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Introduction: Hip involvement in patients with spondyloarthritis is responsible for disability and functional impairment. Its treatment is not codified. Our study aimed to determine the associated factors with moderate and severe hip involvement in spondyloarthritis patients. It also aimed to assess the efficacy of tumour necrosis factor inhibitors (TNFi) on hip disease. Methods: We conducted a cross-sectional study, including 44 spondyloarthritis patients with hip involvement. Hip involvement was diagnosed based on radiographic findings. We assessed the following parameters: Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), patient global assessment (PGA), and Lequesne index. We compared these parameters and the mean radiographic joint space width between the time of the study to those right before the use of TNFi. Results: Hip involvement was bilateral in 31 patients. The mean age was 44.56±12.21 years. There were 29 men. Severe and moderate involvement (BASRI-hip>3) was reported in 21 hips from 75 affected. These patients were older and had longer diagnosis delays than patients with BASRI- hip Conclusion : Our study showed that higher body mass and Lequesne indexes are associated with moderate and severe hip involvement. TNFi may improve both the Lequesne index and PGA and stabilize the radiological findings.

Background Bone disease is common in patients undergoing hemodialysis. It is the result of bone turnover abnormalities and the decrease of bone mineral density (BMD). We aimed to determine the usefulness of serum bone turnover markers and BMD measurement by dual-energy x-ray absorptiometry (DXA) in hemodialysis patients. Methods We conducted a cross-sectional study including 90 hemodialysis for more than 12 months. Bone mineral density was assessed by DXA. Peripheral blood samples were obtained from each patient before dialysis in a fasting state within a week of the DXA. Biochemical variables of calcium and phosphate were measured. One bone formation marker (bone-specific alkaline phosphatase (bAP), one bone resorption marker (carboxy-terminal telopeptides of type 1 collagen (CTX)) were measured. Total alkaline phosphatase (TAP), intact parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) which is a bone-derived hormone were also measured. Results CTX values were 6.25 times higher than the normal limit of the assay. Bone alkaline phosphatase levels were less than 10 ng/mL in 28.8% of cases. 23% of patients have osteoporosis and 45% have osteopenia. Femoral BMD had negative correlations with age and PTH levels. FGF23 levels were significantly increased in patients with osteoporosis affecting the lumbar. The levels of bAP and CTX showed a positive correlation. Both circulating bAP and CTX levels showed also positive correlations with PTH levels. Fractures, observed in 12.2% of cases, were associated with low PTH values and the existence of osteoporosis. Conclusions Our study showed that osteoporosis and fracture are common in dialysis patients. The reduced BMD was associated with advanced age and elevated levels of PTH. Markers of bone turnover and FGF23 may play a role in the diagnosis of bone disease in hemodialysis patients. DXA measurement is necessary for the monitoring for bone loss.

Introduction La maladie de Ledderhose est une fibrose nodulaire progressive de l’aponevrose plantaire superficielle due a une proliferation fibroblastique du collagene type 3 avec une neovascularisation intense. C’est une pathologie rare qui touche souvent l’homme de plus de 40 ans. L’osteogenese imparfaite est egalement une pathologie genetique rare due a une anomalie de la production de collagene type 1. L’objectif de cette etude est de rapporter une association inhabituelle entre ces deux pathologies rares chez deux freres. Resultats Nous rapportons le cas de deux freres âges de quatorze et dix sept ans, issus d’un mariage consanguin de premier degre, aux antecedents de fractures multiples survenant a faible energie. L’aine est suivi pour une arthrite juvenile idiopathique. A l’examen clinique, une coloration bleue des sclerotiques, une deformation des os longs a type d’incurvation humerale et femorale et une asymetrie de longueur des deux membres inferieurs etaient notes chez les deux patients. Un retard de croissance etait note chez le frere aine. Le bilan radiologique a montre une hypertransparence osseuse diffuse, des corticales amincies, un aspect strie des os longs avec des fractures incompletes. Le diagnostic d’une osteogenese imparfaite a ete retenu chez les deux freres. Le reste de l’examen n’a pas montre des anomalies de la dentigenese, une perte auditive, une atteinte neurologique, ni une atteinte cardiorespiratoire. La densitometrie osseuse a montre une diminution du Z score chez les deux freres a (−4,2 et −2,7). Un traitement par les bisphosphonates a ete prescrit. Ils ont recu du pamidronate par voie intraveineuse pour prevenir d’autres fractures osseuses. Au cours de suivi, ils ont developpe des nodules au niveau de la plante des pieds. L’examen physique a montre au moins deux nodules dans chaque plante. L’echographie des parties molles et l’imagerie par resonance magnetique pratiques chez le petit frere ont montre un epaississement des aponevroses plantaires de facon bilaterale donnant un aspect de fibromatose plantaire. Le diagnostic de maladie de Ledderhose etait retenu chez les deux patients. Dans les limites de nos connaissances, c’est le premier cas rapporte qui traite l’association de maladie de Ledderhose avec une osteogenese imparfaite. Conclusion La maladie de Ledderhose est une pathologie rare qui peut etre meconnue par les cliniciens. L’atteinte nodulaire bilaterale peut faciliter le diagnostic. Toutefois un nodule isole peut orienter vers une origine tumorale. La presence de cette pathologie en association a une osteogenese imparfaite est une entite rare. La question qui reste difficile a poser : s’agit-il d’une association fortuite ?

Introduction La malobservance therapeutique est une des principales causes d’echec therapeutique dans les rhumatismes inflammatoires chroniques (RIC). Plusieurs etudes rapportent un niveau d’observance assez faible chez les malades suivis pour polyarthrite rhumatoide sous traitement conventiels ou biologique [1] . Le but de notre travail etait d’evaluer le niveau d’observance des patients sous biotherapie en moyennant un questionnaire valide et de rechercher les facteurs influencant cette observance. Materiels et methodes Il s’agit d’une etude monocentrique transversale ayant collige 56 patients suivis pour PR. Tous les patients inclus sont sous biotherapie depuis au moins 3 mois (les patients sous anti-CD20 ont ete exclus). Le niveau d’observance etait evalue en utilisant le questionnaire Compliance Questionnaire-Rheumatology (CQR)19. Le cut-off de bonne observance est estime a 80. Resultats Il s’agit de 56 patients (9 hommes/47 femmes) âges en moyenne de 59,68 ± 11,6 ans. L’âge moyen au moment du diagnostic etait de 44,6 ± 11,1 ans [19 ans–67 ans]. La duree moyenne de l’evolution de la PR etait de 180,8 ± 112,4 mois. Le DAS moyen etait de 3,8 ± 1,6. Tous nos patients ont recu au moins un traitement synthetique conventionnel avant la biotherapie. Concernant le traitement biologique, 82 % (n = 46) des patients sont traites par anti-TNF (17 par infliximab, 4 par adalimumab,10 par etanercept, 2 par golimumab, 13 par certolizumab) et 10 patients par anti-IL-6. Cinquante-deux pour cent (n = 29) de nos patients etaient sous biotherapie sous-cutanee. Pour 36 patients, il s’agit de leur premiere biotherapie. Selon le questionnaire CQR19, seulement 30,6 % des patients sont observants. Les femmes etaient significativement plus observantes par rapport aux hommes (p = 0,04). On ne note pas de difference d’observance selon l’âge, la duree d’evolution de la PR, le niveau d’etudes et le milieu (rural ou urbain). Le fait qu’il s’agisse ou non de la premiere biotherapie ou d’un switch vers une biotherapie sous-cutanee n’influe pas sur l’observance (p = 0,37, p = 0,4). L’observance est bonne chez 29 % des patients sous biotherapie sous-cutanee. Elle est moins bonne chez les patients realisant leur injection 1 fois/mois (27 % etaient observants) par rapport a ceux dont l’injection est hebdomadaire(50 %). Chez les sujets non observants, on a releve plus d’evenements infectieux (38 % vs 20 %). Concernant l’activite de la maladie, elle est en moyenne plus elevee chez les non observants que chez les observants avec une difference significative(3,98 vs 2,83; p = 0,000). En effet, la valeur du CQR19 etait negativement correlee au score d’activite de la maladie (r = −0,3, p = 0,032). Discussion Notre etude met en evidence une observance de 30,6 % chez les patients atteints de PR sous biotherapie. Ce niveau d’observance reste faible et a un impact assez important sur l’evolutivite de la maladie. Il depend de plusieurs facteurs lies au patient, a la maladie ou au type du traitement. Des strategies d’education therapeutique sont indispensables afin d’ameliorer le niveau d’adhesion therapeutique. Conclusion Des etudes a plus large echelle sont requises afin de mieux definir les facteurs influencant l’adhesion therapeutique dans les RIC.

Introduction L’osteogenese imparfaite(OI) est une maladie genetique rare due a une anomalie de la production de collagene type 1. Elle touche essentiellement l’os avec un risque fracturaire eleve, mais egalement le systeme oculaire, auditif, neurologique et cardiopulmonaire. Elle regroupe selon la classification de Silence et de Glorieux [1] , [2] sept types de pathologies heterogenes allant de la forme letale a la naissance aux formes benignes pouvant etres de decouverte fortuite a l’âge adulte. Nous rapportons une serie de cinq patients atteints d’osteogenese imparfaite. Patients et methodes Il s’agit d’une etude retrospective incluant cinq patients suivis au service de rhumatologie pour OI sur une periode de 9 ans (2011–2020). Resultats Notre serie comporte cinq patients dont trois jeunes hommes de 19, 17 et 14 ans et deux femmes de 21 et 45 ans. L’âge moyen de decouverte de la maladie etait de 9 ans avec des extremes de six mois a 17 ans. La circonstance de decouverte etait la survenue de fractures multiples a faible energie pour tous les patients. Une consanguinite parentale de premier degre etait notee chez trois patients. L’examen clinique de nos patients avait revele des deformations des os longs a type d’incurvations chez tous les patients, une raideur articulaire avec limitation de la mobilite, une inegalite des membres inferieurs, une scoliose et un retard de croissance chez deux patients. Une hypoacousie etait notee chez un patient, une coloration bleue des sclerotiques chez trois patients. Un seul patient avait une anomalie de la dentigenese. Aucun de nos patients n’avait une atteinte cardiovasculaire. Les radiographies standards avaient montre une hyper transparence osseuse diffuse avec des corticales amincies, des deformations des os longs, un aspect strite de l’os pour tous les patients, avec des fractures incompletes chez trois patients et une protrusion acetabulaire chez deux patients. La densitometrie osseuse avait objective un Z-score bas chez tous les patients variant de −2,7 a −5,3 deviation standard. Un traitement par des bisphosphonates par voie intraveineuse etait indique pour tous les patients. Trois patients ont eu de l’acide pamidronique a la dose 15 mg trois jours de suite tous les six mois et deux patients de l’acide zoledronique a la dose de 4 mg tous les six mois. L’evolution etait marquee par la diminution de la frequence des fractures et une amelioration du Z-score et de la densite osseuse chez deux patients. Conclusion L’OI est une pathologie rare mais peut etre invalidante. Le pronostic fonctionnel depend de la severite de l’atteinte qui peut etre grave a cause des deformations osseuses et rachidiennes ainsi que l’atteinte neurologique et respiratoire. Une prise en charge adequate par la reeducation en association a l’utilisation des bisphosphonates peut ameliorer la qualite de vie des patients.

Background:Although the management of rheumatoid arthritis (RA) has been booming since the advent of biological treatments, the consequences of this disease remain multiple, both physical and psychological.Objectives:The aim of our work was to investigate the factors influencing anxiety and depression in RA.Methods:This was a cross-sectional study of 49 RA patients. We used the Hospital Anxiety and Depression scale (HAD) to assess anxiety disorders.Results:We included 24 women and 5 men with an average age of 54.1 years. Sixty-nine percent of patients were unemployed and 81% had health insurance coverage. RA had been evolving for an average of 11.43 ± 7.32 years and the mean time to diagnosis was 2.35 years. It was erosive in 93.8% of cases. An atlanto-axial dislocation was found in 4.1% of cases and coxitis in 8.2% of cases. Eighty-three percent of patients were on cs-DMARDs and 14.2% were on biotherapy. Most patients had low active disease (53%) with a mean DAS28CRP score of 2.74 ± 0.81. Twelve percent of patients had a probable anxiety and 18% had a probable depression.A long delay in diagnosis was associated with a higher risk of anxiety disorders. Working patients had a lower risk of depression while patients from rural areas had a higher risk. The risk of anxiety and depression disorders was associated with increased VAS pain, EGP, and DAS28. In the multivariate study, EGP was the independent risk factor for the development of anxiety and depression disorders.Conclusion:Anxiety and depression disorders are a frequent yet underestimated consequence in RA. Appropriate care in psychiatry is required as soon as the diagnosis is announced.Disclosure of Interests:None declared

Background:In rheumatoid arthritis (RA), the ‘treat-to-target’ therapeutic approach imposes rigorous control of disease activity. Although biological agents have been shown to be effective, these therapies fail sometimes to achieve therapeutic goals.Objectives:In this study we tried to determine predictive factors of good therapeutic response to biologic disease-modifying antirheumatic drugs (bDMARD).Methods:This is a retrospective study including 374 Tunisian patients who received their first biotherapy between 2014 and 2016. Categorical variables were reported in numbers and percentages, while quantitative variables were expressed by mean with standard deviations. The univariate analysis was performed using the student t-test or the Chi2 test. Multivariate analysis was performed by binary logistic regression.Results:Average age of our cohort was 55 ± 12.5 years with a female predominance of 87.2%. The average duration of RA was 11.7 ± 6.7 years. Rheumatoid factors were positive in 79% and ACPA were positive in 72% of cases. After the introduction of biotherapy, low disease activity (LDA) or remission was achieved in 55% of cases (206 patients).No statistically significant difference between biotherapy responder and non-responder groups for age (55.7 vs. 54.7 years; p = 0.44), gender (Female: 86.5% vs. 88.7%; p = 0.08) and disease duration (12 years vs. 11.4 years; p = 0.41). A significant difference between the two groups was found for the positivity of rheumatoid factors (76.4% vs. 88.9%; p = 0.004), methotrexate’s association (65% vs. 53.4%; p = 0.02) and corticosteroids’ use (50% vs. 66.5%; p < 0.001).Positive predictive factors of remission or LDA by biotherapy were female sex (Odds Ratio = 2.2; p = 0.026), presence of rheumatoid factors (Odds Ratio = 2.64; p = 0.001), association with methotrexate (Odds Ratio = 1.69; p = 0.028). Whereas, corticosteroid use (OR = 0.41; p < 10-3) was a negative predictor of disease control by bDMARDs.Conclusion:Achieving LDA low level or even remission is currently achievable with biological treatments. Certain factors need to be studied in order to optimize RA treatment and adapt the right bDMARD for each patient.Disclosure of Interests:None declared

Background:Consequences of rheumatoid arthritis (RA) are many and varied: physical, psycho-affective and financial.Objectives:The objective of our study is to evaluate the impact of RA on sleep quality.Methods:We conducted a cross-sectional study including 49 RA patients. An evaluation of sleep quality using the MOS-Sleep Scale was performed.Results:The mean age of patients was 54.1 years, with a female predominance (89.8%). The mean duration of RA was 11.43 ± 7.32 years with a mean time to diagnosis of 2.35 years. Rheumatoid factor was positive in 77.6% of cases. A atlanto-axial dislocation was found in 4.1% of cases and coxitis in 8.2% of cases. All patients were on symptomatic treatment, 57.1% of whom were on corticosteroid therapy. 83.67% of patients were on cs-DMARDs and 14.2% were on biologics. At inclusion, sleep was optimal in 63.2% of cases and the mean Sleep Problem Index was 26.19 ± 22.77.The index of sleep problems was higher in older subjects and in those with long diagnostic delays. The presence of co-morbidities and atlanto-axial dislocation and/or coxitis was associated with impaired sleep quality. Also, VAS pain and EGP were associated with an increase in the sleep problem index. In the multivariate study, EGP, the presence of co-morbidities and atlanto-axial dislocation and/or coxitis were the independent factors affecting sleep quality.Conclusion:The impact of RA on the patient’s quality of life and especially the quality of sleep is confirmed by several studies in the literature. A global management of the patient is necessary in order to adapt well to his disease.Disclosure of Interests:None declared

Background:The development of biologic disease modifying antirheumatic drugs (bDMARD) has dramatically improved the management of rheumatoid arthritis (RA). However, some patients did not respond or partially respond to biologic agents. Management of first bDMARD failure may involve another biotherapy.Objectives:The aim of our study is to assess the efficacy of second line biologic as well as survival rates of 2nd line biotherapy in RA.Methods:This is a retrospective study based on Tunisian data including 374 RA patients treated with biologic agent from 2014 and followed until December 2018.Results:Tumor necrosis factor inhibitor (TNFi) was the most prescribed class as first-line therapy with 86.4% patients (Etanercept: ETA 54%; adalimumab: ADA 13.6%; certolizumab pegol: CZP 12.8% and infliximab: IFX 5.9%), IL-6 inhibitor (Tociluzimab: TCZ) and anti-CD 20 (Rituximab: RTX) were given respectively to 6.4% and 7.2% cases. The first biotherapy was discontinued for 146 patients (39%). Of these, 79 patients (21.1%) received a second bDMARD (mean age 52.6 ± 11.8; sex ratio = 0.12; ETA 17.7%, ADA 7.6%, CZP 41.8%, IFX 1.3%, TCZ 24.1% and RTX 7.6%). Average DAS28 at second line biotherapy initiation was 5.93 ± 0.96. Overall survival rates of 2nd line bDMARD at 12, 24 and 36 months was respectively 91%, 76.4% and 72.1%. Among the patients receiving second biologic agent, 30.4% patients (24 cases) achieved either low disease activity (LDA) or remission. On average 38 weeks [14 – 96] were needed to reach that therapeutic target. In fact, 27.8% of the TNFi vs. 40% of the non TNFi patients achieved LDA (p = 0.277). Second biotherapy was withdrawn in 16.7% of the cases of TNFi group vs. 20% of the non TNFi group (p = 0.718). Moreover, no significant difference has emerged between the TNFi and the non-TNFi patients when comparing time to biotherapy discontinuation (15.8 months vs. 20.9; p = 0.11).Conclusion:In our study, no significant difference was found between TNFi and non-TNFi switcher in RA. But, treatment strategy after first bDMARD failure is still controversial. Further studies have to be done to get the most beneficial strategy in RA.Disclosure of Interests:None declared

Background:Bone metastases (OM) or secondary cancers bones are bony locations of tumor cells, away from a primary malignant tumor. The Bone metastases are the most common metastases. They can be revealing in 20 to 30% cases or complicate the course of a known cancer. The bone metastases are a pejorative prognostic factor.Objectives:The aim of this study was to identify the Contribution of diagnostic methods for the quest of primitive cancer in presence of bone metastasis.Methods:We conduct a retrospective study of 35 files of patients who were hospitalized in the rheumatology department. All patients underwent a questionnaire and a clinical examination. Additional radiological assessment, bone biopsies, biopsies of other sites, bone scintigraphy and tumor markers were carried out on a case-by-case basis.Results:Thirty-five cases (25 men and 10 women) were analysed. The average age was 61 years [45-85]. Seven patients had a known history of neoplasia. One or more bone biopsies were performed in 8 cases. The vertebrae were the most biopsied bone site (6 cases). The bone biopsies were in favour of carcinoma (3 cases), adenocarcinoma (2 cases), squamous cell carcinoma (1 case) and inconclusive (2 cases). Non bony biopsies (2 pulmonary, 2 prostatic, 1 mammary) concluded to an adenocarcinoma (3 cases) and a carcinoma (2 cases). Bone scintigraphy was carried out in 7 cases and showed in all cases diffuse or localized hyperfixation. The localized value of tumor markers appeared relatively low except for Prostate Specific Antigen (PSA). Other metastatic localisations were identified: hepatic (6 cases) and pulmonary (1 case). The primary cancer identified was pulmonary for 11 patients, prostatic for 7, gynaecological for 4 and digestive for 3. One patient had Otorhinolaryngological cancer and another had bone cancer. Bone biopsy allowed the diagnosis in 6 cases (17%). The primary cancer was discovered by a biopsy of other non-bone sites in 5 cases (14%). Neoplastic antecedents and clinical context were considered sufficient in 16 cases (45%). Primary cancer remained undetermined in 8 cases (22%).Conclusion:Bone biopsy, as well as non-bone biopsy, remains an essential tool in the etiological diagnosis of bone metastases. They are very contributive in the same proportions. PSA is a major diagnostic asset in the search for primary cancer.Disclosure of Interests:None declared

Background:Tuberculosis is still endemic all over the world. The incidence of tuberculous spondylodiscitis (TS) is steadily increasing. Clinical features and outcomes of this affection are various and depending on various parameters, including age.Objectives:Our objective was to explore the differences in presentation and the results of further investigations and the prognosis of TS between young and elderly subjects.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with TS. We carried out a comparative study concerning the clinical biological, imaging features and outcomes between young subjects and subjects aged over 65 years.Results:Fifty-two cases of TS were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). Young subjects was more frequently vaccinated (88.9%) by Bacillus Calmette–Guérin (BCG) (p < 0.001). A delayed diagnosis was noted in both groups (p = 0.24). Lumbar spine involvement was the most common (57.7%). In the two age ranges, the onset of the disease was progressive (p = 0.22), characterized by segmental spine stiffness (p = 0.57) and lumbar pain with general signs (p = 0.27), such as: impaired general condition, fever, night sweats and weight loss. Biological inflammatory syndrome and normochrome normocytic anemia were encountered in both cases (p = 0.08 and p = 0.2, respectively). Standard X-rays and Computed tomography were more performed in young subjects (94.4% and 69.4%, respectively; p < 0.001), unlike magnetic resonance imaging which was more common in elderly subjects but with no statistically significant difference (p = 0.22). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively). Clinical, biological and imaging arguments contributed to positive diagnosis in both groups (p = 0.24). Common medical treatment was anti-tuberculosis: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E) and physical treatment such as immobilization witch was more common in the eldery (56.3%, p = 0.16). The evolution of the disease was characterized by a clear improvement of young subjects during the second week of treatment (p < 0.001). A more frequent clinical improvement in older subjects was during the fourth week but with no statistically significant difference (p = 0.13). The occurrence of immediate complications was more frequent in the elderly (p = 0.23) with a predominance for drug complications (56.3%) such as: hepatic cytolysis (12.5%), hyperuricemia (18.8%) and major intolerance to anti-tuberculosis (18.8%).Conclusion:TS is a frequent condition that needs to be treated rapidly. the clinical presentation of TS in the elderly is less noisy which leads to more frequent complications and mortality.Disclosure of Interests:None declared

Background:Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. It can affect the different parts of the spine.Objectives:The aim of this study was to determine the preferred spinal location of TB.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with tuberculous spondylodiscitis (TS).Results:Fifty-two patients were included (37F/15M). Their mean age was 55.21 years ± 17.79 [19-91]. TS was more frequently unifocal (75%) than multifocal (25%). Lumbar spine involvement was the most common (57.7%) and more frequent in women (63.3%) but with no statistically significant difference (p = 0.2). Other localizations were described such as: dorso-lumbar (21.2%), dorsal (15.4%), lumbosacral (3.8%) and cervical (1.9%). Lumbar pain was present in 34 patients (65.4%) and 29 patients (55.8%) suffered from segmental lumbar stiffness. Imaging was contributive by showing the vertebral location using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively).Conclusion:TS is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. Spinal involvement is often unifocal and mostly diagnosed with lumbar pain or stiffness. Multifocal forms, touching several parts of the spine, however remain rare. Our findings remain consistent with those of the literature.Disclosure of Interests:None declared

Introduction Par son potentiel destructeur et son evolution par poussee la polyarthrite rhumatoide se presente comme un rhumatisme inflammatoire avec un haut risque fonctionnel. Ce volet pronostique important est a l’origine du traitement precoce et de la necessite du controle regulier par le rhumatologue. Depuis l’avenement des traitements biologiques nous avons pu constater une amelioration des indicateurs des parametres fonctionnels, mais apres un echec echappement ou intolerance a un biologique comment evoluerait ces parametres suite a une rotation ? Patients et methodes Nous avons recense trente patients du service de rhumatologie La Rabta de Tunis presentant une polyarthrite rhumatoide retenue suivant les criteres ACR-EULAR et ayant eu au moins une rotation entre 2 traitements biologique. Nous avons retenu comme parametres pour evaluer la fonction : le Health Assessment Questionnaire (HAQ) et l’echelle visuelle analogique (EVA) de la douleur ressentie par le patient, ils ont ete evaluee avant le switch (M0) et aux consultations de suivi au 3e, 6e et 12e mois. L’effet du switch sur le retentissement fonctionnel de la polyarthrite rhumatoide s’est effectue par une etude analytique avec des comparaisons de plusieurs (> 2) moyennes sur series appariees qui ont ete effectuees par le test non parametrique de Friedman, au seuil de 0,05. En cas de differences significatives entre les moments M0, M3, M6 et M12, les comparaisons de 2 moyennes sur series appariees ont ete effectuees par le test non parametrique de Wilcoxon pour series appariees, au seuil de 0,05/nombre de comparaisons, soit 0,05/3 = 0,017. Resultats Trente patients presentant une polyarthrite rhumatoide dont la moyenne d’âge est de 47,2 et la repartition selon le sexe est de 3 femmes pour un homme La moyenne de l’echelle visuelle analogique de la douleur sur 100 etait de 59,375 avant la rotation 59,4 apres 3 mois 34,58 a 6 mois et 15 a 1 an ; la difference n’etait pas significative a 3 mois p = 0,968 mais elle l’est devenue a 6 mois p = 0,000 elle est maintenue significative a 1 an avec p = 0,000. Le Health Assessment Questionnaire (HAQ) moyen etait de 1,84083 avant le switch de 2,13542 a 3 mois du switch de 1,21875 a 6 mois et de 0,63417 a un an, l’etude analytique ne met en evidence une difference significative a 3 mois avec p = 0,275 mais une significativite a 6 mois p = 0,000 et a 1 an p = 0,000. Conclusion A la lumiere de notre etude, l’effet du switch de traitement biologique apres echec ou intolerance semble etre benefique pour l’amelioration du pronostic fonctionnel de la polyarthrite rhumatoide, mais assez retarde d’ou tout l’interet de monitorer les traitements symptomatiques (antalgique/corticoides) et les Cs DMARDS associes dans l’attente de l’amelioration fonctionnelle.

Objectif Evaluer la prevalence des comorbites cardiovasculaires au cours de polyarthrite rhumatoidePr et etudier son impact sur l’activite de la maladie. Patients et methodes Etude retrospective descriptive colligeant 100 cas de PR (criteres ACR/EULAR 2010). Les comorbidites cardiovasculaires suivantes ont ete etudiees : tabagisme, hypertension arterielle (HTA), coronaropathie, diabete type 2 (DT2), dyslipidemie et hyperuricemie. L’activite de la maladie a ete evaluee par la CRP (mg/L) et le Disease Activity Score (DAS28CRP). Resultats L’âge moyen etait de 56,7 ± 9,5 ans avec un sex ratio (H/F) de 0,49. Le DAS28CRP moyen etait de 4,35 ± 1,17. La presence d’au moins une comorbidite etait notee chez 67 % des patients : 48 % des cas avaient une comorbidite et 19 % avaient cumule plus de deux comorbidites. Le tabagisme etait observe dans 18 % des cas suivi par la dyslipidemie (17 %), le DT2 (16 %), HTA (14 %), l’hyperuricemie (13 %) et la coronaropathie (3 %). Les patients ayant une comorbidite avaient une CRP plus elevee (23 [1–102] versus 13,5 [2–169]) (p = 0,008). En revanche, aucune association n’a ete retrouvee entre la presence d’une comorbidite et le DAS28CRP (p = 0,51). Discussion La prevalence des comorbidites cardiovasculaires est estimee a 67 % dans notre etude et a 63,5 % dans la litterature [1] .Notre etude suggere que la presence d’une comorbidite est associee a une PR plus active. Des etudes plus larges sont necessaires pour appuyer nos resultats.

Objectif Evaluer l’indice de masse corporelle (IMC) chez les patients atteints de polyarthrite rhumatoide (PR) et etudier sa relation avec l’atteinte du pied rhumatoide. Patients et methodes Etude descriptive transversale portant sur 40 cas de PR (criteres ACR/EULAR 2010). Le retentissement fonctionnel de l’atteinte du pied a ete evalue par le Foot Function Index (FFI). Plus le score est eleve plus le retentissement est important. L’IMC (kg/m2) etait starifie comme suit : maigreur Resultat Trente-quatre femmes et 6 hommes ont ete colliges. L’âge moyen etait de 58,4 ± 10,8 ans. L’IMC moyen etait de 26,3 ± 5,2 kg/m2. Parmi nos patients, 35 % etaient en surpoids, 20 % etaient obeses, 37,5 % avaient un poids normal et 7,5 % etaient maigres. Le score FFI moyen etait de 43,5 ± 23,9 %. Les patients ayant un IMC Discussion Dans notre etude, l’obesite n’etait pas associee au score FFI. Conformement a nos resultats, Jeong et al., ont montre qu’une elevation de l’IMC n’etait pas un facteur predictif d’un mauvais retentissement fonctionnel du pied rhumatoide et que cette atteinte evolue independamment du statut ponderal du patient [1] .

Background:Low back pain (LBP) is a common health problem among all age groups. Medical students do not seem to be spared. In fact LBP is one of the most common musculoskeletal disorder and its prevalence is variable ranging from 41% to 72%.Objectives:The aim of our study was to determine the prevalence of LBP among Tunisian medical students and to assess its associated factors.Methods:We conducted a cross-sectional study over 2 months carried out on medical students in a Tunisian medical college. A digital questionnaire entered by Google forms was sent by e-mail and was completed by the students. Our study included students from the first year of the first cycle of medical studies up to the third year of the second cycle. Socio-demographic, personal characteristics and life habits were collected. LBP was assessed using the Nordic musculoskeletal health questionnaire. The impact of low back pain was assessed using the Oswestry disability index (ODI).Results:One hundred and seventy-nine students were included. The mean age was 22.9 ± 2.3 years [19.64-38.21]. The sex ratio was 0.29. The average body mass index was 23.55 ± 4.22 kg / m2 [17.67-43.07]. 82% of the students were in the second cycle of medical studies. 26.4% of the students had a regular sports activity. 91.2% spent more than 4 hours a day in a sitting position. The point, annual, and lifetime prevalence of LBP among medical students was 41.2%, 80.4% and 90.6%, respectively. Low back pain was acute in more than 58.8%, subacute in 14.9% and chronic in 26.3%. The mean ODI score was 10.32% ± 8.48% [0-32%]. Students with LBP were significantly younger than students without LBP (p = 0.015). LBP was more common in students who spent more than 4 hours in a sitting position with a difference at the limit of significance (p = 0.059). Being in the 2nd cycle was significantly associated with the occurrence of LBP (p = 0.006). Poor screen projection in the amphitheater was significantly associated with the occurrence of LBP (p = 0.029).We found a statistically very significant relationship between the occurrence of LBP and the poor layout of the amphitheaters (p = 0.000). The feeling of depression was significantly higher among LBP students (p = 0.018). Feelings of fatigue, being overwhelmed, irritability and worry were more frequently found in LBP students, but this difference was not statistically significant. In a multivariate analysis, the only factors that remained statistically significant were feeling of depression (p = 0.046, OR = 3.88; CI = [1,3-11,55]) and the poor layout of the amphitheaters (p = 0.006, OR = 8.99; CI = [2.55-31.69]).Conclusion:The annual prevalence of LBP was 80.4%. These results testify to the magnitude of this health problem. The factors associated to LBP seemed to be essentially modifiable factors. This encourages special attention from medical schools to increase students’ awareness of low back pain and to provide appropriate measures at reduce this musculoskeletal disorder.Disclosure of Interests:None declared

Background:The advent of biotherapies in the late 90s radically changed the face of inflammatory diseases including rheumatoid arthritis. The survival of these innovative therapies is an indicator, in clinical practice, of their long-term efficacy and safety.Objectives:The objective of this study was to assess their use in Tunisia through their survival during rheumatoid arthritis as well as to determine the factors that may influence their therapeutic maintenance in real life.Methods:This is a retrospective study including RA patients (ACR/EULAR 2010 criteria) and putted on biotherapy between 01-01-2014 and 12-31-2016. They were followed until 12-31-2018. The therapeutic maintenance rate at 12, 24, 36 and 48 months as well as the survival curves of biotherapies were analyzed using the Kaplan-Meier survival curves and compared by the Log-rank test. Reasons for interruption and patterns of biological change have been reported. Finally, an analysis of factors influencing survival was performed using Cox regression.A pResults:Three hundred seventy-four patients were included in the study; sex ratio was 0,147. The baseline age was 55 ± 12.5 years [20 – 90] and the average disease duration was 11.7 ± 6.7 years [2 – 41]. Rheumatoid factor and ACPA were positive respectively in 79% and 71% cases. After failure of cDMARD, the first biotherapy prescribed was etanercept in 54% of cases, adalimumab in 14% of cases, certolizumab pegol 13%, infliximab 6%, tocilizumab 6% and rituximab in 7% of cases, with an average DAS28 at baseline 6.01 ± 0.89 [5,37 – 6,50]. Association with methotrexate was observed in 59,6% case and with corticosteroid in 57.2% case. Drug persistency rate at 12 months was 85.8%; at 24 months, 69.9%; at 36 months, 60.6% and at 48 months, 55.9%. Survival was on average 41.7 months with 95% CI (39.47 - 43.91). The presence of rheumatoid factors, the co-prescription of methotrexate as well as good initial therapeutic response were predictor of a better survival of biologicals at a statistically significant level pConclusion:Our study provides information about biotherapy prescription practices in Tunisia and their effectiveness in “real life”. It informs us about the use of these new therapies in our country and has shown an efficacy and a tolerance profile close to those reported in international registers.Disclosure of Interests:None declared

Background:Osseous hydatid cyst is an uncommon disease with weak response to treatment.hydatid disease should be included in the differential diagnosis of cystic lesions of bone in endemic regions. Bone cysts account for only 0.5 to 2.5% of all hydatid cysts in humans.Objectives:To report a case of osseous hydatid disease extended on hip and femurMethods:We report a case of osseous hydatid diseaseResults:A 49 YEAR OLD BRICKLAYER, with no past-medical history and no animal contact, was admitted to our department for a left hip pain. the patient was apyretic and in a good general health condition. He had a very painful walk. the mobilility of the left hip joint was very painful and restricted.The pelvis X-rays showed osteolytic lesions in the ischiopubic branch and in the left femur and proximal extremity of the tibia.The C-Reactive protein value, the protein electrophoresis were normal. tumor markers test was negative.An ultrasound of the hip showed a low abondance intra-articular effusion. The Pelvic MRI showed multilocular appearance extending over the bone and muscle with breach of the bone cortex of the femur very suggesting of the diagnosis of a bony and muscular echinococcosis.NO other localization of hydatidosis were detected, body ct scan was normalConclusion:Hydatid disease occurs worldwide and mainly associated with sheep farming. The liver and lungs are the most common locations. Bone cysts are uncommon but severe. Although immunofluorescent assays are useful, the final diagnosis depends on histology. The treatment is almost surgery. Recurrence is commonDisclosure of Interests:None declared

Background:During the last decade, the treatment of chronic inflammatory rheumatism (CIR) has been greatly improved with the advent of biotherapy.However, the use of biological treatment can lead to a number of side effects including abnormalities in the blood count.Objectives:The aim of this study was to assess the different hematological side effects of biological treatment in patients with rheumatoid arthritis (RA) and spondyloarthitis (SA).Methods:This study included patients with RA (ACR/EULAR 2010) and SA (ASAS 2009) registred with the Tunisian Biologic National Registry (BINAR).Patients were followed and treated with biologics for 2 years of less. Clinical data relative to biological treatment, including haematological side effects, have been collected.Results:Two hundred and ninety-eight patients (178 women and 111 men) were included in the study.The mean age was 49.2 ± 14.1 years. The male/female ratio was 0.6. The mean diseases durations for RA and SA were respectively 6.7 ± 3.5 years and 6.5 ±3.6 years.Anti-TNFα agents were prescribed in 87.9% of patients (n = 263) with respectively: Infliximab (20.4%) Etanercept (23.1%), Adalimumab (24.6%) and Certolizumab (26.5%).Tocilizumab and Rituximab were prescribed in 10.4% and 5% of the patients, respectively.Blood count abnormalities were noted in 15.4 % of patients (n=46).Neutropenia was the most frequently anomaly met on the hemogram (9.1%) followed by anemia (3.4%) and thrombocytopenia (3%). Pancytopenia was found in 11.4% of patients (n=34).The median time between biological therapy initiation and the onset of hematologic manifestations was 4.8 months [1-12]. Biological treatment was interrupted in two patients.In the other cases, the biological treatment was maintained with close monitoring of blood cell count. No case of death related to these hematological disturbances has been reported.Conclusion:In our registry, hematological side effects of biological treatment were found in 15.4% of cases and were noted with a median delay of 4.8 [1-12] months after the treatment initiation. Further studies are needed to confirm our preliminary results.Disclosure of Interests:None declared

The purpose of this study was to determine the predictors of bone mineral density (BMD), bone mineral content (BMC), and bone turnover markers in obese postmenopausal women. In this cross-sectional study, 81 postmenopausal women aged 58.40 ± 6.08 years were analyzed. Anthropometric parameters were recorded. Serum glucose parameters, serum lipid profiles, adipokines, renal, hepatic parameters, and bone markers concentrations were determined by well-validated laboratory routine methods. BMD, BMC, and body composition were measured by Dual X-ray Absorptiometry. We found a significant correlation of BMD with age, years since menopause, anthropometric parameters, glycemia, alkaline phosphatase, fat mass, and lean mass. Multiple regression analysis demonstrated that years since menopause, waist circumference, alkaline phosphatase, trunk fat, and lean mass were independently associated to BMD. Also, age, years since menopause, anthropometric parameters, total cholesterol, alkaline phosphatase, fat mass, and lean mass were correlated to BMC. However, only waist circumference and trunk fat were independently related to BMC. Bone turnover markers were significantly correlated to the age, glycemia, HbA1c, adipokines, hepatic parameters, and lean mass. Nevertheless, only adipokines, gamma glutamyl transferase (GGT), and alkaline phosphatase were independently associated to bone turnover markers. These observations suggest that number of years since menopause, waist circumference, alkaline phosphatase, trunk fat, and lean mass were the only significant predictors of BMD. However, waist circumference seems to be a stronger predictor than trunk fat for BMC. Moreover, adiponectin, resistin, GGT, and alkaline phosphatase were significant predictors of the bone resorption (CTX-I) and the bone formation (P1NP) markers.

Background Cervical spine involvement is common during RA and is characterised by its potential severity. Objectives To determine the prevalence of cervical involvement in RA, to clarify the contribution of MRI to diagnosis and to identify predictive factors for cervical rheumatoid involvement. Methods Our study included 30 RA patients with a duration of more than 2 years. Results 16 patients (53%) were assessed on the two imaging methods (standard radiographs in 37% and MRI in 53%), of which 2 cases (7%) were asymptomatic. This cervical involvement was dominated by the C1-C2 pannus objectivated in 50% of cases and AAS. Of the AAS, aAAS was the most frequent with a prevalence of 23%, followed by the pAAS found in 10% of the cases, the vAAS present in 7% of the cases then the lAAS and the rAAS objectivated in 3% each. The ASS was found in 3 cases(10%), odontoid erosion in 11 cases (37%), C1-C2 arthritis in 5 cases (16%) and inflammatory spondylodiscitis in 6 cases (20%). MRI resulted in a better study of the C1-C2 pannus and odontoid erosions as well as the evaluation of the impact of rheumatoid lesions on the neural axis: a medullary imprint was noted in 4 cases (13%). Several factors were associated with cervical rheumatoid involvement: the presence of cervicobrachial neuralgia or bulbomedullary signs, duration of PR ≥5 years, HAQ score ≥1.1 and positive RF. The search for factors associated with AAS has revealed the duration of the disease, DAS 28≥3.2 and the presence of a biological inflammatory syndrome. Conclusions Cervical involvement accompanies the active and destructive forms of RA. It can be asymptomatic, it is the interest to seek it in a systematic way in RA. The standard radiography with dynamic views is to be realised first-line. The MRI must be indicated in order to make an early diagnosis, to carry out an accurate lesional assessment and to guide the therapeutic decision. Disclosure of Interest None declared

Background Brucellosis is an endemic zoonosis in the Mediterranean basin. The osteo articular localization, although rare, remains redoubtable. Objectives The aim of our work is to study the characteristics of osteoarticular brucellosis in Tunisia. Methods This is a descriptive retrospective study including 27 cases of osteoarticular brucellosis, collected in a rheumatology department over a period of 12 years (2006–2017) Results The Sex Ratio Female/male was 1.07 with an average age of 50.9 years. 15–76 Diagnosis delay was 5.9 months [0.3–13]. The diagnosis of spondylodiscitis was retained in 23 patients (85.2%) and sacroiliitis in 4 cases (14.8%). Spinal or sacroiliac pain was found in all patients. Fever was present in 22 patients, sweat in 11 patients, loss of weight or appetite were respectively found in 16 and 12 patients. Eleven patient reported fatigue. Laboratory examination found high erythrocyte sedimentation rate in 23 patients with an average of 69.4 mm. 10–120 CRP was elevated in 26 patients with an average of 59.6 mg/L [3.3–237], the WBC average was 9451 elements/ml [5550–14 000]. Wright serology was positive in all cases, Rose Bengal was positive in 15 cases, and IFI was positive in 3 cases. Brucella melitensis was isolated in blood cultures in 3 cases. Standard X Rays showed disk involvement in 21 patients, vertebral lesions in 20 cases and sacroiliitis in 4 patients. Sectional imaging (MRI or CT) was performed for all patients confirming standard X rays data and showing abscess in 13 patients and epiduritis in 7 patients. The most affected spinal segment was the lumbar one (13 cases), cervical localization was found in 5 cases and thoracic in only 1 case. The spondylitis was multifocal in 2 cases. Spinal disc biopsy was performed in only 4 cases, neither anatomopathologic nor bacteriological examination were conclusive. The treatment was based on the cycline and rifampicin combination for an average duration of 4.5 months. 3–9 The evolution was favourable in the majority of the cases with a relapse in only 2 cases. Conclusions Osteoarticular brucellosis is a focal form of brucellosis, the most frequent location is spinal and whose adequate treatment allows a favourable evolution. Disclosure of Interest None declared

Introduction L’introduction des biotherapies anti-TNF alpha (ATF) a revolutionne la prise en charge therapeutique de la spondyloarthrite (SpA). Pourtant, pres de 30 % de ces patients sont non-repondeurs a chacun des ATF. Il n’existe pas de recommandations internationales validees concernant le type de la sequence therapeutique pour chaque situation clinique apres echec d’un 1er ATF. Le but de ce travail est de determiner les facteurs d’une bonne reponse a un deuxieme ATF apres rotation. Patients et methodes Il s’agissait d’une etude transversale, incluant des patients atteints de SpA ayant beneficie d’au moins une rotation. L’evaluation de l’efficacite de la biotherapie a ete faite a 3 mois. A 6 mois, nous avons procede a l’evaluation du maintien de l’efficacite pour les SpA. Une analyse des facteurs predictifs d’une bonne reponse a ete menee. Resultats Trente patients SpA ont ete inclus. A 3 mois, le taux de reponse au 2e ATF etait comparable au 1er ATF (80 %). A 6 mois, cette reponse etait maintenue chez 86,7 % de la population. Les facteurs predictifs d’une bonne reponse trouves etaient, l’âge jeune de debut de la SpA ( Conclusion Les ATF sont un traitement cle au cours des spondyloarthrites, le profil des repondeurs a un deuxieme ATF apres echec d’un premier peuvent etre d’un grand apport pour le clinicien notamment dans l’attitude therapeutique lors des switch.

The dynamic nature of the skeleton is achieved by a remodeling process. Receptor activator of nuclear factor kappa B (RANK) ligand (RANKL) stimulates bone resorption by activating RANK signaling. Therefore it is considered as a candidate gene regulating susceptibility to osteoporosis. In the current study, we have investigated the association between the RANKL gene -693G C and -643 C T polymorphisms and bone mineral density (BMD) in a population of postmenopausal Tunisian women.Polymorphic sites in RANKL gene (rs9533155 -693G C and rs9533156 -643 C T polymorphisms) were determined using PCR-RFLP analysis in 566 postmenopausal Tunisian women. All statistical analysis were examined by SPSS software.We have detected a significant difference in lumbar spine and hip BMD for -643C T genotypes. For -693G C genotypes, a significant difference was detected only in hip BMD. The distribution of -643C T genotypes and alleles between three groups (osteoporotic, osteopenic and normal women) revealed a significant association of the TT genotype with development of osteoporosis (p = 0.01; odds ratio 2.15), although for the -693G C polymorphism, no significant results were found.We have demonstrated the association of the -643C T polymorphism with BMD variation and osteoporosis risk in postmenopausal Tunisian women.

Introduction Les patients atteints de polyarthrite rhumatoide presentent un risque plus important de developper des pathologies infectieuses par rapport a la population generale. Certaines de ces pathologies peuvent etre prevenues par la couverture vaccinale (infection a pneumocoque/grippe/hepatite B/hepatite A.). Notre etude a pour but d’evaluer la prevalence des patients ayant ete sensibilises a la vaccination ainsi que les raisons de non vaccination contre la grippe la meningite et le pneumocoque. Patients et methodes Notre serie comporte quarante-huit patients atteints de polyarthrite rhumatoide ayant ete hospitalises ou ayant consulte au service de rhumatologie de la Rabta entre mars 2017 et juin 2017. Nous avons releves les donnees demographiques et cliniques, les traitements de fond, le statut vaccinal ainsi que les causes de non vaccination pour chaque patient. Resultats Quarante-huit patients atteints de PR etaient inclus avec un âge moyen de 48,2 ans. La couverture vaccinale etait de 31,25 % (n = 15) pour la grippe, 25 % (n = 12) pour le pneumocoque et 6,25 % (n = 3) pour la meningite. Pour les patients vaccines, le vaccin contre le pneumocoque etait propose dans 100 % des cas par le rhumatologue, celui de la grippe etait dans 66,67 % des cas prescrit par le rhumatologue, dans 20 % par un medecin generaliste et dans 13,3 % par un endocrinologue, pour le vaccin contre la meningite les patients etaient sensibilises dans 100 % des cas par l’information sur le pelerinage. L’absence de proposition etait la premiere cause de non-vaccination. Pour le vaccin antigrippal, les facteurs predictifs de proposition etaient le traitement par biotherapie (p Conclusion La prevalence des patients presentant une PR et ayant ete vaccines est basse ce qui confirme que la couverture vaccinale chez ce groupe de patients immunodeprimes est tres faible et nous amene donc a sensibiliser d’avantage non seulement nos patients mais aussi les medecins de famille et les professionnels de sante a l’importance des vaccins recommandes a ce genre de patients.

Introduction La survenue de coxite au cours des rhumatismes inflammatoires chroniques constitue un facteur pronostique de grande importance vu le retentissement fonctionnel de l’atteinte de l’articulation coxo-femorale. Le but de ce travail est d’evaluer la prevalence de cette atteinte dans les rhumatismes inflammatoires chroniques (PR/AJI/SpA) et de decrire l’evolution de cette atteinte en fonction de la pathologie. Patients et methodes Quatre-vingt-deux patients presentant un rhumatisme inflammatoire chronique ont ete colliges. Il s’agit de patients suivis au service de rhumatologie entre 2004 jusqu’en mars 2018. Tous les patients etaient sous biotherapie pendant au moins deux ans. Les donnees demographiques cliniques, les scores d’activite ainsi que la necessite de prothese totale de la hanche ont ete relevees. Resultats Les patients de l’etude etaient repartis comme suit : 36,58 % (n = 30) presentaient une polyarthrite rhumatoide, 36,58 %(n = 30) une spondylarthrite et 26,83 (n = 22) arthrite juvenile idiopathique ayant un âge moyen respectif de 48,3 ans, 47,6 ans et 32.17 ans. 26,67 %(n = 8) des patients atteints de PR presentaient une coxite dont 62,5 % (n = 5) bilaterale et 37,5 %(n = 3) unilaterale. Le delai moyen de decouverte de la coxite etait de 11,7 ans. L’evaluation des scores d’activite trouve un das28 CRP abaisse de 28 % en moyenne. L’evolution etait une amelioration de la mobilite d’une hanche au moins dans 37,5 %, un aspect stable 12,5 % des cas et l’aggravation dans 50 % (n = 4) necessitant dans 3 cas une PTH bilaterale et un cas de synoviorthese. Pour le groupe des spondylarthrite, 23,33 % (n = 7) des patients presentaient une coxite dont 57,14 % (n = 4) etaient bilaterales et 32,86 % (n = 3) unilaterales. Le delai moyen de decouverte etait de 8,22 ans. Les scores d’activite ont diminue a l’introduction de la biotherapie de 37 % pour le BASDAI et 30 % pour la BASFI en moyenne. Une amelioration etait notee dans un seul cas 14,28 %, une stabilite de l’atteinte un seul cas 14,28 % pour le reste une PTH etait pratiquee dans 71,43 % (n = 5) des patients. Pour la population arthrite juvenile idiopathique, 45,45 % (n = 10) des patients avaient une coxite dont 80 % (n = 8) etaient bilaterales et 20 % unilaterales. Le delai moyen de decouverte de cette atteinte etait de 14 ans avec des scores d’activite moyen : das28CRP abaisse de 32 % en moyenne pour les formes peripheriques et un BASDAI diminue de 34 %, Basfi 27 % une evolution defavorable dans 60 % des cas necessitant dans 40 % des cas une synoviorthese et dans 60 % des cas une PTH. Conclusion La SpA reste le rhumatisme inflammatoire chronique le plus pourvoyeur d’une atteinte de la coxo-femorale avec le plus d’evolution pejorative malgre le traitement biologique qui reste sans un grand effet sur ce type d’atteinte.

The association of bone mineral density (BMD) with obesity and insulin resistance remains unclear. This study aimed to explore these associations in Tunisian menopausal women. Eighty-one postmenopausal women were recruited. Data were analyzed for obese (N = 57) and non-obese women (N = 24) and for insulin-resistant (N = 43) and non insulin-resistant women (N = 36). Anthropometric and biochemical parameters were recorded. BMD in different sites and body composition were measured using dual-energy X-ray absorptiometry. Higher BMD was observed in obese women than those non-obese in the left femur (p = 0.0067), right femur (p = 0.0108), total hip (p = 0.0077), and the whole body (p = 0.0276). Also BMD was significantly greater in insulin-resistant women than in non-insulin-resistant women when measured in the left femur and total hip. Positive correlations were recorded between BMD and anthropometric parameters, body composition parameters, and glycemia (r = 0.249, p 0.05). Multiple linear regression analysis shows that only trunk fat (p 0.05) and lean mass (p 0.05) were independently and positively related to BMD, and the waist circumference was the only anthropometric parameter independently and negatively associated to BMD. BMD is improved in obese and insulin-resistant women. Also, trunk fat and lean mass are likely to be key positive independent factors for BMD.

Spinal fractures in patients with ankylosing spondylitis may be the result of minor trauma. These fractures may lead to severe neurological deficits, and they are difficult to detect using standard radiography. Often, CT-scans and MRI are required for diagnosis.

Resume Introduction L’atteinte cardiovasculaire au cours de la polyarthrite rhumatoide (PR) est de plus en plus frequente et semble etre liee a la severite de la maladie. Elle est dominee par les cardiopathies ischemiques secondaires a l’atherosclerose, les atteintes cardiaques specifiques de la polyarthrite rhumatoide etant souvent asymptomatiques et de decouverte echographique ou autopsique. La pericardite represente l’atteinte cardiaque la plus frequente. Son expression clinique est rare et se complique exceptionnellement de tamponnade. Observation Nous rapportons l’observation d’une patiente âgee de 53 ans, suivie pour polyarthrite rhumatoide seropositive et erosive evoluant depuis six ans qui a presente un tableau de tamponnade jugule par un drainage pericardique et une corticotherapie a forte dose. L’histologie du pericarde a conclu a une pericardite fibrineuse. Sous colchicine 1 mg/j, il n’y a pas eu de recidives avec un recul de dix mois. Conclusion La pericardite est rare au cours de la polyarthrite rhumatoide. Les formes constrictives et celles compliquees de tamponnade sont graves pouvant mettre en jeu le pronostic vital. Le recours a une pericardectomie, constant dans les formes constrictives, est parfois necessaire en cas de tamponnade. Des observations et les etudes randomisees realisees pour les pericardites idiopathiques suggerent l’interet de la colchicine pour le traitement et la prevention des recidives de pericardites associees a la polyarthrite rhumatoide.

Introduction Les calcifications vasculaires (CV) representent un facteur de risque de mortalite important au cours de la maladie renale chronique. Il est donc important de connaitre les facteurs de risque associes a leur developpement. Le but de ce travail etait de determiner la prevalence des CV chez les hemodialyses et d’identifier leurs facteurs de risque. Patients et methodes Etude transversale sur une periode de 4 ans regroupant 90 patients hemodialyses chroniques depuis au moins une annee et âges de plus de 20 ans. Un bilan incluant le dosage de la calcemie, phosphatemie, PTH et FGF23 a ete realise. Nous avons recherche sur les radiographies standard du rachis lombaire de profil les depots calciques au niveau des parois anterieure et posterieure de l’aorte abdominale. Nous avons reparti les patients en 2 groupes : G1 ceux ayant des CV et G2 sans CV. Nous avons realise une comparaison entre ces deux groupes. La recherche des facteurs de risque a ete effectuee egalement en calculant l’odds ratio (OR). L’etude statistique a ete realisee a l’aide du Logiciel SPSS. Resultats Il s’agissait de 90 patients hemodialyses : 58 hommes et 32 femmes. L’âge moyen de notre population etait de 53,01 ± 14,60 ans. La duree de l’hemodialyse etait de 3,94 ± 1,99 ans. La valeur moyenne de l’indice de masse corporelle (IMC) etait de 25,79 ± 4,67 kg/m2. Le diabete (42 %), l’hypertension arterielle (66 %) et l’insuffisance coronaire (22 %) etaient les principales comorbidites observees dans notre population. La moyenne de la calcemie etait de 2,084 ± 0,32 mmol/L. Celle de la phosphatemie etait de 1,84 ± 0,57 mmol/L. Le taux moyen de la PTH etait de 425,70 ± 380,78 ng/L. Les concentrations seriques de FGF23 etaient de 221,87 ± 248,96 pg/mL. Cinquante-six pour cent des patients se situaient dans les valeurs cibles de la PTH (2 a 9 fois la normale). Des calcifications vasculaires ont ete observees dans 31,11 % des cas (n = 28). Les facteurs de risque associes a ces calcifications etaient : l’âge avance (G1 : 61,03 ans vs G2 : 49,38 ans ; p : 0,000), la menopause (p : 0,004), l’IMC eleve (G1 : 27,23 kg/m2 vs G2 : 25,15 kg/m2 ; p : 0,000), le diabete [OR : 3,78 (IC 95 %)], l’HTA [OR : 3,1 (IC 95 %)], l’âge de debut de l’hemodialyse (G1 : 58,21 ans vs G2 : 46,38 ans ; p : 0,000). Les concentrations de PTH (G1 : 448,01 pg/mL vs G2 : 415,45 pg/mL ; p > 0,5) et FGF 23 (G1 : 275,84 pg/mL vs G2 : 195,88 pg/mL ; p > 0,5) avaient une tendance a etre plus elevees en cas de CV mais cette difference n’etait pas significative. Les CV etaient associees a un risque d’insuffisance coronaire [OR : 3,8 (IC 95 %)]. Discussion Ces calcifications vasculaires sont plus frequentes, plus severes et plus rapidement evolutives chez les dialyses par rapport a la population generale [1] . Les mecanismes responsables des calcifications vasculaires sont encore imprecis. Ces facteurs de risque sont classes actuellement en facteurs traditionnels, qui representent les facteurs favorisant la maladie cardiovasculaire dans la population generale ; et en facteurs non traditionnels qui sont specifiques de la MRC. Les principaux facteurs traditionnels associes au developpement des CV sont le diabete, les concentrations basse de HDL cholesterol, l’HTA, l’hypertrophie ventriculaire gauche et l’âge avance [2] . Les principaux facteurs de risque non traditionnels rapportes dans la litterature sont l’hyperparathyroidie secondaire, l’hypercalcemie, la genetique et la duree de la dialyse. Le role de FGF23 dans la survenue de CV n’est pas bien clair [3] . Conclusion Notre etude a montre que les CV sont frequentes chez les hemodialyses. Les facteurs de risque de calcifications vasculaires retrouves dans notre etude etaient : l’âge avance, la menopause, l’IMC eleve, le diabete, l’HTA, l’âge avance de decouverte de debut de l’hemodialyse. Les CV etaient associees a un risque plus important d’insuffisance coronaire. Les concentrations du FGF 23 etaient plus elevees en presence de CV, mais la difference n’etait pas statistiquement significative.

Background Brucellosis is a major health problem in Mediterranean countries, including Tunisia. The clinical presentation of this zoonosis varies considerably, but osteoarticular involvement and spinal brucellosis particularly, is the commonest complication. Methods This study was carried out between 2006 and 2013. Forty patients with infectious spondylodiscitis hospitalized in the department of Rheumatology were analyzed. All patients were thoroughly interrogated, subjected to a rigorous clinical examination and a battery of investigations including: complete blood count, urine analysis, blood culture, erythrocyte sedimentation rate, C-reactive protein (CRP) and serology for brucellosis. The imaging ordered including: plain X-ray of the lumbosacral spine, bone scan and magnetic resonance imaging (MRI) with contrast enhancement of the spine. Results Ten of the forty patients (25%) proved to have spinal brucellosis. The mean age of this patients was 51 years (range 15 – 68 years) and female/male ratio: 1,5. The mean delay of diagnosis was 7 months. The following symptoms were observed: fever in 9 patients and back pain in all patients. Other symptoms were less frequently observed, such as splenomegaly (one patient), peripheral adenopathy (two patients) and diarrhoea (one patient). Laboratory exams showed elevated erythrocyte sedimentation rate in most of them (8 patients), high levels of CRP in all patients and leukocytosis in 7 cases. Wright serology was positive in all of them. Brucella melitensis was isolated in blood cultures in 2 cases. Standard X-rays were performed in all patients; they showed signs of spondylodiscitis in the lumbar spine in 5 cases, cervical in one case and dorsal in two cases. CT-scan and MRI confirms the diagnosis and showed associated epiduritis (3cases) or abscess (4 cases). Bone biopsy and histopathological examination were performed in three cases. A combination of cycline and rifampicin was given to all patients. The duration of therapy was between 6 and 8 weeks. Conclusions Brucellosis is present with various clinical signs in endemic areas and may simulate many diseases. The need for prompt diagnosis and treatment of spinal brucellosis is of the utmost importance to prevent serious bone destruction and severe neurologic sequelae. Disclosure of Interest None declared

Cardiovascular involvement in rheumatoid arthritis (RA) is increasingly observed and may be associated with the severity of rheumatoid arthritis. It is dominated by heart ischemic diseases related to atherosclerosis. Specific rheumatoid heart disease is commonly asymptomatic and found at autopsy or by echocardiography. Pericarditis is the commonest cardiac complication of RA. It is rarely clinically apparent and pericardial tamponade is exceptional.Herein, we report an unusual case of a 53-year-old female patient with a six-year history of seropositive and erosive rheumatoid arthritis who had developed a pericarditis complicated with tamponade resolved by pericardiocenthesis and high dose systemic steroids. Histopathology showed chronic inflammation and fibrosis. Under 1mg/day of colchicine, there were no recurrences at 10 months.Pericarditis is uncommon in rheumatoid arthritis. Forms with constriction or tamponade may have a fatal outcome. Pericardectomy usually recommended in constrictive forms, is sometimes indicated for tamponade. Some observations and randomised studies of idiopathic pericarditis suggest that colchicine may be interesting for the treatment and prevention of recurrences of rheumatoid arthritis-associated pericarditis.

Background Enthesitis is the inflammatory process marked by the insertions of tendons, ligaments and joint capsules on the bone and it is the cardinal feature and diagnostic criteria of spondyloarthritis (SpA). Although, it is usually revealed by clinical examination, the enthesitis can be asymptomatic, both in the axial and peripheral skeleta. Objectives Our objective is to investigate by colour Doppler ultrasound (CDU) the modality and the frequency of involvement of Achilles enthesitis, the main site of involvement in SpA after calcaneal entheses, to identify its characteristic features, and to correlate these findings with clinical complaints and radiographic evidence. Methods Our study is prospective. Thirty patients with SpA diagnosis were included. The diagnoses were ankylosing spondylitis in 18 patients, psoriatic arthritis in 8, SpA associated with inflammatory bowel diseases (IBD) in 3, and Reiter9s disease in one patient. All of them were clinically evaluated and underwent CDU examination of Achilles entheses. Particular attention was given to the detection of enthesis thickness, structure, cortical bone insertion, junction between tendon and entheses, body of tendon, calcifications, erosions, bursae, power Doppler signal and vascularization. Results Patients male/female ratio was 4 (24/6), mean age was 30 (range 16-53) years and mean disease duration was 8 (range 1-13)years. Mean (SD) BASDAI and BASFI scores were 33 and 64 respectively. Twenty-three of the 30 SpA patients (76%) showed at least one abnormal finding of the enthesitis on CDU examination, affecting 43 of 60 Achilles entheses examined (71%). Only 11 Achilles entheses (18%) showed vascular signals in the periosteal areas or in the area of enthesis fibrocartilage. Ultimate correlations were found between pain and tenderness with increased vascularity. In addition, 29 (48%) and 8 (14%) of 60 Achilles entheses examined showed, respectively, cortical bone irregularities and erosions. Fourteen (87%) of 16 clinically detected Achilles enthesitis and 4 (57%) of 7 Achilles entheses with swelling on clinical examination presented corresponding abnormalities on CDU examination. CDU revealed Achilles tendon calcifications in 30% without significant correlation between talalgia or sex of patients but with excellent agreement with radiography. Deep retrocalcaneal bursitis was found in 3 (13%) and there was a significantly correlation with talalgia. Conclusions This study demonstrates the characteristic features of Achilles enthesitis detectable by CDU in the SpA and shows a good correlation with clinical as well as with radiography findings. It may be useful and complementary to the clinical evaluation to track down this reach of Achilles tendon. Further researches are needed to improve the role of CDU in diagnosis and follow up of SpA course. References Li CA, Kim HO, Lee SY, Lee SI. Assessment of Achilles enthesitis in the spondyloarthropathies by colour Doppler energy ultrasound in the context of the “enthesis organ”. Scand J Rheumatol. 2010 Mar;39(2):141-7. Disclosure of Interest None declared

Background Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. Objectives The objective of this study was to define high-resolution chest CT (HRCT) and pulmonary function test (PFT) abnormalities to identify asymptomatic, preclinical forms of RA-ILD that may represent precursors to more severe fibrotic lung disease. Methods Our study is prospective. We collect 20 RA patients with no respiratory functional sign. All patients met the 1987 diagnostic criteria of the American College of Rheumatology (ACR). We analyzed chest HRCTs in consecutively enrolled RA patients and subsequently classified these individuals as RA-ILD or RA-no ILD based on the presence/absence of ground glass opacification, septal thickening, reticulation, traction bronchiectasis, and/or honeycombing. Coexisting PFT abnormalities (reductions in percent predicted FEV1, FVC) were also used to further characterize occult respiratory defects. Results Twenty patients were included in the study. Their demographic and clinical characteristics are summerized in the table below. In this study, all RA patients were treated with combinations of DMARDs and cortico steroids (7.5 mg per day) that included methotrexate (MTX), with a dose ranging from 10 to 15 mg (mean at 12.33 mg) per week; however, only 4.6% of RA patients used Leflunomide (20 mg per day). In terms of additional environmental risk factors, the prevalence of smoking was very low (1/20). Radiographic abnormalities are objectified in 4 cases 20% of cases. The most common abnormality is represented by interstitial syndrome found in 3 cases: diffuse reticulomicronodular images in 2 cases and pleural thickening in one case. The results of our study showed a restrictive syndrome in 5 cases (25%) and a mixed syndrome in 1 case (5%). Among the 13 patients with ILD on HRCT, only 4 have a restrictive syndrome. As regards the restrictive syndrome (CVF equal to 69% of the theoretical in both cases), corresponding HRCT was normal. In the case of mixed syndrome CT revealed centrolobular and para septal emphysema predominantly in the bi upper lobe. Conclusions HRCT represents an effective tool to detect occult/asymptomatic ILD that is highly prevalent in our unselected, university-based cohort of RA patients. Disclosure of Interest None declared

Background Fibroblast growth factor-23 (FGF23) is a bone-derived hormone. The association between FGF-23 levels and clinical outcome in hemodialysis patients suggests that FGF-23 can be considered as a cardiovascular risk in this population, Moreover, relationship between FGF-23 and osteoporosis remains unclear in dialysis patients. Objectives The aim of the study was to demonstrate the association between FGF-23 levels with either osteoporosis and cardiovascular risk factors in hemodialysis patients. Methods We conducted a transversal study over a period of 4 years [2009-2012] including 80 patients under hemodialysis therapy over one year period. Blood samples were drawn before hemodialysis session from patients. We measured calcium, phosphate, 25 OH-vitamin D and fibroblast growth factor (FGF23). Bone mass density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at the lumbar spine and total hip. Lumbar spine X-rays were used to diagnose vascular calcification. All statistical analysis were performed using the Windows SPSS 19 package. Results Eighty patients were included: 51 male and 29 female. The mean age was 53.27 years [20; 89]. The mean age of onset of hemodialysis was 50.42±14.49 years. The mean body mass index (BMI) was 25.91±4.86 kg/m 2 and the mean weight was 68.16±13.36 kg. Diabetes, hypertension and dyslipidemia were observed respectively in 45%, 66.3% and 15% of cases. Serum calcium and phosphorus levels were respectively 2.06±0.39 mmol/L and 1.83±0.57 mmol/L. The average rates of parathyroid hormone (PTH), vitamin D and FGF23 were respectively 422.60±382.8 pg/mL 15.92±11.39 ng/mL, and 248.96±221.87 pg/mL. Osteoporosis affected the hip in 20% of cases and the spine in 9% whereas osteopenia was observed in 44% of cases in the hip and 33% of cases in the spine lumbar. Vascular calcifications (CV) were found in 31.11% of cases. Negative correlation was observed between FGF23 and vitamin D (r: -0.245, p: 0.027). Patients with dyslipidemia had higher FGF23 levels than patients without dyslipidemia (239.28 pg/mL vs 123.19pg/mL). No correlation was found between FGF23 and following parameters: calcium and phosphorus levels, PTH levels, BMI and weight. FGF levels 23 tend to be higher in hemodialysis with CV but this difference was not significant (275.85 pg/mL vs 195.88 pg/mL, p:0.231). Lumbar osteoporosis was associated with high concentrations of FGF23. Conclusions Our study showed that FGF-23 levels are increased in hemodialysis patients. We demonstrate also that higher concentrations of FGF23 are associated with osteoporosis in lumbar spine. Given the association FGF23 and dyslipidemia, this factor can be considered as a cardiovascular risk in hemodialysis patients. Disclosure of Interest None declared

Background Spondyloepiphyseal dysplasia (DSE) is a genetic chondrodysplasia causing early osteoarthritis witch predominates in hips, knees and shoulders. We report in this context 7cases. Objectives We propose to study the clinical and radiologcal features of spondyloepiphyseal dysplasia in our patients. Methods We studied the clinical and radiological features collected from records of patients treated for spondyloepiphyseal dysplasia. Results This was 7 patients (4H/3F) 31. Their middle age was 31,5 years. The diagnosis delay was on average 6,25ans [4 months-13 years]. Clinical signs were present in all cases: low back pain in 3 cases, hip disease in 3 cases, and a dwarfism in 2 cases. The clinical examination objectified abnormalities in all patients. This was strain in six cases: flexion of the elbows and/or knees, scoliosis in 3 cases each. Joint restriction in one or both hips was observed in 2 patients. The diagnosis was retained in all patients on radiological data. Vertebral dysplasia was demonstrated in 4cas. Femoral involvement was noted in 2 cases (pseudo rheumatoid dysplasia), knees in 2 cases. Three patients underwent measurement of bone mineral density, which found osteoporosis. Treatment was to prescribe analgesics and nonsteroidal antiinflammatory for all patients, a support unit in rehabilitation and physical medicine in one case and total hip in one case. Conclusions SDE is a child or adolescent pathology which must always be suspected in advanced osteoarthritis in young adults. Early diagnosis, through a better understanding of this entity, could improve the quality of life of these patients. References Kohler G, Hesse B. Epiphyseal dysplasia–symptoms and differential diagnostic aspects. Z Orthop Ihre Grenzgeb. 2004 Jul-Aug;142(4):397-402. Acknowledgements SDE. Disclosure of Interest None declared

Background Low bone mass is common in patients undergoing hemodialysis. Osteoporosis can be associated with serious bone health problems, especially fragility fractures. Objectives The aim of the study was to determine the frequency of osteoporosis in hemodialysis Tunisian patients and to identify the risk factors of low bone mass in this population. Methods We conducted a cross-sectional study over a period of 4 years [2009-2012] including 90 hemodialysis. Blood samples were drawn before hemodialysis session from patients. We measured calcium, phosphate, alkaline phosphatase (ALP) and intact parathyroid hormone (PTH). Bone mass density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at the lumbar spine and total hip. Using WHO criteria as a cutoff point, osteopenia was defined as a T-score lower than -1 and osteoporosis was defined as a T-score lower than -2.5. All statistical analysis were performed using the Windows SPSS 19 package. Results Ninety patients were included: 58 male (64%) and 32 female (36%). The mean age was 53.01±14.60 years. The mean age of onset of hemodialysis was 50.06±14.82 years. Serum calcium and phosphorus levels were respectively at 2.084±0.32 mmol/L and 1.84±0.57 mmol/L. The average rates of PTH and ALP were respectively at 425.70±380.78 pg/mL and 88.35±72.56 UI/L. Fifty six percent of patients have PTH values between 2 and 9 times the upper normal limit of the assay as recommended by KDIGO (Kidney Disease: Improving Global Outcomes). However, 19% of patients have PTH values less than 2 times the upper normal limit of the assay. The mean of BMD was 0.854±0.152 g/cm 2 in the hip and 1.155±0.218 g/cm 2 in the lumbar spine. Twenty three percent of patients have osteoporosis and 45% have osteopenia. Osteoporosis affected the hip (20%) more than the spine (5.5%). Regarding risk factors, femoral BMD had significant negative correlations with the with the following parameters: age (r:-0.289; p:0.006), age of onset of hemodialysis (r:-0.359; p:0.001) and PTH level (r:-0.275; p:0.009). However, no correlations was found between lumbar spine BMD and the following parameters: age, age of onset of hemodialysis, calcium, phosphorus and PTH level. Conclusions Our study showed that osteoporosis is common in dialysis patient [1]. The most common region of bone loss was the hip. The decrease in cortical BMD was associated with advanced age, age of onset of hemodialysis and elevated levels of PTH [2]. References Nybo M, Jespersen B, Aarup M, Ejersted C, Hermann AP, Brixen K. Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis–across-sectional, longitudinal study. Biochem Med. 2013;23(3):342-50. Huang GS, Chu TS, Lou MF, Hwang SL, Yang RS. Factors associated with low bone mass in the hemodialysis patients–a cross-sectionalcorrelation study. BMC Musculoskelet Disord. 2009; 4;10:60. Disclosure of Interest None declared

It is a retrospective study, reviewing all cases of vertebral tuberculosis recorded between 1989 and 1999 in La Rabta Hospital (Tunis). 29 patients have been included whose average age was 49 years. The main symptoms which appeared within a average period of six months were vertebral pain, associated with fever in half of the cases. The diagnosis of infectious spondylitis was made according to the results of Computer tomography in 26 cases. The diagnosis of infection was confirmed by characteristic histological pattern and/or culture biopsy. 27 patients were cured without complications except for 2 of them who developed a spinal cord compression. This complication was quickly stemmed by steroid therapy.

Background This is the second part of the study about the prevalence of osteoporotic fractures in the Tunisian population and which includes 1311 women, aged 64.07±9.31 years, which revealed the presence of fractures in 212 women (16.2%), mainly represented by vertebral fractures (59.83%). What about the subsequent risk of fracture in this cohort? [1] Objectives The aim of this study was to determine the probability of fracture predicted by Frax (fracture risk assessment tool) comparing women with and without history of fracture. Methods A prospective and comparative cohort of 111 postmenopausal women with medical history of fracture (G1) and 111 postmenopausal women without medical history of fracture (G2), matched for age, race and body mass index were included in the study. BMD was measured by dual energy X-ray absorptiometry (DXA) at lumbar spine and femoral neck. We calculated Frax values for hip in both groups and evaluated osteoporotic fracture in this cohort. Both statistical and descriptive analyses were performed. Results The mean age was 65.92±9.48 years in G1 and 64.55±9.98 years in G2 (p=0.296). BMI values in G1 and G2 were respectively 29.18±4.96 and 28.82±4.62 kg/m2 (0.573). Mean values of FRAX TOOL for major osteoporotic fracture in G1 and G2 were respectively 1.507±0.788 and 0.764±0.390 (p=0.000). And, mean Frax values for hip fracture in G1 and G2 were 0.384±0.504 and 0.161±0.232 respectively (p=0.000). The discriminative capacity of FRAX analyzed by the Area Under Curve (AUC), Receiver Operating Characteristics (ROC). The AUC were 0.873 (CI 95%; 0.827-0.919) for major osteoporotic fracture and 0.68 (CI 95%; 0.612-0.752) for hip fracture. Therefore odds ratio for major osteoporotic and hip fracture were 18.2 and 3.1. ![Figure][1] Conclusions Our study confirmed the significant increase of fracture risk in patients with a history of fracture thereby enhancing the need to strengthen prevention of osteoporosis fracture in our population. Furthermore, our study demonstrated that in Tunisian female patients, cut-off FRAX values are 0.873 and 0.68 for major osteoporotic fracture and hip fracture respectively References 1. Sahli H, Testouri N, Chihaoui MB, Salah AH, Cheour E, Meddeb N, Zouari B, Sellami S. Bone mineral density in healthy Tunisian women. Maturitas. 2009 Jul 20;63(3):227-32 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5697 [1]: pending:yes

Background Although bone biopsy is a golden standard in the diagnosis of chronic kidney disease mineral and bone disorders (CKD-MBD), this method is invasive and repetitive evaluation of bone status cannot be possible. Objectives The aim of this study was to clarify the issue of bone metabolic markers in regular hemodialysis (HD) patients. Methods A prospective study included 90 patients under HD therapy over a three month period. Hematological and biochemical blood samples were collected after at least 10 h of fasting just prior to the HD session. One bone formation markers: bone-specific alkaline phosphatase (BAP) and one bone resorption marker carboxy-terminal telopeptides of type 1 collagen (CTx) were selected for study. Both statistical and descriptive analyses were performed. Results Ninety patients were included: 58 male (64%) and 32 female (36%). The mean age was 53.01±14.66. The body mass index was 25.79±4.67 kg/m 2 . The mean age of onset of nephropathy was 48.40±15.09. It was diabetic nephropathy in 30 cases, glomerulonephritis in 34 cases, vascular nephropathy in 6 cases, amyloidosis in 1 case, polycystic in 4 cases, tubulointerstitial nephropathy in 9 cases and indeterminate nephropathy in 6 cases. The mean age of onset of HD therapy was 50.06±14.82 years. The levels of BAP and CTx showed a strongly positive correlation (r=0.56, p Conclusions The determination of serum intact parathyroid hormone has been used for many years as an indirect predictor of CKD-MBD. The introduction of modern biomarkers of bone metabolism offers the possibility of a direct assessment of bone metabolism. BAP is a bone formation marker, it is not influenced by either renal dysfunction or the HD procedure because it is exclusive metabolized in the liver. Thus, serum BAP concentration can provide useful information about the rate of bone remodeling in HD patients. Even if CTX is cleared by the kidney, our study showed that circulating BAP and CTx levels are strongly correlated with serum PTH levels. Therefore, in HD patients, bone metabolic markers including BAP and CTx may accurately reflect bone turnover. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6000

Muscular involvement is rare, representing less than 1% of hydrated cyst localisation's. Clinical symptoms are insidious and non-specific causing a frequent delay in diagnosis. We report the observation of a 50 year-old woman consulting for inguinal tumefaction with radiological exploration suggestive of hydrated cyst of adductors muscles. Magnetic resonance imaging is helpful in diagnosis, since it reveals a very suggestive aspect. Treatment is based on surgery, which cures patients but incurs a low risk of local relapse.