patient presenting chronic painless swollen joints, accompanied by progressive motion restriction and progressive walking difficulties. Radiologically, there was enlargement of the epimetaphyseal portions of the large joints, metacarpal heads, and phalanges, and platyspondyly with irregular delineation of the endplates of the vertebral bodies. Normal values were found for the erythrocyte sedimentation rate and C-reactive protein level. Rheumatoid factors and antinuclear antibodies were negative. The combination of the dysplastic abnormalities of the joints and the spine, the absence of destructive lesions of rheumatoid arthritis and the negativity of inflammatory and immunologic tests led to the diagnosis of progressive pseudorheumatoid dysplasia. Conclusions Progressive pseudorheumatoid dysplasia is an autosomal recessive disease characterized by abnormal cartilage homeostasis. It should be included among the differential diagnoses of juvenile idiopathic arthritis. Disclosure of Interest None Declared

Background Cardiac involvement in ankylosing spondylitis is uncommon. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis. Methods A retrospective study including 50 patients with ankylosing spondylitis. all patients underwent a complete physical examination with a heart and lung auscultation and an electro-cardiogram (ECG). Transthoracic ultrasound was performed whenever there was an abnormal physical examination and/or ECG. Results the study included 47 men and 3 women, the sex ratio is 15.6. The average age of onset was 26±7 years. The mode of onset is axial in 95% of cases (low back pain and/or buttock). The extra-articular manifestations are present in 54% of cases. Cardiac involvement is present in 9 cases (18% of cases). The reason for consultation is dyspnea in 2 patients. In other cases, cardiac involvement was discovered incidentally. Aortic regurgitation was noted in 4 patients. Mitral insufficiency was found in 3 cases. Two patients have predominantly septal hypertrophic cardiomyopathy and one patient presented an array of pulmonary insufficiency. The average time of onset of cardiac involvement was 8±5 years. All patients were put under special medical treatment of their heart, with good clinical outcome. Conclusions Cardiac involvement in ankylosing spondylitis is seen more frequently in men, especially in the old cases. A close relationship between time to onset of aortic insufficiency and duration of disease progression was found. It would be responsible for one third of deaths of patients. It was significantly more frequent in HLA B27 positive patients (especially complete atrioventricular block and aortic insufficiency). Cardiac involvement should be sought routinely in patients with APS because it presents a poor prognosis that can be life-threatening. Disclosure of Interest None Declared

Objectives To gain additional knowledge on the joint manifestations of Behcet’s disease, with special attention to epidemiological and clinical aspects. Methods Retrospective review of 100 cases collected over a period of 13 years. All the patients met International Study Group for Behcet’s disease criteria. 60 % of patients had rheumatic manifestations. Ophthalmic examination and the pathergy test were performed in all patients, sacroiliac radiographs were taken in 58 patients. HLAB51 and B27 antigens were investigated in 70 patients, antinuclear antibodies were sought in in 57 patients, C3, C4 in 44 patients. Results Joint manifestations were present in more than half of the patients (60%) and were inaugural in 38% of cases. The knees and ankles were the joints most commonly affected. Monoarthritis and oligoarthritis polyarthritis are denoted respectively in 26%, 19%, 14% of cases. arthralgias occured in 80% of cases. Two patients showed a sacroilite isolated. Furthermore, popliteal cyst was noted in 4 cases, broken in 2 cases. The arthritis is associated with erythema nodosum in 55% of cases and in 70% pseudofolliculitis cases. The HLA B51 and HLA-B27 were found in 13.8% and 36.9% of cases, these joint manifestations were benign, limiting and never evolved to deformation or destruction. Conclusions Joint manifestations are common in Behcet’s disease. The unusual forms deserve to be known since they can raise diagnostic problems when they are inaugural. Rheumaticmanifestations of Behcet’s disease are the most frequently associated with erythema nodosum and pseudofolliculitis Disclosure of Interest None Declared

Background Primary hyperoxaluria Type 1 is a congenital metabolic disease characterized by exaggerated production of oxalic acid. It is due to the deficiency of the hepatic enzyme, the alanine- glyoxylate aminotransferase. Calcium oxalate deposits may occur in several organs espacielly in kidneys, bones and soft tissus. Bone oxalosis is rare. Methods We report a new case of bone oxalosis collated in the internal medecine departement of the Military Hospital of Tunis. Results A twenty-one-year-old man was admitted for exploration of an end-stage renal failure. He had been on maintenance hemodialysis. He complained diffuse polyarthralgia and proximal bone pain. Physical examination revealed an average general state, an ascites, oedema of lower limbs and hepatomegaly. Joints were not painful. A liver biopsy was performed and closes in the diagnosis of primary oxalosis with deficiency of alanine- glyoxylate aminotransferase. The assay of oxalic acid was 8.4 mg/l (normal between 1.3 mg/l and 2.3 mg/l). Radiological examinations showed cortical erosions at metacarpophalangeal joints and phalanges, in addition to increased density area surrounded by areas of demineralization in carpal bones. In long bones, there were cortical defects associated to metaphyseal and epiphyseal mesangial sclerosis bands. Percutaneous iliac crest biopsy was performed and revealed large numbers of oxalate crystals within the medullary space with giant-cell granulomas, fibrosis and trabeculae rarefaction.The crystals were arranged in a radial rosettelike pattern and were birefringents under polarized light. These changes were associated with features of secondary hyperparathyroidism. Conclusions Bone oxalosis is rare, it was described since 1950. Radiological abnormalities are various. It also stresses that bone oxalosis may mimick secondary hyperparathyroidism, especially radiologically. Differential diagnosis is therefore mandatory and diagnosis should be anatomopathological. References Salyer WA, Keren D. Oxalosis as a complication of chronic renal failure. Kidney lnt 1973;4:61-66 Salyer WA, Keren D. Oxalosis as a complication of chronic renal failure. Kidney lnt 1973;4:61-66 Carsen GM, Radkowski MA. Calcium oxalosis. Radiology 1974 Gherardi G, Poggi A, Sisca 5, Calderaro V, Bonucci E. Bone oxalosis and renal osteodystrophy: a histopathological, histochemical and ultrastructural investigation. Arch Pathol Disclosure of Interest None Declared

Background Pulmonary hypertension (PH) is a serious form of pulmonary complication that occurs in Systemic lupus erythematosus (SLE). It is less frequent in SLE compared to systemic sclerosis. The symptoms of PH in SLE are non-specific and so it is under-recognized.There are several potential causes of PH in SLE including thromboembolic disease, pulmonary vasculitis, hypoxia and fibrosis due to interstitial lung disease. The treatment is based on a combination corticosteroid and immunosuppressive. Anticoagulants are indicated in cases of anti phospholipid syndrome (APS). Objectives This study aim is to estimate the prevalence of PH in SLE detected by echocardiography. Methods This is a retrospective study of 80 patients with SLE fulfilling the criteria of the ACR (American College of Rheumatology), followed in the Department of Internal Medicine of the Military Hospital of Tunis from 2000 to 2010. Echocardiography with measurement of pulmonary artery pressure was performed in 72 patients. A mean pulmonary artery pressure above 30 mm Hg was used to define a PH. Results Ten patients (7%) had a pulmonary artery pressure more than 30 mmHg. Two of them had lung disease (the first one emphysematous lung and the other interstitial lung disease due to SLE). Three patients had mitral regurgitation. An anti phospholipid syndrome (APS) was noted in 4 cases (40%). Five other patients with SLE had a single PAH (50%). Anti-Sm antibodies were positives in 3 cases. Conclusions PH is a rare complication of SLE. Its detection is based on echocardiography. Its prognosis is poor and experts suggest that the underlying SLE should be aggressively treated with immunosuppressive therapy in addition to PH-specific treatment. References N. Galie, A. Torbicki, R. Barst, P. Dartevelle, S. Haworth, T. Higenbottam et al. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The task force on diagnosis and treatment of pulmonary arterial hypertension of the european society of cardiology. Eur Heart J, 25 (2004), pp. 2243–2278 E. Badui, D. Garcia-Rubi, E. Robles, J. Jimenez, L. Juan, M. Deleze et al. Cardiovascular manifestations in systemic lupus erythematosus. Prospective study of 100 patients. Angiology, 36 (1985), pp. 431–441 L. Fauchier, P. Goupille, D. Babuty, C. Marchal, J.P. Valat, J.P. Fauchier et al. Precapillary pulmonary arterial hypertension disclosing systemic lupus erythematosus. Arch Mal Coeur Vaiss, 89 (1996), pp. 477–480 Disclosure of Interest None Declared

Introduction Pulmonary arterial hypertension (PAH) is a rare disease characterized by the progressive increase in pulmonary artery pressures, leading to right heart failure. Systemic lupus erythematosus (SLE) is the second connectivity after Scleroderma can be complicated by PAH. This study aims to estimate the prevalence of PAH in SLE, detected by echocardiography. Materials and methods This is a retrospective study of ten years about 80 patients with SLE fulfilling the criteria of the ACR (American College of Rheumatology), followed in our department of internal medicine. Echocardiography with measurement of pulmonary artery pressure was performed in 72 patients. Above 30 mmHg mean arterial pressure was used to define PAH. Results Ten patients (7% of cases) had pulmonary arterial pressure greater than 30mmHg. Two of them had lung disease (the first with emphysematous lung and the other a lupus interstitial lung disease). Three patients had mitral insufficiency. A syndrome of anti-phospholipid antibodies (APS) was noted in four patients (40% of cases). Five other lupus patients had isolated PAH (50% of cases). We noted a positive anti-Sm antibody in three patients (40% of cases). Discussion PAH is a rare and severe complication of SLE and is a bad prognostic factor. Its detection is based on echocardiography. PAH lupus may be the expression of APS or secondary to pulmonary fibrosis or left valvulopathy. The treatment is based on corticosteroids and immunosuppressive association. Anticoagulants are indicated in cases of APS. Conclusion Due to the severity of PAH in SLE, a screening echocardiography should be systematically offered to patients with SLE to treat early this serious complication and to enhance prognosis.