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Introduction et objectifs La polyarthrite rhumatoide (PR) est un probleme de sante publique au Maroc, c’est le rhumatisme inflammatoire le plus frequent. L’arrivee des biotherapies a ouvert des perspectives therapeutiques importantes. Cependant, ils ajoutent un poids supplementaire a la charge economique de la maladie vue leurs couts eleves. L’objectif de ce travail est d’estimer les couts directs et indirects lie a la PR chez la population marocaine sous biotherapies. Materiel et methodes Il s’agit d’une etude de cohorte retrospective aupres des patients atteints de PR sous biotherapies a l’hopital El Ayachi de Sale entre juillet et decembre 2019. Le recueil des donnees a ete realise par entretien face a face a l’aide d’un « case report form ». Le complement d’information a ete realise a partir du dossier patient. L’etude a ete realisee selon un point de vue societal (patients, assurance maladie obligatoire et regime d’assistance medicale [RAMED]) sur un horizon temporel de six mois. Les couts directs et indirects et le retentissement sur l’activite professionnelle et societale ont ete releves. Les resultats ont ete exprimes en moyenne et [minimum–maximum]. Resultats Au total, 43 patients ont ete interroges. L’âge moyen de la population etait de 49,5 ± 14,6 ans avec une nette predominance feminine, 37 femmes (86 %) dont 34 (79 %) n’ont pas depasse le niveau d’instruction primaire. Les beneficiaires du RAMED representaient 74,4 % de la population etudiee. La majorite des patients etaient sous rituximab (62,7 %) et 37,3 % etaient sous etanercept, golimumab, infliximab, et tocilizumab. La moyenne semestrielle des couts directs totaux de la PR etait de 5284 € [1055–46 782]. La moyenne du reste a charge du patient etait de 854 € [4–9831]. La moyenne des couts supportes par les organismes gestionnaires et le RAMED etaient respectivement de 5121 € [880–18 810] et de 3414 € [909–18 933]. Les depenses en biotherapies seules representaient entre 40 a 51 % des couts directs totaux de la PR. Concernant les couts indirects, 17 patients ont arrete de travailler definitivement soit 63 % de la population active. Le cout estime perdu en salaire a cause de la PR est de 3028 € soit 72 % de la masse salariale mensuelle. Sur les 37 femmes, 4 (11 %) ont divorce et 8 (22 %) sont reste celibataires jusqu’a l’âge de la menopause a cause de la maladie selon elles. Une tierce personne etait necessaire pour 37 patients (86 %) avec une depense mensuelle moyenne de 70 € [7–224]. Le sport, les loisirs et les tâches menageres ont ete arrete chez 35 patients (86 %) des cas. Conclusion Les couts resultants de la chirurgie et de la biotherapie restent les postes de depense les plus eleves pour tous les intervenants ; patients, OG, et Etat. A cela s’ajoute L’impact societal qui est clairement defini par l’arret du travail chez une majorite de la population active.

Objectives:The aim of this study was to calculate direct costs amount in rheumatoid arthritis (R.A) patients in the Moroccan register of biologicals RBSMR registry.Methods:Patients in the Moroccan register of biologicals RBSMR registry with available 1-year data were included. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Biologic use and costs were compared.Results:197 patients data (female sex (86,8%), mean age (52,3± 11 years), illiteraty (45,7%)) were analyzed. The median annual direct costs per patient were €1,665 [€1,472 - €9,879]. For all patients, the mean annual direct costs per treated patient for each biological agent is presented in Figure 1.The total annual direct costs of biological agents in the RBSMR registry were 978 494 €. Rituximab was given to 67% of patients and constituted 25.7% of the total annual budget. TNF-blockers and Tocilizumab were prescribed in 14.2% and 18.8% of cases and represented respectively 27.3% and 47% of this overall budget.Conclusion:This study presents a global overview of the direct costs of biological therapy associated with RA patients, taking as a source the Moroccan registry of biological therapies in rheumatic diseases. Those results show that overall cost of biological agents according to the Moroccan register is very high. There is a real need for development of strategies for better governance of those costs.Disclosure of Interests:None declared

Background:Objectives:The aim of this study was to estimate the annual direct cost of biologics in rheumatoid arthritis and to evaluate the impact of social factors on biological use and costs.Methods:Patients in the Moroccan register of biologicals (RBSMR) with available 1-year data were included. Variables related to socio-economic status, disease and biological were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Biological use and costs were compared based on social factors.Results:Our study included 197 patients (female sex of 86.8%, mean age of 52.3 ± 11 years). Patients were on one of the following therapies: Rituximab (n=132), Tocilizumab (n=37) or TNF-blockers (n=28). 44.2% of included patients have the RAMED medical assistance (health insurance scheme for the economically underprivileged). Illiteracy was noted in 45.7% of cases. Median one-year direct costs per patient were €1,665 [€1,472 - €9,879].There was no statistically significant difference in costs between men and women (p>0.05), between illiterate and literate (p>0.05). There was a statistically significant difference in costs between patients with the RAMED medical assistance scheme and other health insurances (pConclusion:This study showed that Moroccan RA patients had equal access to biologics regardless of their gender or level of education. Indeed, the insurance system influence the costs of biologics. Accessibility of those expensive treatments in a developing country seems be explained by efforts of the Moroccan ministry of health who has allocated a substantial budget for biologic DMARDs for patients with RAMED in the tertiary structures in our country.Disclosure of Interests:None declared

Objectives:To investigate the knowledge, believes, and fears of patients with Chronic Inflammatory Rheumatic Diseases (CIRD) in Morocco regarding the Covid-19 pandemic.Methods:COVID-19 related knowledge was evaluated through following items: clinical presentations, age of infection, transmission routes, self-reported preventive behaviors, patient’s approach in case of suspicion of being infected by COVID-19 and vaccination. We also investigated the source of the patients’ information.Believes and fears of patients regarding COVID-19 was assessed using 2 items that explored participant’s perception of the degree of threat to public health and their individual infection susceptibility compared to the general population.Results:A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics.350 patients had participated in this online survey (mean age of 46,1 ± 14,4, 68% were women, 15.7% were illiterate, 45.7% were unemployed, rural residence in 11.7% of cases).The correct answer rates of the 6 questions of the knowledge section of the questionnaire were 53.4-100% with an average mean of 90.7%. The mean COVID-19 knowledge score was 5,43/6 (SD:0,48). Most participants (96.6%) correctly identified the age group concerned about Covid-19 infection. Remarkably 92.3% of the participants recognized 3 clinical features when 97.7% and 72.3% of the sample recognized perfectly modes of transmission and disease prevention measures. 87.4% of patients knew the recommended course of action to do if they have fever or cough and have recently been in contact with an infected patient. 64% of the study population thought that there was no vaccine available yet.The sources of information on COVID-19 were in descending order: rheumatologist (56.6 %), personal research (on the internet or other) (43.4%), video broadcasts on national television channels (28%), other Awareness Video (24.2%).Regarding the patients believes and fears toward COVID-19, 81.7% of patients believed that the pandemic is a serious threat for the public health and 80.6% thought that their CIRD makes them more exposed to the risk of contamination than general population.Conclusion:The results of this survey show a high prevalence of patient concern about COVID-19. However, the majority of patients responded correctly on the mode of transmission and the means of protection for the COVID-19 infection. Those results could be explained by enormous awareness-raising efforts carried out by our differents departments of our government.Disclosure of Interests:None declared

Background:The Coronavirus pandemic caused many consequences on well being, access to care and therapeutic maintenance in patients with chronic diseases.Objectives:To assess the impact of COVID-19 on therapeutic maintenance of patients with Chronic Inflammatory Rheumatic Diseases (CIRD) and to identify related factors to difficulties in access to rheumatologist care during the COVID-19 pandemic.Methods:A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics, impact of COVID-19 on access to rheumatologist care and therapeutic maintenance during the confinement. Reasons of therapeutic interruption and of diificulties in access to healthcare were precised.Results:We received answers from 350 patients (female sex of 68%, mean age of 46,1 ± 14,4 years) suffering from Chronic Inflammatory Rheumatic Diseases (CIRD):rheumatic arthritis (RA) (62.3%), spondyloarthropathies (34.3%), and undifferentiated CIRD (3.4%). The global average disease evolution was 12,1 ± 9,7 years.The patients were treated with conventional Disease-modifying anti-rheumatic drugs (cDMARDs) and biologic Disease-modifying anti-rheumatic drugs (bDMARDs) in respectively 67.4% and 30.6% of cases. Corticosteroids and Nonsteroidal Anti-Inflammatories (NSAIDs) intake was noted in 39.1 and 33.7% of patients.Difficulties to access to rheumatologist care appointments were reported in 82.9% of the participants. Reasons of thoses difficulties are summurized in Figure 1.Figure 1.Causes of difficulties of access to Rheumatologist care during COVID-19 pandemic.Half of patients declared that the pandemic had affected their therapeutic compliance. Discontinued drugs were in decreasing order: Synthetic antimalarials (68.4%), NSAIDs (45.8%), Methotrexate (43.8%), bDMARDs (25.2%), Sulfasalazine (18.2%) and Corticosteroids (10,2%).Causes of treatments interruption are summarized in Table I.Table 1.Causes of treatments interuption in patients with CIRDDrugsNot found in pharmaciesThe pharmacy refuses to give me the treatment without a recent prescriptionTo avoid the decrease in immunity and therefore to avoid catching Covid-19I stopped the follow-up, and so I stopped the treatment...Other reasonsNSAIDS027.874.144.427.8Corticosteroids014.392.957.150Methotrexate70.1310.416.422.4Sulfasalazine012.52575100Synthetic antimalarial69.20023.161.5Leflunomide00000bDMARDs07.440.744.451.9Conclusion:The COVID-19 pandemic impacted heavly on therapeutic maintenance in CIRD patients in our country. Patients expressed many difficulties in access to appropiate management. Facing to all thoses consequences, we need to devolopp as soon as possible adequate solutions adapted in such health crisis, especially therapeutic education and telemedecine.Disclosure of Interests:None declared

Objectives:To evaluate the effect of containment, during the Covid-19 pandemic, on the pain of patients with CIRD, and to analyze the factors associated with the experience of pain.Methods:A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Impact of COVID-19 on This is a cross-sectional study that consecutively includedPatients were asked to assess the global pain which they had experienced before and during the containment period, using a single Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (greatest pain).Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the study data.We performed univariate then multivariate analysis to search any related factors to pain perception during to quarantines. Qualitative values were analyzed by the chi2 test. Quantitative values were analyzed by the Student test when the measures were normally distributed or by nonparametric test (Mann–Whitney U) when the measures were not normally distributed (Kolmogorov–Smirnov test was used to test normality).Results:Among the 350 patients who answered to the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3% and undifferentiated CIRD 3.4%.Pain experience caused by the CIRD during the containment was reported by 79.1% of patients.The level of pain, using the VAS of Pain increased significantly during the COVID-19 pandemic (4,6 ± 2,8 and 5,4 ± 3 before and during the containment; pIn multivariate analysis, the factors implicated in pain were the negative impact of Coronavirus on access to rheumatologic care, discontinuation of therapeutic adherence, the disturbed quality of sleep and the negative psychological impact (table 1).Table 1: Summarize multivariable analysis of factors associated with painful experience related to CIRD during containement.Table 1.Multivariable analysis of factors associated with painful experience related to CIRD during containementPImpact on monitoring0.05Impact on therapeutic adherenceQuality of sleep disturbed0.001Negative psychological impact0.02Conclusion:This survey showed the that the COVID-19 pandemic have incresed painful experience in CIRD patients. Factors influencing painful experience should be taken into account to help patients to cope with their chronic rheumatism and this global health crisis.Disclosure of Interests:None declared

Background:In rheumatoid arthritis, studies have shown that the response to a second TNF inhibitor is better if the first TNF inhibitor was stopped for a secondary failure or adverse event compared to a primary failure [1,2]. However, few studies have provided evidence regarding the response to a second TNF inhibitor based on the reason for discontinuation of the first TNF inhibitor in patients with a diagnostic of spondyloarthritis (SpA).Objectives:To evaluate the efficacy of the 2nd TNF inhibitor in real life from a cohort of patients with SpA from the Moroccan registry of biological therapies in rheumatic diseases (RBSMR Registry), according to the reason for discontinuation of the 1st TNF inhibitor.Methods:We have included from the RBSMR Registry any patient with a diagnosis of SpA starting a 2nd TNF inhibitor on inclusion in the registry or during the 1st year of follow-up. A descriptive study was conducted by measuring the therapeutic maintenance of the 2nd TNF inhibitor as well as the disease activity in different groups of patients according to the reason for stopping the first TNF inhibitor: stopping for ineffectiveness, side effect or non-availability of the drug.Results:Of the total 194 patients with SpA included in the RBSMR registry, 40 patients were on their 2nd TNF inhibitor at one year follow-up. The mean age of the patients was 43.6 ± 15.1 with a male predominance (57.5%) and a mean of disease duration of 13.75±6.95 years. At 1 year, treatment was maintained in 72.5% of all patients: 100% after ineffectiveness, 82% after discontinuation for side effects and 52.9% for unavailability of the first TNF inhibitor. Moderate disease activity as defined by an Ankylosing Spondylitis Disease Activity Score using ASDAS-CRP Conclusion:This pilot study gives us a small insight into the fate and efficacy of the 2nd TNF inhibitor based on the reason for discontinuation of the first. The follow-up data at 2 and 3 years will allow us to include more patients and thus be able to do a real statistical study with a comparison between the different groups.References:[1]Remy A, Avouac J, Gossec L, Combe B. Clinical relevance of switching to a second tumour necrosis factor-α inhibitor after discontinuation of a first tumour necrosis factor-α inhibitor in rheumatoid arthritis: a systematic literature review and meta-analysis. Clin Exp Rheumatol. 2011;29:96–103.[2]Chatzidionysiou K, Askling J, Eriksson J, Kristensen LE, van Vollenhoven R, ARTIS group. Effectiveness of TNF inhibitor switch in RA: results from the national Swedish register. Ann Rheum Dis. 2015;74:890–6.Disclosure of Interests:None declared.

Objectives:The aims of our study are to determine the new comorbidities appearing under biologic therapy, their prevalence, and the factors implicated in their appearance.Methods:It’s a multicentric historical-prospective cohort including 10 rheumatology departments of Moroccan University Hospitals. The data were collected from the national register of patients under biologic therapy supervised by the Moroccan Society of Rheumatology. An electronic follow-up questionnaire is completed every 6 months by the investigator.Results:The study included 418 patients: 224 with Rheumatoid Arthritis (RA) who represented 53.6% and 194 with spondyloarthropathy (SP) who represented 46.4%.The prevalence rate of comorbidities appearing after one year of treatment with biologic therapy was 15.7% in RA and 8.4% in SP. The rate of cardiovascular diseases was 12.9% (arterial hypertension, myocardial infarction and/or ischemic stroke), 6.4% was the same value of hypercholesterolemia and depression, diabetes 3.3%, ulcer 3.2%, and osteoporosis 9.7%. The sedentary rate was 54.8% and smoking was about 3.3%.No patient had developed hypertriglyceridemia or chronic obstructive pulmonary disease.In the group of patients with RA, the average age of the patients who had developed a new comorbidity was 51,8 ± 11,3 years, women represented 87.5%, the average of Body Mass Index (BMI) was 27,6 ± 5,9 and the average duration of the disease was 14,1 ± 9,2 years. The disease activity score (DAS28) had an average of 3,15 ± 1,47.59.6% of patients used Rituximab, 23.8% Tociluzimab, 8.1% Etanercept, 5.8% Adalimumab, 0.18% Infliximab, and 0.9% Golimumab.In the group of patients with SP, the average age of the patients who had developed a new comobidity was 40,2 ± 13,7 years, men represented 63.4%, and the average of BMI was 24,3 ± 4,94.The activity of the desease, had an average Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 2,62 ± 1,79 and ankylosing Spondylitis Disease Activity Score (ASDAS) of 1,93 ± 1,09.Regarding the type of biologic therapy, 33.2% of patients used Etanercept, 30.1% Adalimumab, 24.9% Infliximab, 9.8% Golimumab, 1.6% Secukinumab, and 0.5% Tociluzimab.Conclusion:Our study showed a high prevalence of cardiovascular disease in patients under biologic therapy. This can be explained by the sedentary lifestyle secondary to rheumatic disease.Disclosure of Interests:None declared

Background:NAObjectives:To estimate the annual direct costs of biological therapies in Spondyloarthropathies (SpA) and to establish possible factors associated with those costs.Methods:The main data source was the Moroccan registry of biological therapies in rheumatic diseases (RBSMR). We included SpA patients with available 1-year data. Variables related to socioeconomic status, disease and biological therapy were collected. Differences in costs across groups were tested by Mann–Whitney and Kruskal–Wallis tests. Correlations analysis was performed in search of factors associated with high costs.Results:We included 89 SpA patients. The mean age was 40.6± 13.6 years, with male predominance 68.9 %. Patients received one of the following therapies: TNF-blockers (n =79), Biosimilar of TNF-blockers (n =8) and Il17-blockers (n =2). Median one-year biologic costs per patient were 9 569, 39 €. The total annual of biotherapies in AS patients was 851 675, 98 €.Figure 1Annual mean drug costs per treated patient (€: Euro)The costs are presented in Euro using an exchange rate of (1 Moroccan Dirham = 0.091Euro).TNF-blockers constituted 95 % of the total annual budget. Biosimilar of TNF-blockers and Il17-blockers represented 3 % and 2 % of this overall budget, respectively.Although the costs were not significantly different in terms of gender or level of study, the insurance type significantly affected the cost estimation.No correlation was found between the annual direct costs of biotherapies and body mass index nor with BASFI or BASDAI.Conclusion:In Morocco, a developing country, the annual direct costs of biological therapies are high in AS patients. Our results may contribute to the development of strategies for better governance of these costs.Disclosure of Interests:None declared.

Introduction Platelet rich plasma (PRP) has been used for around ten years in degenerative and traumatic diseases of the locomotor apparatus by sports physicians, rheumatologists, radiologists and orthopaedic surgeons. Indications are currently increasing, unfortunately, however, there is a lack of evidence regarding the efficacy of PRP in these new indications. The aim of this article is to carry out a review of the literature, in order to state the level of evidence for the efficacy of PRP in five major diseases.

Background:Patient education for RA patients has been shown to improve adherence and self-management of this chronic disease.Objectives:To assess the impact of illiteracy on assimilation of a patient education session on methotrexate self-injection in RA patients.Methods:Prospective pilot study that included 27 consecutive patients (81.5% female, mean age 44.4 years, illiteracy rate 40.7%) with RA (median duration of progression of 4 years, mean delay in referral for specialist of 6 months, median duration of methotrexate use of 1 year). The patients benefited from an individual patient education session to learn how to self-inject with methotrexate subcutaneously. The patient education session was supervised by a nurse and a rheumatologist. A 10-question dichotomous questionnaire was then administered to patients to assess the level of uptake of messages passed during the patient education session. The prevalence of correct answers was compared between illiterate and non-illiterate patients.Results:The mean duration of patient education session is 13 min.Table I illustrates the results of the correct responses prevalence and the comparison of correct response rates between illiterate and non-illiterate patients.Table 1.Prevalence of correct responses and comparison of correct response rates between illiterate and non-illiterate patients.QuestionsN=27IlliteratePYes (N=11)No (N=16)1.Do I always have to self-inject on the same day of the week? (%)96,390,9100NS2.Should Methotrexate be protected from light and away from children? (%)96,310093,7NS3.Can I self-inject anywhere on my thigh and belly 5 cm from the navel? (%)85,210075NS4.Is it important to change the injection sites? (%)70,472,768,75NS5.Do I need to pinch the skin before self-injection? (%)92,610087,5NS6.Can I always use the same needle for each injection? (%)81,590,975NS7.Do I have to wear gloves to inject Methotrexate? (%)81,590,975NS8.Do I have to apply an antiseptic product (alcohol, Betadine) to the injection site before self-injecting? (%)88,990,987,5NS9.Can I use the rest of the MTX ampoule for the next injection? (%)74,181,868,7NS10.Do I tell my doctor if I have side effects? (%)100100100NSConclusion:This study suggests that illiteracy does not affect the assimilation of information given during a patient education session. These preliminary results should encourage the development of patient education programs in our context where illiteracy rate is high.Disclosure of Interests:None declared

Background:Lumbar radicular pain is the most common chronic neuropathic pain syndrome. Antidepressants are highly recommended for neuropathic pain, but there is no evidence for their efficacy.Objectives:The aim of this double-blind, randomised, placebo-controlled trial is to determine whether Clomipramine (an antidepressant) is more effective than placebo in reducing pain in individuals with resistant chronic lumbar radicular pain.Methods:A double-blind, randomized, clinical trial. Sixty-two patients with resistant chronic lumbar radicular pain were included. (The sample size was calculated on the assumption that clomipramine would reduce the incidence of lumbar radicular pain of 35%, compared with placebo, with a two-sided test, an alpha level of 0.05, and a power of 85%). Patients were randomly allocated to receive either Clomipramine by slow intravenous infusion for 10 days in a hospital setting with progressively increasing doses, 25 mg on the first day, 50 mg on the second day and 75 mg on the third day until the tenth day, or placebo (500 ml of physiological serum a day). For both groups, paracetamol is added intravenously at a dose of 3g per day for ten days, Parecoxib for 3 days and ten sessions of lumbar spine rehabilitation including analgesic massage, muscle strengthening and joint maintenance. At the exit, clomipramine was relayed with 25 mg per day orally until the 90th day for clomipramine group, and paracetamol was authorized in both groups, in case of severe pain. The primary outcome was pain intensity, measured at baseline, 5th day, 10th day and 90th day using VAS pain (10 mm). Secondary outcome included DN4-questionnaire, lumbar radicular discomfort (VAS 10 mm), pain-free perimeter of walking (min), disability assessed using the Roland Morris Disability questionnaire and severity of mood symptoms assessed using the Hospital Anxiety and Depression scale (HAD), measured on days 0, 5, 10 and 90.Results:31 patients were assigned to the clomipramine group and 31 to the placebo group. There were no differences between the groups in demographic characteristics. Treatment by Clomipramine had a significantly greater reduction in pain, discomfort and DN4 from the 5thday (p = 0.000, p = 0.001 and p = 0.004 respectively) than the placebo, with an improvement maintained until 90th day. There was a statistically significant improvement in pain-free walking distance and disability for the clomipramine group from the 10thday (p = 0.02 and 0.001 respectively) and that maintained until 90thday. However, there was no significant improvement in HAD between the 2 groups. (p ≥ 0.1).Conclusion:This double-blind, randomized, clinical trial shows that clomipramine is quickly effective and maintained over time in the management of resistant chronic lumbar radicular pain. It can therefore be part of the therapeutic arsenal in this sense.Disclosure of Interests:None declared

Background:The technique of Kinesio-Taping is a method of adhesive bandage exerting traction on the skin which would favorably influence the muscular and articular systems by reducing the pressure exerted on the subcutaneous mechanoreceptors thus reducing pain and muscle tension.Objectives:The aim of this study is to assess the effectiveness of Kinesio-Taping in the short and medium term on pain and function in patients with chronic nonspecific low back pain compared to a placebo.Methods:We conducted a double-blind, two-arm randomized clinical trial. The study should include a total of 70 patients randomized into 2 groups: Kinesio-Taping (n = 35) and control group (n = 35). To this date we have included 46 patients.All patients receives four I-shaped adhesive strips arranged in a star-like shape and applied to the most painful region of the lower back with a tension between 25% to 30% in the taping group. The placebo group received a taping procedure with no tension.Taping is applied three times (at baseline, fourth and eighth day). Patients are assessed at baseline, on day 14 and at 4 weeks by the Arabic version of the Oswestry Physical and Functional Disability Index (ODI) which is the primary outcome. The secondary outcomes are the assessment of pain and functional disability according to the visual analog scale (VAS) evaluated on a scale of 0 to 10, as well as Rolland-Morris score.Results:Both groups were comparable at baseline concerning the demographical and clinical characteristics (P > 0.05) (table 1). The result of repeated measures ANOVA showed a significant change in ODI score and in VAS for pain and functional disability as well as Rolland-Morris score in both groups. Using the ANCOVA, controlling for pre-test scores, a significant difference was found between the two groups (table 2).Table 1. Clinical characteristics of study population.Conclusion:Our clinical trial offers preliminary evidence on the superiority of Kinesio-Taping in the treatment chronic back pain compared to placebo concerning the reduction of pain and disability. Thus, it can be used as a complementary method in chronic non-specific low back pain.Table 2. Primary and secondary outcomes in the Kinesio-Taping and placebo group.Disclosure of Interests:None declared

Background: Total knee arthroplasty (TKA) is a very common procedure, particularly implemented for the treatment of knee osteoarthritis (OA). Patient expectations after TKA surgery now include being able to enjoy appropriate recreational activities representing ambulatory activities beyond that of just pain relief and adequate knee motion (1). Since recreational activity comprises of more complex functions and requires longer standing durations, walking for 6-meter in a straight line in the timed up and go test (TUG) does not fully reflect the functional capacity of patients with TKA, and TUG test may be limited to detect the balance and mobility capacity in TKA patients (2, 3). As such, there is a need to determine more effective and functional evaluation tools that better reflect realistic situations in order to assess ambulatory performance level for patients with TKA. However, no studies have been conducted in patients with TKA to examine the applicability of the L-test, which assesses ambulation of individuals and consists of complex mobilization activity. Objectives: The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the L-test for TKA patients. Methods: Twenty-four patients with TKA due to knee OA, operated by the same surgeon, were included in this study. Patients performed trials for L-test twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The tester recorded the performance time while the participant was asked to get up from a chair, walk 3 m in a straight line, turn right, continue walking for 7 m in a straight line, turn left, walk back along the same path and sit down in the chair at their usual walking speed. Prior to the real testing session, the L-test was demonstrated by the tester and all participants were allowed to a practice trial. Results: The L-test showed an excellent test-retest reliability (ICC2,1= 0,98) in this study. Standard error of measurement (SEM) and MDC95 for L-test were 1,01 second and 2,8 second, respectively. Conclusion: This study found that the L-test is a reliable test for patients following TKA. Overall, the excellent test-retest reliability of the L-test indicates that it may be an applicable standardized method to assess TKA patients who are able to walk greater distances and have better gait in more functional situations. Clinicians and researchers can be confident that changes in L-test time above 2,8 seconds, represent a “real” clinical change in an individual patient with TKA. We, therefore, recommend the use of L-test as complementary outcome measures for balance and functional evaluation in TKA patients. References: [1]Swinkels, A., & Allain, T. J. (2013). Physical performance tests, self-reported outcomes, and accidental falls before and after total knee arthroplasty: an exploratory study. Physiotherapy theory and practice, 29(6), 432-442. [2]Deathe, A. B., & Miller, W. C. (2005). The L test of functional mobility: measurement properties of a modified version of the timed “up & go” test designed for people with lower-limb amputations. Physical therapy, 85(7), 626-635. [3]Kim, J. S., Chu, D. Y., & Jeon, H. S. (2015). Reliability and validity of the L test in participants with chronic stroke. Physiotherapy, 101(2), 161-165. Disclosure of Interests: None declared

Background:Methotrexate is a gold standard for treatment of RA. In our context, RA patients prefer to be injected by paramedics rather than self-injecting. This can be explained by patients’ bad perceptions of self-injection or lack of information. Appropriate self-injection education can therefore be an important element in overcoming these obstacles and improving disease self-management.Objectives:Compare the RA patients’ perceptions on methotrexate self-injection before and after a patient education session.Methods:Prospective pilot study that included 27 consecutive patients (81.5% female, mean age 44.4 years, illiteracy rate 40.7%) with RA (median duration of progression of 4 years, mean delay in referral for specialist of 6 months, median duration of methotrexate use of 1 year). The patients benefited from an individual patient education session to learn how to self-inject with methotrexate subcutaneously. The patient education session was supervised by a nurse and a rheumatologist with a control a week later. Perceptions of the reluctance to self-inject and the difficulties encountered by patients were assessed before the patient education session, after the 1st and 2nd self-injection of methotrexate using a 10 mm visual analog scale. Patients also reported their level of satisfaction (10 mm VAS) after the 1st and 2nd self-injection.Results:The mean duration of patient education session is 13 min.Table I compares the evolution of the degrees of reluctance to self-injection, the difficulties encountered, and the satisfaction experienced by the patients.Table 1.Evolution of RA patients’ perceptions on the methotrexate self-injection. (N = 27)BeforeAfter the 1stself-injectionAfter the 2end self-injectionpVAS reluctance (0-10mm)6,5 ± 3,62,2 ± 2,91,0 ± 2,3VAS difficulty (0-10mm)7,5 ± 2,62,5 ± 2,71,0 ± 1,9VAS satisfaction (0-10mm)-8,9 ± 1,89,5 ± 1,50,002Conclusion:This study suggests the effectiveness of a methotrexate self-injection patient education session in RA patients. It also highlights the value of patient education in rheumatologic care. A large-scale study is necessary to better interpret and complete these preliminary results from this pilot study.Disclosure of Interests:None declared

Background Posterior tibial tendon involvement is common in rheumatoid arthritis. Ultrasound has an important place in the examination of this tendon. Objectives Evaluate the prevalence of ultrasound signs of posterior tibial tendon involvement in rhumatoid arthritis. Methods This is a cross-sectional study that included fourteen consecutive patients (100% female, mean age 55.3 years) with rhumatoid arthritis (median duration of progression of 13.5 years, mean specialised care of 2.1 years). A grey and Doppler ultrasound study was performed on affected feet, looking for effusion, thickening or corporal thinning, hypoechoic aspect, fissures, and Doppler activity in the posterior tibial tendon. Results 28 feet were studied with ultrasound evaluation of the posterior tibial tendon. Figure 1 illustrates the prevalence of the pathological aspects of the posterior tibial found on ultrasound examination. Conclusions This study illustrates the different pathological aspects of the posterior tibial tendon. It highlights the high prevalence of this tendinopathy in the rheumatoid foot. Ultrasound allows accurate assessment of this tendon in RA patients. A large-scale study compared with a control group is necessary to better interpret and complete these preliminary results. Disclosure of Interest None declared

Background The foot and the forefootin particular are often one of the first areas to be affected by rheumatoid arthritis. The joint destruction develops not only as a result of synovitis but also as a result of specific biomechanical stresses leading to deformity Objectives Evaluate the prevalence of ultrasound signs of rheumatoid arthritis in the joints of the ankle and foot. Methods This is a cross-sectional study that included 14 consecutive patients (100% female, mean age 55.3 years) with rheumatoid arthritis (median duration of progression of 13.5 years, mean specialised care of 2.1 years). A grey and Doppler ultrasound study was performed by looking for effusions, synovitis, Doppler activity and bone erosions in the joints of the ankle and foot. Results 28 feet were studied with an ultrasound evaluation of 308 joints. The prevalence of ultrasound signs of RA are shown in table 1 and 2. Conclusions This study describes the various ultrasound signs at the joints of the ankle and foot. There is a high prevalence of synovitis in the ankle and hindfoot. Doppler activity has been rarely found. A large-scale study compared with a control group is necessary to better interpret and complete these preliminary results. Disclosure of Interest None declared

Background Impairment of foot function is known in rheumatoid arthritis. Objectives Evaluate the functional status of the foot in patients with RA and look for factors associated with impaired foot function. Methods This is a cross-sectional study that consecutively included 14 patients (100% female, mean age 55.3 years) with RA (median duration of evolution of 13.5 years, mean specialised care of 2.1 years). The functional status of RA was assessed by the HAQ (Health Assessment Questionnaire). RA activity was evaluated by DAS28 and DAS44. The FFI score (Foot Function Index) was used to determine the functional status of the foot. A correlation analysis was made between the FFI score and DAS28, DAS44 and HAQ as well as with the duration of progression of the RA and the delay of specialised management. Results The median score of the HAQ (Health Assessment Questionnaire) was 1.6. The median score for the Foot Function Index (FFI) was 53.6. The medians of DAS 28 and DAS 44 were 5.3 and 3.8. The median of the different FFI score items was: Pain Sub-scale: How severe is your foot pain ? Q1: Foot pain at its worst ? 7 (6; 9,25), Q2: Foot pain in morning ? 5,5 (2; 7), Q3: Pain walking barefoot ? 4 (1,75; 8,15), Q4: Pain standing barefoot ? 5 (3,25; 8,25), Q5: Pain walking with shoes ? 4 (1,75; 5,75), Q6: Pain standing with shoes ? 4,5 (3; 5,5), Q7: Pain walking with orthotics ? 3 (3; 3), Q8: Pain standing with orthotics ? 3 (3; 3), Q9: Foot pain at end of day ? 5 (2,75; 7) Disability sub-scale: How much difficulty did you have ? Q10: Difficulty walking in house ? 2 (0; 3,25), Q11: Difficulty walking outside ? 5,5 (3; 8), Q12: Difficulty walking 4 blocks ? 5 (4; 9), Q13: Difficulty climbing stairs ? 6,5 (4; 8,25), Q14: Difficulty descending stairs ? 6 (3,5; 8,25), Q15: Difficulty standing tip toe ? 8,5 (5,25; 10), Q16: Difficulty getting up from chair ? 5 (1,5; 8), Q17: Difficulty climbing curbs ? 4,5 (2; 7,25), Q18: Difficulty walking fast ? 8,5 (4,75; 10) Activity Limitation sub-scale: How much of the time do you ? Q19: Stay inside all day because of feet ? 7 (2; 8,25), Q20: Stay in bed all day because of feet ? 5 (2; 3,25), Q21: Limit activities because of feet ? 5,5 (1; 8), Q22: Use assistive device (cane, walker, crutches, etc) indoors ? 0 (0; 3,25), Q23: Use assistiw device (cane, walker, crutches, etc) outdoors ? 0 (0; 0,75). No correlation was found between the FFI and the HAQ. DAS 28 and DAS44 did not correlate with the FFI either. Alteration of foot function as indicated by a high FFI score was associated with a delay in specialist management by a rheumatologist (r=0.535, p=0.04). Conclusions This study provides insight into the impact of RA on foot function. The HAQ, DAS28 and DAS44 would not reflect the functional deterioration of the foot in RA. In addition, an alteration of foot function would be associated with a delay in specialist management by a Rheumatologist. A large-scale study is underway to validate and complete these preliminary results. Disclosure of Interest None declared

Objectives To evaluate the prevalence of ultrasonographic gout specific signs of foot joints. Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B mode. 330 articular sites were studied at their dorsal surface. The ultrasound has objectified the presence of two signs: hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) and tophaceous deposits at the joint cavity. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1. Conclusions This study showed a predilection for the gout specific ultrasound signs (DC and tophaceous deposits) in the tarsometatarsal and metatarsophalangeal joints, especially in the first MTP. The contribution of musculoskeletal ultrasound seems to be very interesting to objectify the presence of gout specific signs of the foot joints. Disclosure of Interest None declared

Objectives To present a booklet and a CD-ROM with a mini-atlas including 100 sections illustrating the normal ultrasound musculoskeletal anatomy. Methods We performed an ultrasound examination of large and small joints of the medical staff not suffering from any musculoskeletal disorder. Ultrasound examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B mode. Finally, for the sake of clarity of the presentation of this library, we presented each image accompanied with another showing the valid positioning of the probe and an annotated schema for each section made. Results We present in the form of CD-ROM and booklet a photo library of a mini-atlas. The joints studied are: The wrist and hand The elbow The shoulder The ankle and foot The knee and the hip 100 sections were performed, we presented them together with images showing ther normal corresponding musculoskeletal anatomy, the valid positioning of the probe, and also an annotated schema corresponding to each section. We give here below the example of a section illustrating a cross-section of flexor digitorum superficialis and profondus tendons Conclusions We hope that we give to rheumatologists a simple tool to recall and standardize the practice of musculoskeletal ultrasound. We intend to enrich it, in the future, with the pathological images and interventional ultrasound videos. Disclosure of Interest None declared

Objectives To compare the prevalence of ultrasonographic gout specific signs at the dorsal and plantar surfaces of the metatarsophalangeal joints (MTP). Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B mode. 150 articular sites were studied at their dorsal and plantar surfaces. The ultrasound has objectified the presence of two signs: hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) and the tophaceous deposits at the joint cavity. We compared the prevalence of the two signs between the dorsal and palmar surfaces at each site studied. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1. Conclusions Our study suggests that globally, DC predilect significatily in dorsal than in plantar surfaces of MTP joints. These results should be verified on a larger population. Disclosure of Interest None declared

Objectives To compare the prevalence of ultrasonographic gout specific sign double contour between the dorsal and palmar surfaces of the hand joints. Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B and Doppler modes. 560 articular sites were studied at their dorsal and palmar surfaces. We compared the prevalence of the hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) between the dorsal and palmar surfaces at each site studied. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1 Conclusions Our study suggests that globally, DC predilect significatily in dorsal than in palmar surfaces of hand joints. These results should be verified on a larger population. Disclosure of Interest None declared

Objectives To evaluate the prevalence of ultrasonographic gout specific signs of hand and fingers joints. Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B mode. 540 articular sites were studied at their dorsal surface. The ultrasound has objectified the presence of two signs: hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) and the tophaceous deposits at the joint cavity. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1. Conclusions This study showed a predilection for the gout specific ultrasound signs (DC and tophaceous deposits) of the wrist and MCP joints. The contribution of musculoskeletal ultrasound seems to be very interesting to objectify the presence of gout specific signs in the hand and fingers joints. Disclosure of Interest None declared

Evaluate the prevalence of sarcopenia on patients with rheumatoid arthritis (RA), the influence of sarcopenia on disease activity and factors associated with sarcopenia. One hundred and twenty-three patients aged over 18 years with RA based on the 1987 ACR/EULAR classification criteria were enrolled. We performed a whole body DXA scan using a dual-energy X-ray absorptiometry (DXA) scanner lunar prodigy to measure fat mass, lean mass, and bone mass in the whole body and body parts. According to the anthropometric equation by Baumgartner et al., sarcopenia was defined as Relative skeletal mass index (RSMI)

Objective:Introduction: Would cardiovascular autonomic reflexes help in understanding the diagnosis and the management of primary hypertension (PHT). The purpose of this study was to evaluate the cardiovascular autonomic reflexes in patients with primary hypertension (PHT), including masked hyperten

This study aims to explore patient’s concerns when discussing sexual problems caused by chronic low back pain with their healthcare provider. It also aims to identify factors influencing and limiting such communication. A cross-sectional analysis of 100 consenting chronic low back pain sexually active patients was carried out. Patients answered questions on their disease characteristics and sex life. They also mentioned prohibitions of discussing sex with their healthcare provider and their expectations of such discussion. Factors influencing patient’s experiences were analyzed. Median of chronic low back pain duration was 36 (24–72) months and back pain intensity using visual analogical scale (0–100 mm) was 50 ± 10.7 mm. Eighty-one percent of our patients complained of sexual problems, 66 % have never discussed the subject with their healthcare provider. Barriers which prevent discussion on sex include the taboo character of the topic, inappropriateness of visit conditions, and patient disinterest in sex. Ninety-three percent of patients expressed the need of sexual problems’ management in chronic low back pain consulting. Seventy-four percent expected information and advice from their healthcare provider about recommended intercourse positions so as to avoid pain. Thirty-three percent of patients wanted their partner to be involved in the discussion and 81 % preferred talking with a healthcare provider of the same gender. Ability to communicate on the topic was associated with the decrease of patient sexual satisfaction and limited by patient illiteracy. Our study evidences that sex discussion between patient and healthcare provider is restricted by several barriers and that patients expect more involvement from their healthcare provider on the subject. Illiteracy and level of sexual satisfaction seem to be the strongest factors influencing this communication.

The purpose of this study was to assess prevalence and severity of insomnia in participants diagnosed with chronic low back pain (CLBP) and to identify factors associated with this insomnia. One hundred CLBP consenting participants were recruited. Sociodemographic, CLBP features and sleep characteristics were collected. Patients answered validated measures of insomnia severity and fatigue. Statistical analysis examined the relationship between insomnia, sociodemographic characteristics of patients and CLBP parameters. Seventy-eight percent of patients suffered from insomnia. Insomnia due to back pain was reported in 64 % of cases. Insomnia was early, middle and late in, respectively, 39, 60 and 41 % of patients. Insomnia was sub-threshold, moderate and severe in, respectively, 34, 42 and 2 % of patients. ISI Global score was at 18.07 ± 7.3. ISI correlated significantly with pain intensity (r = 0.587; p < 0.0001), fatigue level (r = 0.495; p < 0.0001) and body mass index (r = -0.209; p = 0.03). Multiple linear regression models have revealed that pain intensity (β = 1.984; 95 % CI (1.517-2.451); p < 0.0001) and fatigue (β = 0.284; 95 % CI (0.192-0.377); p < 0.0001) were the strongest determinants for predicting insomnia in CLBP patients. Our study suggests that the prevalence of insomnia is important in CLBP patients, occurring especially at the middle of sleep. Insomnia was essentially sub-threshold or moderate. Back pain and fatigue experienced by patients were the strongest factors associated with this insomnia.

Objectives The purpose of this study was to determine the prevalence of rheumatoid cachexia and analyze factors that might be associated with it. Methods This was a cross-sectional study using the data from 83 patients with rheumatoid arthritis (RA). Demographic and socio-economic parameters were collected. The disease activity was assessed by the tender joint count (TJC), swollen joint count (SJC), pain assessed by a visual analogue scale (pVAS), global activity disease evaluated by the physician and the patient using a visual analogue scale (gVAS) and blood markers of inflammation (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). Anthropometric measurements (weight, height, waist circumference (WC), body mass index (BMI)) were recorded for each patient. WC was interpreted and classified according to recommendations of WHO in 2 categories of risk of metabolic complications: low risk (WC≤93.9 cm in men and WC ≤79.9 cm in women) and high risk (WC≥102.0 cm in men and 88.0 cm for WC≥ woman). The skinfold thickness was measured using the clamp Harpenden in 4 sites: triceps, biceps, subscapular and suprailiac regions. Fat-free mass index (FFMI) and fat mass index (FMI) were calculated using the equation of Durnin and Wormersley and the equation of Siri. Rheumatoid cachexia has been defined by an FFMI 90th percentile. Results 83 patients were included with a mean age of 51.7±13.3 years and a female predominance (87%). The median of RA duration was 7 years [4 to 14]. 9 patients (15.5%) have a rheumatoid cachexia, 8 of them (88.9%) are women with a normal BMI. The rheumatoid cachexia was associated with advanced age and a high metabolic risk (p Conclusions This study suggests that rheumatoid cachexia is frequent in patients suffering from RA, which may be associated with advanced age, a normal BMI and the risk of metabolic complications. These results should be verified by studies on a larger scale. Disclosure of Interest None declared

The vertebral hydatidosis is uncommon. It causes problems in diagnosis and in management. A case of an extensive vertebral hydatidosis with few symptoms is reported. A 21-year-old man has consulted for recurrent lumbosciatica that has been evolving for 1 year. Clinical exam was normal. Plain radiographic films disclosed a lytic lesion throughout the bodies of L4 and L5 and calcifications thrown on the liver area. The computed tomography (CT) and the magnetic resonance (MR) images revealed multicystic bony lesions involving the lumbar spine with extension into the spinal canal. Abdominal ultrasound showed also cyst lesions in the right kidney and in the liver. The diagnosis of vertebral and abdominal (liver and kidney) hydatidosis was retained. Four sets of 4-week albendazole cures were given with a 2-week interval in between. Our case of extended vertebral hydatidosis with few symptoms confirms the clinical latency and diagnosis difficulties usually encountered in this disease. This often leads to a late diagnosis of the stage of spinal cord compression. Radiological diagnosis and determination of extension of the hydatid cyst are usually provided by CT and MRI. Vertebral hydatidosis should be evoked in lumbosciatica especially in endemic regions.

Objectives We aimed to analyze in children suffering from chronic haemophilic arthropathy relation between there functional impact and there quality of life. Methods Twenty- three children (mean age of 10.9±3.5 years [4-18]) suffering from severe haemophilia (median disease duration of 12 months (6; 18),median diagnosis delay of 0 months (0, 7)) were included. Functional impairment and quality of life were respectively assessed by the Moroccan versions of Children Health Assessment Questionnaire (CHAQ) and the European Quality of Life (the EUROQOL). A statistical analysis was conducted to determine the correlation between these two parameters using the r of Spearman Results Chronic haemophilic arthropathy affected knee, elbow, ankle and wrist in respectively 50, 27.5, 20 and 2.5%. Median CHAQ was 0.37 (0, 1.25). EUROQOL domains were affected as following: Mobility (69.6%),usual activity (65.2%), self-care (65.2%), anxiety/depression (43.4%) and pain (34.7%) Table 1 summarize correlation between the CHAQ and the 5 domains of EUROQOL. Conclusions This study suggests that the functional impact of chronic haemophilic arthropathy in children affected by severe hemophilia seems mainly related to the domains of mobility, self-care and usual activity of the EUROQOL. Further studies are required to verify those results. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4867

Background Research on patients with chronic illness has demonstrated that self-esteem is related to the reported level of physical restrictions, functional status and perceiption of symptom severity. Previous literature suggests that low self-esteem causes more negative affect for chronic disease patients than healthy populations. Objectives This study aims to evaluate the frequency of low self esteem in patients with rheumatoid arthritis (RA) and to identify factors influencing it. Methods It is a cross-sectional study including 103 patients with RA. The demographic characteristics of patients and the characteristics of RA were collected. Pain and fatigue were assessed using the analogic visual scale (0-100 mm), the disease's activity was evaluated by DAS-28 ESR, the functionnal disability by the arabic version of the health assessment questionnaire (HAQ), and the the psychological state by the arabic version of the questionnaire Hospital Anxiety and Depression (HAD). The level of self-esteem was measured using the Rosenberg Self-esteem Scale (RSES). Participants have reported their agreement, on a five-point Likert scale (0 = strongly disagree, 4 = strongly agree) on 10 statements concerning self-perceived aspects of self-esteem. Total scores range from 10-40. A low self esteem rate was defined by a general scroe less than 311. Results 103 patients were included with a mean age of 49.7±11.4 years and a female predominance (90 (87.4%)). The median of RA duration was 8.16 years [3.25 to 14.16]. The average DAS28 - ESR was 4.28±1.75, with a median HAQ 0.5 [0 -1.37]. 58 patients (56.3%) have low self esteem. Low self-esteem was significantly associated to a high activity of the RA (OR=1.652, IC95% [1.254-2.176], p

Objectives There have been few studies on the impact of rheumatoid arthritis (RA) on the work of the household. Our study aims to evaluate the impact of rheumatoid arthritis (RA) on women in Moroccan home. Methods Demographic data, clinical and biological characteristics of the disease were collected. Depression was assessed by HAD questionnaire (Hospital Anxiety and Depression Scale). Working from home has been assessed by a multiple choice questionnaire [1] (no problems, some problems, many difficulties and disabilities) on the following items: the ability to do household chores, cleaning the house, washing floor, washing the dishes, cooking, and caring for children and husband. Women who failed to achieve at least one household activity were considered unable to domestic work and they were compared to those who have no such disability. Univariate and multivariate logistic regression was performed to identify factors associated with this disability for domestic work. Results 90 women (mean age 49.7±11.4 years) with Rheumatoid arthritis were included. The disease9s median duration was 8 years [4,14], the median of DAS28-ESR was 4.27±1.75 and median of HAQ was 0.5 [0, 1, 37]. The inability to domestic work was found in 31 patients (34.5%), this inability related to the following items: do household activities (23.3%), clean the house (26.7%), wash the floor (34.4%), caring for children and husband (14.4%), washing dishes (26.7%) and cook ( 17.8%). In univariate analysis the inability of domestic work was associated with high disease activity (OR =2.23, p Conclusions We conclude that RA is highly predictive of homemaking disability in moroccan women, especially those with active RA and significant functional impairment. References Household work disability of Arab houseswives with rheumatoid arthritis. Clin Rheumatol. 2007. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5812

Objectives Score distributions and associations between the RAID score and RA demographic and disease related variables were examined in rheumatoid arthritis (RA) patients. Methods 103 patients diagnosed were enrolled in the study. Disease activity was assessed through the Disease Activity Score (DAS) 28 scale. quality of life was evaluated with The EQ-5D, and Health Assessment Questionnaire (HAQ) was completed by all patients. Pain and fatigue were evaluated with pain Visual analogic scale (VAS) and fatigue VAS respectively. The Rheumatoid Arthritis Impact disease (RAID) was used for the evaluation of the impact of rheumatoid arthritis. Results The mean RAID was 3,78±2,15. The distribution of the RAID: 32% had a score between 0 and 2, and 13.5% between 7 and 10. In univariate analysis the RAID score correlated with pain (r=0,79; IC95% (0,05-0,06); p Conclusions This study suggested that RAID associated with disease activity, functional capacity, Pain, fatigue and EQ-5D. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4863

Objectives This study aimed to evaluate the frequency of sleep disorders in patients with rheumatoid arthritis (RA) and to explore the determinants of these disorders. Methods It is a cross-sectional study including patients with RA. Patients with a known psychiatric disorder were excluded from the study. The demographic characteristics of patients and the characteristics of RA were collected. Pain and fatigue were assessed by a visual analogue scale (0-100 mm), the disease activity by DAS28 - ESR (Disease Activity Score), the Functional Disability by the Arabic validated version of the Health Assessment Questionnaire (HAQ), the quality of life by Euroqol 5D and psychological state by the Arabic validated version of the questionnaire Hospital Anxiety and Depression (HAD) with its two items anxiety and depression. Participants completed the self-rated questionnaire “Pittsburgh Sleep Quality Index (PSQI)” that assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven “component” scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The total score ranges from 0 (no disorder) and 21 (major problems) 1 . Univariate and multivariate linear regression was performed to determine factors associated with poor sleep quality. Results 103 patients were included with a mean age of 49.7±11.4 years and a female predominance (90 (87.4%)). The median of RA duration was 8.16 years [3.25 to 14.16]. The median of global score PSQI was 5 [2-9]. Poorer Sleep quality was significantly associated with high disease activity (r =0.381, 95% CI [0.465, 1.320], p Conclusions Our study suggests that sleep disorders, in rheumatoid arthritis, are more frequently found in patients with associated anxiety disorders. References Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis; FS Luyster, ER Chasens, MCM Wasko et al; Journal of Clinical Sleep Medicine, Vol. 7, No. 1, 2011 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4772

Objectives The purpose of this study was to identify physical activity behaviors of Moroccan patients with RA and her associations with RA demographic and disease related variables. Methods A cross sectional study was conducted in 103 RA. Socio-demographic characteristics and Disease specific variables were documented. Disease activity was measured with Disease Activity Score 28 (DAS28), quality of life was assessed with rheumatoid arthritis impact disease (RAID), fatigue was evaluated by fatigue Visual Analogic scale and Health Assessment Questionnaire (HAQ) was completed by all patients. Physical activity was evaluated with the Arab version of the International Physical Activity Questionnaire (IPAQ) short version. Results A total of 90 women and 13 men with RA participated in this study. Mean age of participants was 49.7±11.4.disease duration was a median of 8.16 years [3,25-14,16]. Total amount of physical activity was a median of 1873 (346-4053) MET-minute/week. However in 30.8% the physical activity was low. In univariate analysis lower physical activity (IPAQ) correlated with higher disease activity (OR=-3.9; CI95%>899–300; p 2146–845; p= 43.4–3.3; p=0,02) and low quality of life (RAID) (OR=-2.8; CI95%>610–107p=0,006). No relationship was found between PA, age, disease duration and BMI. After multivariate analysis HAQ (OR=-3.1; CI95%>991–85; p=0.002) and DAS28 (OR=-3.1;CI95%>2587–606) still strongly associated with PA. Conclusions This study suggested that lower physical activity associated with high disease activity and poor functional capacity. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5826

Objectives To compare the disease activity score (DAS)28- ESR versus DAS28 -CRP, and to determine the factors that might influence their difference. Methods Patients with RA were included in a cross-sectional study. We have collected the demographic characteristics and the characteristics of the RA: duration of evolution, morning stiffness in minutes, functional impact of the disease assessed by the HAQ (Health Assessment Questionnaire), and current corticosteroid dose. The disease activity was assessed by the DAS28-ESR and DAS28-CRP. A simple correlation between DAS28-ESR and DAS28-CRP was performed. We considered a difference between DAS28-ESR and DAS28-CRP as significant when it is greater than or equal to 0.6 [1]. Factors influencing this difference were tested by univariate then multivariate logistic regression. Results 103 patients were included with a female predominance (87.4%). Mean age was 49.7±11.4 years. Median disease duration was 8 years [3-14]. There was a strong positive correlation between the two indexes of 0.91 (p Conclusions Our study shows a strong positive correlation between the DAS28-ESR and DAS28 -CRP. But DAS VS 28 would be higher than the DAS28 CRP in patients with high pain intensity and significant functional impairment. References Are the C-reactive protein values and erythrocyte sedimentation rate equivalent when estimating the 28-joint disease activity score in rheumatoid arthritis? Clin Exp Rheumatol. 2008 Sep-Oct;26(5):769-75. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5807

Background Polymorphisms in Vitamin D receptor (FokI (VDR-F) and BsmI (VDR-B)), Estrogen receptor (Pvu II (ESR1P) and Xba I (ESR1X)), Collagen type1 (SpI (COL1A1) and Calcitonin Receptor (Alu I (CTR)) are thought to be candidate markers for osteoporosis. Based on the fact that osteoporosis and periodontal diseases are bone destructive diseases, we investigated the relationship between polymorphisms in these candidate genes and bone mineral density (BMD) of lumbar spine and femoral neck in patients suffering from chronic periodontitis (CP). Methods Lumbar spine and femoral neck BMD of individuals included in this study were diagnosed using the dual X-ray absorptiometry method. Blood was drawn and Genomic DNA was prepared and genotyped using MetaBone Clinical Arrays kit (Genomica, Spain). The genotyping and polymorphisms identification consisted on the simultaneous amplification of five regions of the genome containing the six SNPs of interest. Clinical attachment level (CAL), gingival bleeding index (GI), and probing depth (PD) and Simplified Oral Hygiene Index (OHI-S) were determined in all participants by a single experimented examiner. Results Table 1 (below) shows SNPs and variant alleles prevalence of genes associated with metabolic bone disorders in 18 chronic periodontitis patients: Statistical analysis showed that women with CP carrying the genotype VDRF-FOKI (Ff) have a lower lombar BMD (p=0.003) and higher number of teeth loss (p=0.003). However, we were not able, in this preliminary study, to show any association between BMD of lumbar spine L2–L4 and Ward9s BMD in CP patients and polymorphisms in different geotyped genes; Vitamin D receptor BsmI (VDR-B), Estrogen receptor PvuII (ESR1P), Collagen type1 SpI (COL1A1) and Calcitonin Receptor Alui (CTR). Furthermore, no association was found between these polymorphisms and severity parameters of chronic periodontitis. Conclusions This preliminary study showed that Lower lombar BMD were observed in patients who carried VDRF-FOKI Ff genotype and lower prevalence of normal variants of VDRB-BSMI, CTR-ALUI and ESR1X-XBAI in the population of chronic periodontitis women. A larger case control study is ongoing in order to get bigger data to complete this report. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5961

Objectives The psychological aspect of rheumatoid arthritis (RA) is often overlooked in the clinical monitoring of the disease. The aim of our study was to determine the prevalence of depression and anxiety in rheumatoid arthritis (RA) and to identify factors that influence them. Methods Patients with RA were included in a cross-sectional study. We have collected the demographic characteristics and the characteristics of the RA: duration of evolution, morning stiffness in minutes, functional impact of the disease assessed by the HAQ (Health Assessment Questionnaire) and disease activity estimated by the DAS28-ESR. The psychiatric assessment was made by the DASS -21 (Depression, Anxiety and Stress Scale). Factors influencing depression and anxiety were tested by univariate and multivariate logistic regression. Results 103 patients were included with a mean age of 49.7±11.4 years and a female predominance (n=90 (87.4%)). the median of disease progression duration was 8.16 years [3.25-14.16]. The diagnosis of depression was found in 23.3% of patients and the anxiety in 30.1% of them. In the univariate analysis, depression and anxiety were associated with a high disease activity, a significant pain intensity and a significant functional impairment (p Conclusions Our study shows a high frequency of both anxiety and depression in the RA. It seems that anxiety is more frequent than depression. Both events would be more marked in patients with significant functional impairment. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5817

Background Ankylosing spondylitis (AS) is a chronic disease, which causes deformities and workforce decline. This, in turn, might lead to psychological distress and less self esteem. Objectives Our objective was to determine the relationship between self esteem, psychological well-being and disease parameters in AS patients. Methods One hundred patients (30 women, 70 men, mean age 38.88±12.6 years) were included in this cross-sectional study according to the modified New York criteria for AS. Psychological status was assessed by the Hospital Anxiety and Depression Scale including the depression and anxiety subscales. Pain, disease activity and functional status were respectively assessed by visual analogue scale, the Bath Ankylosing Spondylitis Disease Activity Index and the Bath Ankylosing Spondylitis Functional Index. Finally, to assess fatigue and self esteem we have used Multidimensional Assessment of Fatigue and Rosenberg scale for self esteem. Results Only 29% of AS patients have a good self esteem. Patients who had low self esteem were suffering from depression and anxiety more than patients with good self esteem (respectively 69 vs. 6.9%; p Conclusions This study suggests that AS patients are suffering from a low self esteem. Disturbance of self esteem in this chronic rheumatism seems to be closely related to an active disease and a bad psychological status. Those results should be confirmed by larger studies. Disclosure of Interest None Declared

Background Tocilizumab (TCZ) is a humanized anti-interleukin 6 (anti-IL 6) receptor antibody that has been demonstrated in previous clinical trials to improve rheumatoid arthritis (RA) and prevent radiographic progression. Musculoskeletal ultrasonography (MSUS) has increasingly been used as outcome measures in clinical trials of RA. Thus, we aimed to evaluate clinical and ultrasonographic (US) progression in RA patients treated with TCZ. Methods Twenty two consecutive patients, affected by RA [19 females, median age of 41 years (35,50), median disease duration of 72 months (36,171)] who were non-responders or partial responders to DMARDs therapy were commenced on Tocilizumab. The patients underwent clinical, laboratory, and assessment at baseline and after 6 months. The Disease Activity Score in 28 joints (DAS28) was recorded at inclusion and after a 6 months of therapy.The German ultrasound score included the following joints of the clinically dominant hand and foot: wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints. Synovitis and synovial vascularity were scored semiquantitatively (grade 0–3) by gray-scale (GS) and power Doppler (PD) ultrasound. Clinical remission after 6 months of treatment was defined when DAS 28 was Results At baseline, the median DAS28 score was 5.2 (4.4, 6.2) and the synovitis scores were 9.5 (6.7, 15) in GS ultrasound and 2.5 (0,7.2) in PD ultrasound. After 6 months of therapy, the DAS28 significantly decreased to 1.6 (0.8,2.4); p Conclusions This study indicates good evolution of RA patients under TCZ on basis on clinical and ultrasonographic findings. These results should be verified by further studies. Disclosure of Interest None Declared

Objectives Assessment of fatigue in Moroccan patients with rheumatoid arthritis (RA) and its relationship with disease parameters. Methods 1089 Moroccan patients with rheumatoid Arthritis (RA) were included in the multicenter cross-sectional study QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis). The presence of fatigue was researched and its degree was assessed by a visual analogue scale (VAS) ranging from 0 to 100 mm. The presence and intensity of fatigue were correlated to the RA patient and disease parameters (sex, DAS 28, score of Health assessment Questionnaire (HAQ), corticosteroids intake, presence or absence of sleep disorders or psychological problems). Results The mean age of our patients was 49 ± 12.6 years with a female predominance of 80.3%. The average of disease duration was 6 (3, 12) years. The mean DAS28 was 4.9 ± 1.68. The average of HAQ was 1 (0.4, 1.6). Fatigue was present in 97.1% patients and the average of VAS fatigue was 43.2 ± 26.6 mm. A high level of fatigue was associated with female gender (44% versus 39%, p = 0.05), an important level of disease activity (r = 0.544, p Conclusions Fatigue is a major problem in our patients with RA and must be included in their routine assessment. In our sample, fatigue appears to be related to female sex, high level of disease activity and greater functional disability. Disclosure of Interest None Declared