Search

Introduction La rachialgie commune (RC) est un probleme de sante publique qui cause un handicap chronique avec un impact social important et un cout de soins eleve. Sa physiopathologie et sa prise en charge restent insuffisamment maitrises. Les cytokines, notamment l’interleukine 8 (IL-8), semblent intervenir dans cette pathologie [1] . Le but de notre travail etait d’identifier la capacite de l’IL-8 a distinguer les patients ayant une rachialgie commune des temoins sains. Patients et methodes Nous avons mene une etude transversale type cas-temoin incluant 30 patients suivis pour rachialgie commune confirmee par une imagerie par resonance magnetique (IRM) et 42 temoins sains de toute symptomatologie articulaire. Pour chaque patient nous avons recueillie les parametres suivants : l’âge, type de rachialgie, presence de radiculalgie, l’Echelle Visuelle Analogique (EVA) de la douleur rachidienne et radiculaire et l’etiologie de la rachialgie a l’IRM. La concentration serique de l’IL-8 a ete dosee par methode de Chimiluminescence. Nous avons realise une courbe ROC et calculer l’aire sous la courbe afin d’evaluer la capacite de l’IL-8 a distinguer les patients ayant une RC des temoins sains. Resultats L’âge moyen etait de 41,33 ± 10,19 ans (43 ± 9,23 vs 40,11 ± 10,76 ans, p = 0,22). Dans le groupe RC, la duree d’evolution de la symptomatologie etait de 4,72 ± 3,03 ans. L’EVA-rachis moyenne et l’EVA-radiculalgie moyennes etaient de 2,48 ± 2,03 et 3,3 ± 2,54, respectivement. Quatre-vingts pour cent des patients avaient une radiculalgie (n = 24). La rachialgie etait d’origine discale dans 22 % des cas (n = 16) et arthrosique dans 20 % des cas (n = 14) a l’IRM. La concentration de l’IL-8 etait significativement plus elevee chez les patients ayant une RC par rapport a celle des temoins sains (24,06 ± 54,53 vs 4,5 ± 1,47 pg/mL, p = 0,05). De plus, une correlation entre la concentration de l’IL-8 et l’EVA-radiculalgie a ete retrouvee (r = 0,377, p = 0,044). L’IL-8 etait capable de distinguer les patients ayant une rachialgie commune du groupe temoin sain avec seuil 5,69 pg/mL. L’aire sous la courbe etait bonne (0,850). La sensibilite et la specificite etaient de 70 % et 100 %, respectivement. Conclusion Notre etude concorde avec celle de Wang et al., la concentration de l’IL-8 etait plus elevee chez les patients ayant une rachialgie commune par rapport aux temoins sains [2] . Nous avons trouve un resultat interessant, l’IL-8 etait capable de distinguer les patients ayant une RC des temoins avec un seuil de 5,69 pg/mL avec une sensibilite de 70 % et une specificite de 100 %. Ce resultat peut ouvrir les perspectives pour des nouvelles therapeutiques dans la prise en charge la rachialgie commune.

BackgroundFoot entheses involvement is a common manifestation of spondyloarthritis (SpA). It can be responsible for functional impairment. The superiority of ultrasound (US) examination in foot entheses damages detection has been reported [1].ObjectivesWe aimed to compare the US findings of foot entheses between SpA patients and asymptomatic healthy control subjects.MethodsWe conducted a cross-sectional study including 37 SpA patients (G1) fulfilling ASAS criteria for Axial SpA and 37 healthy subjects (G0) matched by age and gender. Demographic and clinical characteristics were collected. A blind US of foot entheses was performed by Mindray DC-70 equipment with a 6-16 MHz linear probe. Calcaneal enthesis (CT) and plantar fascia (PF) were examined bilaterally. A total of 296 entheses were assessed.In G1, disease activity was evaluated using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS).Statistical Package for Social Sciences (SPSS) was used for analysis.ResultsThe study included 58 men and 16 women. The mean age was 44.6 ± 12.3 years. In G1, the mean disease duration was 108.2±94 months. The average BASDAI was 4.5±2.2. The average ASDASCRP was 3.2±1.3. In G1, clinical examination showed tenderness at the posterior insertion of the CT or inferior insertion of PF in 16.2% of patients.However, US lesions of the CT were found in 97% of cases in G1 and 67.6% in G0, p:0.001. US lesions are presented in Table 1.Table 1.Elementary US lesions in SpA and healthy control groupsEnthesisG1 (n (%))G0 (n (%))pCalcaneal tendonThickness15 (40.5)6 (16.2)0.02Erosion9 (24.3)1 (2.7)0.007Enthesophyte29 (78.4)20 (54)0.03Calcification14 (37.8)10 (27)0.32Bursitis4 (10.8)3 (8.1)1PD signal10 (27)00.001Plantar fasciaThickness30 (81.1)27 (73)0.4Erosion11 (30)1 (3)0.002Enthesophyte12 (32.4)2 (5.4)0.003Calcification18 (48.6)6 (16.2)0.003PD signal11 (30)0G0: control group, G1: Spondyloarthritis group, PD: power dopplerCalcaneal tendon thickness was noted in 40.5% in G1 and 16.2% in G2 (p=0.02). Hypo-echogenicity and loss of normal fibrillar structure were more frequent in G1 (86.5% versus 29.7%, pVascularity at power Doppler was significantly more frequent in G1 (p=0.001 in CT and pIn G1, the disease activity was higher in patients with structural damage lesions of the CT (ASDAS CRP: 3.2 versus 1.9; p=0.01). However, there was no associations between vascularity at power Doppler and high disease activity (p=0.47).ConclusionOur study showed that the US lesions of the heel entheses were frequent in SpA patients compared to healthy control. Moreover, US can reveal enthesitis even in asymptomatic patients.The disease activity was higher in patients with US structural damage lesions of the CT.References[1]De Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009; 68(2):169-74.Disclosure of InterestsNone declared

BackgroundRegular physical activity (PA) highly recommended for patients with inflammatory diseases [1]. It was shown to significantly improve disease activity [1]. However, data regarding the effects of physical activity on disease activity and clinical enthesitis scores in patients with SA are scarce.ObjectivesWe aim to assess the effects of performing PA on disease activity and clinical enthesitis scores in patients with SA.MethodsWe performed a cross-sectional study including patients with axial spondyloarthritis. Each patient was asked if he performed regular physical activity. Clinical disease activity scores were calculated: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score using C-Reactive Protein (ASDAS-CRP). Clinical enthesitis scores were calculated: Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) [2], Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) [3] and Leeds Enthesitis Index (LEI) [4].ResultsThirty-seven patients were included: 29 males and 8 females. The mean age was 44.51±12.08 years. The mean disease duration of 9±7.8 years. Regular PA was reported by 51% patients (19). Aerobic exercise was performed by 48.6% of patients (walking: 27%, jogging: 8.1%, football: 5.4%, biking: 2.7%, handball: 2.7% and fitness exercise: 2.7%). Anaerobic exercise was performed by only one patient (2.7%) and consists of weightlifting.The mean weekly duration of PA was of 4.32±3.4 hours. Means BASDAI, ASDAS-CRP, and ASDAS-ESR were of 4.74±2.2, 3.02±1.2 and 3.26±1.3, respectively. Mean MASES was of 2.95±2.86, LEI of 1.51±1.72 and SPARCC of 2.97±3.42. Patients who performed regular PA had significantly lower disease activity evaluated with BASDAI (3.53 vs 5.45, p=0.007), ASDAS-CRP (2.64 vs 3.44, p=0.045) and ASDAS-ESR (2.84 vs 3.7, p=0.44).Clinical enthesitis scores were also significantly lower in physically active patients (MASES: 1.74 vs 4.22, p=0.007, LEI: 0.95 vs 2.11, p=0.038, SPARCC: 1.79 vs 4.22, p=0.029).However, no significative difference was found between the two groups regarding CRP (16.11 mg/L vs 39.67 mg/L, p=0.107).No correlation was found between the weekly number of hours of PA and the evaluated scores.ConclusionPhysical activity was associated with lower disease activity scores and lower clinical enthesitis score. This highlights the importance of physical activity as a non-pharmacologic treatment in SA for the management of disease activity and entheseal involvement.References[1]Osthoff A-KR, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases. 2018 Sep 1;77(9):1251–60.[2]Heuft-Dorenbosch L, Spoorenberg A, Tubergen A van, Landewé R, Tempel H van der, Mielants H, et al. Assessment of enthesitis in ankylosing spondylitis. Annals of the Rheumatic Diseases. 2003 Feb 1;62(2):127–32.[3]Maksymowych WP, Mallon C, Morrow S, Shojania K, Olszynski WP, Wong RL, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Annals of the Rheumatic Diseases. 2009 Jun 1;68(6):948–53.[4]Gladman DD, Inman RD, Cook RJ, Maksymowych WP, Braun J, Davis JC, et al. International spondyloarthritis interobserver reliability exercise--the INSPIRE study: II. Assessment of peripheral joints, enthesitis, and dactylitis. The Journal of Rheumatology. 2007 Aug 1;34(8):1740–5.Disclosure of InterestsNone declared

BackgroundThe Keele start back Tool (SBT) is a 9-item self-reported questionnaire validated to identify individuals with non-specific low back pain (LBP) who have prognostic factors for persistent disabling pain. Thus, it is a useful component of stratified care, where patients’ prognostic subgroups are matched with appropriate treatment.ObjectivesThe aim of our study was to report the prevalence of SBT-calculated risk for back pain disability in Tunisian military patients.MethodsIt was a cross sectional study. The SBT questionnaire was administered to patients > 18 years presenting with common low back pain in outpatient Military teaching hospital in Tunis, Tunisia (from January to Mars 2021). The normality of data distribution was checked by the Kolmogorov-Smirnov test. Quantitative variables were presented as mean ± standard deviation (SD) or median (interquartile range), as appropriate. The categorical variables were expressed as percentages.ResultsOut of 114 participants; the mean age at diagnosis was 79 +/- 12 years old, sex ratio was equal to 1, the median of symptom duration was 22 (6-36) months, 83 (72.8%) were employed, 54 (47.4%) were on active military duty.Comorbidities reported in our patients were distributed as followed: 52 (45.6%) cases of overweight, 21 (18.4%) cases of obesity, 17 (14.9%) had hypertension, 13 (11.4%) suffered from type 2 diabetes, 10 (8.8%) had dyslipidemia, 6 (5.3%) cases of hypothyroidism and 3 (2.6%) cases of auto-immune diseases.Seventy (61.4%) participants reported anxious thoughts, 75 (65.8%) patients expressed avoidance beliefs, 59 (51.8%) patients mentioned catastrophizing thoughts and 50 (43.9%) were dealing with low mood. Mean SBT psychological score was at 2.68 +/-1.5.Patients reported a mean SBT score of 5.31+/-2.1 with the following risk stratification: 27 (23.7%) scored low-risk, 47 (41.2%) medium risk, and 40 (35.1%) high-risk.ConclusionThis is the first study to report the prevalence of SBT-designated risk subgroups among Tunisian population. Medium or high-risk scores for back pain disability were more prevalent the surveyed sample. Also, rates of low mood and anxious thoughts indicate a need for future research to explore psychosocial factors in non-specific low back pain.Disclosure of InterestsNone declared

BackgroundSeveral scoring systems have been developed to quantify ultrasound (US) abnormalities of the entheses in patients with spondyloarthritis (SpA). These scores included entheses of the lower limb, triceps tendon, and lateral epicondylar tendon [1] [2].Studies regarding the involvement of supraspinatus enthesis in patients with SpA are scarce.ObjectivesThis study aimed to assess the supraspinatus enthesis in patients with axial SpA using ultrasonography.MethodsWe performed a cross-sectional case-control study including 74 subjects (148 entheses):• G1: 37 patients with axial radiographic SpA diagnosed according to Assessment of SpondyloArthritis International Society (ASAS) criteria.• G0: 37 age and sex-matched healthy controls.All subjects underwent the US by a qualified-US rheumatologist.The long axis of the supraspinatus was assessed with the patient’s hand placed near the ipsilateral hip and the elbow directed posteriorly.Following parameters were evaluated at the bone attachment supraspinatus tendon: thickness, echogenicity, loss of normal fibrillar structure, calcifications, enthesophytes, erosions, cortical irregularities, bursitis, and vascularity at power Doppler.Statistical analysis was performed using SPSS Statistics software version 21.ResultsThe mean age was 44.62 + 12.31 years. There were 29 men and 8 women for each group. In G1, the mean disease activity using ASDAS-CRP was 3.03 with levels ranging from 0.10 to 5.66.The mean thickness of supraspinatus tendon at its bone attachment was 4.54 ± 0.84 mm in G1 versus 4.02 ± 0.57 mm in G0 (p=0.03). Receiver Operator Curve (ROC) analysis showed the cutoff point with the best accuracy in distinguishing patients of controls to be 4.65 mm, with a sensitivity of 45.9% and specificity of 86.5% (air under the curve (AUC) value: 0.666 (p=0.014). Hypo-echogenicity and loss of normal fibrillar structure were noted in 27% (n =10 patients) and 5% (n = 2), respectively, in G1.Structural damage lesions were found in 3 % in G0 (n= 1) and 51 % in G1 (n=19), p< 0.0001.In G1, structural damage lesions included: calcifications (38%, n=14), erosions (30%, n = 11), cortical irregularities (16%, n=6), and enthesophytes (8%, n=3).In G0, structural damage lesions comprised: calcifications (3%, n=1) and cortical irregularities (3%, n=1).Vascularity at power Doppler was found in 11% in G1 (n= 4) and 0 % in G0.Subacromial-subdeltoid bursitis was noted in 3% in G1 (n=1) and in 0% in G0.ConclusionOur study showed that structural damage lesions of supraspinatus enthesis were frequent in patients with SpA compared to healthy controls. A cutoff of 4.65mm supraspinatus’s thickness was able to discriminate patients with SpA from healthy controls. This finding suggests that supraspinatus enthesis evaluation can be added in entheses US scores.References[1]de Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. févr 2009;68(2):169‑74.[2]Balint PV, Terslev L, Aegerter P, Bruyn GAW, Chary-Valckenaere I, Gandjbakhch F, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. déc 2018;77(12):1730‑5.Disclosure of InterestsNone declared

BackgroundA regular monitoring of structural damage in patients with rheumatoid arthritis (RA) is necessary to adjust the treatment. However, the rhythmicity of new radiographs to assess the structural damage is not codified. There is no biomarker able to reflect structural damage.ObjectivesOur study aimed to assess the relationship between the modified Sharp score and the platelet to lymphocyte ratio.MethodsWe performed a cross-sectional study including 53 patients with RA. A cell blood count was performed for each patient, and PLR was calculated. Modified Sharp score and its components (erosion score and joint space narrowing score) were evaluated using the radiograph of hands and feet.Statistical analysis was performed using SPSS (Statistical Package for Social Sciences).ResultsOf the 53 patients, 39 were female (Sex Ratio: 2.8). The mean age was 53.9 ± 12.7 years. The mean age of the onset of the disease was 43.8±13.5 years. The mean disease duration was 10.1 ± 8.2 years. The mean DAS 28-ESR score was 4.64 ± 1.23.The mean value of PLR was 161.62 ± 86.59. The mean modified Sharp score was 46.33 ± 37.74. Thirty-two percent of patients had a modified Sharp score greater than 50. The mean scores of joint erosion and joint space narrowing were 12.76 ± 15.05 and 33.57 ± 25.80.Modified Sharp score was correlated to the PLR (r: 0.501; p Moreover, joint space narrowing score and joint erosion score were correlated to the PLR (r: 0.558; p Patients with a modified Sharp score ≥ 50 had a higher PLR (203.12 ± 101.71 versus 142.33 ± 74.07).As shown in Figure 1, the ability of PLR to distinguish patients with a modified Sharp score ≥ 50 was good with an AUC of 0.704 (p= 0.021) with a cut-off of 130.5 (sensitivity=75%, specificity=65.7%).Figure 1.ROC curve assessing the ability of PLR to distinguish patients with a modified Sharp score ≥ 50ConclusionOur study showed that the modified Sharp score correlated with PLR, which ​​can be useful to distinguish patients with severe structural damage with a cut-off of 130.5. This finding suggests that this ratio is a reliable marker to reflect radiographic joint damage.Disclosure of InterestsNone declared

BackgroundHip involvement occurs in about one-third of patients with spondyloarthritis (SA) [1]. It can be responsible for significant disability and functional impairment.ObjectivesThis study aimed to assess the associated factors with hip involvement in SA.MethodsWe conducted a cross-sectional study, including 165 patients with SA diagnosed according to Assessment of SpondyloArthritis international Society (ASAS) criteria over a period from 2017 to 2021. Demographic, clinical, biological and radiographic data were collected. We compared following parameters assessed at the time of diagnosis of coxitis: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Bath Ankylosing Spondylitis Radiology Index (BASRI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).We used logistic regression analysis to identify factors associated with hip involvement in SA.ResultsA total of 165 Patients were enrolled (121 men and 44 women), the mean age was 46.13 ± 13.07 years. The mean age of disease onset was 35.01 ± 12.55 years. The average diagnostic delay was 37.54 ± 50.51 months. The average disease duration was 10.91 ± 6.94 years.Eighty seven percent of patients had axial spondyloarthritis, 72% had extra-articular manifestations.Mean ESR and CRP values were 37.49 ± 28.1 mm and 30.14 ± 43.55 mg/L, respectively. Mean BASDAI and ASDAS-CRP values were 4 ± 1.8 and 3.09 ± 1.13, respectively.Hip involvement was noted in 60 patients (36.4%). It was bilateral in 75% of cases (n=45). A total number of affected hips was 105.Following parameters were significantly higher in patients with hip involvement: age over 40 years old (73.3 vs 56.3%, p=0.030), symptoms duration over 10 years (60% vs 40.2%, p=0.015), elevated CRP (87.9% vs 73.7%, p=0.036), radiographic sacroiliitis (95% vs 82.7%, p=0.023), frequency of pulmonary involvement (25.0% vs 11.4%, p:0.023), frequency of osteoporosis (20.0% vs 8.6%, p:0.034), BASMI (3.71 vs 1.65, pA multivariable logistic regression model showed that age over 40 years (OR=2.688 [1.020 - 7.083], p=0.045), radiographic sacroiliitis (OR=5.656 [1.007 - 31.769], p=0.049), and very high disease activity (ASDAS-CRP≥3.5) (OR=5.328 [1.774 - 16.002], p=0.003) were independently associated with hip involvement in SA.ConclusionOur study showed that age, symptoms duration, radiographic sacroiliitis, extra-articular manifestations, axial structural damage, elevated CRP, and very high disease activity were associated with hip involvement. These finding suggest that the control of disease activity and inflammation may prevent the onset of hip involvement. There are controversial findings regarding the association between HLA B27 gene and hip involvement [2].References[1]Vander Cruyssen B, Vastesaeger N, Collantes-Estévez E. Hip disease in ankylosing spondylitis. Curr Opin Rheumatol. 2013 Jul;25(4):448-54.[2]Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, Chou CT. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2011 Jun;40(6):552-8.Disclosure of InterestsNone declared

BackgroundThe incidence of low back pain (LBP) was 40.5 per 1,000 person-years in active military population and thus was comparable to the general population. Other than pain and disability, chronicity of LBP has a significant impact on work through the high rates of resulting sick leave. The Start Back Tool (SBT) questionnaire is a well-known tool used to detect patients with prognostic factors for persistent and disabling back pain. The risk of chronicity in individuals on active military duty suffering from acute back pain is yet to be explored.ObjectivesThe aim of our study was to assess the risk of chronicity in active Tunisian military population compared to non-military controls using the SBT questionnaire.MethodsCross sectional study in which we enrolled adult patients suffering from acute back pain, who consulted the outpatient department of rheumatology in the military hospital of Tunis from January 2021 to Mars 2021. All patients had a standardized clinical examination. They completed the SBT questionnaire in the validated Arabic language version. Patients were stratified in two groups, active military group (AMG) and non-military group (NMG). Categorical variables were compared with the χ2 -test. Comparisons of the differences of continuous variables were performed by Student’s T-test.ResultsWe included 54 patients in the active military group and 60 patients in the non-military group, epidemiologic characteristics were distributed respectively as followed: mean age was at 43+/-8 versus 53+/-13 years old (pActive military group patients had significantly higher proportions of high risk SBT scores than non-military patients 50% versus 22% (2.27 risk ratio 95% CI 1.47 to 3.08; p=0.002), with total mean of scores significantly higher in the active military group 5.81 (95% CI 5.33 to 6.29) versus 4.85 (95% CI 4.43 to 5.27), p=0.014.Active military group patients scored significantly higher on the psychological SBT sub-score with a mean of 3.02 (95% CI 2.8 to 3.24) versus 2.38 (95% CI 2.07 to 2.7) p=0.032, they were more susceptible to express low mood 53% versus 35% (1.51 risk ratio 95%CI 1.13 to 1.89; p=0.044).There was no significant difference in expressed anxiety 69% versus 55% (p=0.139), catastrophizing thoughts 57% versus 47% (p=0.252) and avoidance beliefs 72% versus 60% (p=0.170) though all of these parameters were more prevalent in the active military group.ConclusionThough NMG patients had more classic low back pain risk factors such as age and obesity, this did not prevent the AMG to show higher trends toward chronicity via SBT scores. This is to our knowledge the first study to assess the high risk of persistent disabling back pain using the SBT in a Tunisian military population. The implementation of risk stratification for patients with low back pain in routine military health may improve physical function and time off work, sickness certification rates and reductions in healthcare costs compared to usual non-stratified care.Disclosure of InterestsNone declared

BackgroundGonarthrosis is the most frequent and common condition of the lower limb, responsible for gonalgia, stiffness, leading sometimes to major functional impotence. The WOMAC with its three domains (pain, stiffness and function) is a valid index for the evaluation of lower limb osteoarthritis [1].The management of gonarthrosis is multidisciplinary with rehabilitation as the mainstay.Currently, aquatic gymnastics is more and more prescribed in the management of this pathology.ObjectivesThe objective of our work was to compare the contribution of aquatic rehabilitation to classical one in patients with gonarthrosis through the WOMAC score.MethodsThis is a prospective, comparative study conducted over a period of 15 months, between September 2016 and December 2017, including 120 patients recruited at the Physical Medicine and Functional Rehabilitation Department of The HMPIT, in whom the diagnosis of gonarthrosis was made according to the ACR criteria.The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a conventional rehabilitation program. The second group, called G2, received aquatic rehabilitation.Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.ResultsThe average age of the general population was 54.85 ± 9.5 years [40- 81 years].The average age of G1 was 59.07 ± 10.2 years versus 50.63 ± 6.4 years for G2.Among the 120 patients, 28 were male (23%) and 92 were female(77%) There were 6 males and 54 females in group 1 versus 22 males and 38 females in group 2.Initially, the average WOMAC pain was 15.1 ± 3.9 in G1 and 12.3 ± 1.22 in G2.There was a statistically significant difference between the 2 groups (p=0.01). After rehabilitation, there was an improvement in the WOMAC pain score of 17% in G1 and 50% in G2 with a statistically significant difference between the 2 groups (pThe average WOMAC score for stiffness was initially 5.1 ± 2 in G1 and 3.2 ± 2 in G2 with no statistically significant difference between the 2 groups (p=0.076).After rehabilitation, an improvement of this score was noted in both groups, it was 19% in G1 and 50% in G2 with a statistically significant difference between the 2 groups (pThe average initial WOMAC function score was 42.32 ±15.7 in G1 and 33 ± 11 in G2 with a statistically significant difference between the 2 groups (p=0.002).After conventional rehabilitation, this score had improved by 10% and after hydrotherapy, the improvement was 46% with a statistically significant difference between the 2 groups (pConclusionThese results were aligned with the literature and confirmed the effectiveness of functional treatment whether aquatic or classic with better outcome for aquatic rehabilitation. The best would be to combine the different methods according to the needs of the patient and their functional capacities in order to ensure a better adherence.References[1]Guermazi M, Poiraudeau S, Yahia M, Mezganni M, Fermanian J, Elleuch MH, et al. Translation, adaptation and validation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for an Arab population. Osteoarthr Car- tilage. 2004;12(6):459-68.Disclosure of InterestsNone declared

BackgroundKnee osteoarthritis (KOA) is the most common pathology of the lower limb. It is multifactorial and constitutes a real public health problem. Nowadays, in addition to the rehabilitation that is part of the multidisciplinary management of this affection, water gymnastics is increasingly finding its place [1].ObjectivesThe main objective of our work was to compare the contribution of aquatic gymnastics compared to classical rehabilitation in patients with knee osteoarthritis through a clinical evaluation.MethodsThis is a prospective, comparative and evaluative study carried out in a department of Physical Medicine and Functional Rehabilitation over a period of 15 months between September 2016 and December 2017, including 60 patients with KOA.The patients were randomly divided into 2 groups of 60 patients each one. The first(G1) benefited from a classic rehabilitation program. The second(G2) benefited from water gymnastics. Two clinical evaluations were carried out: T1 before the start of rehabilitation and T2 at the end of the eight weeks of treatment.ResultsThe mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).55 patients presented with a misalignment of the lower limbs with a varus knee in 33% of cases (G1 25% and G2 42%). 5 patients in G1 and 7 patients in G2 had a valgus knee. In G1, one patient had recurvatum and two patient had knee flexum with no statistically significant difference between the two groups.After classic rehabilitation, Zohlen’s sign had disappeared in 6 patients for the right knee and 3 patients for the left knee. However, after water gymnastics, this sign had disappeared in 12 patients for the right knee and in 16 patients for the left knee.A functional mobility sector (>90◦) was found in all patients with an average of 120◦ in G1 and 126◦ in G2. After rehabilitation, an improvement of 2% in G1 and 5% in G2 was noted with a statistically significant difference between the two groups (pThirty-sex percent of G1 patients had quadriceps amyotrophy versus 32 % of G2, which disappeared in 5 patients after classic rehabilitation and in 6 patients after hydrotherapy.48 patients of G1 and 56 patients of G2 presented with quadriceps retraction which disappeared in 21 subjects of G1 after classic rehabilitation and in 45 subjects of G2 after hydrotherapy.A retraction of the hamstrings was noted in 13 and 18 patients respectively in G1 and G2 with a total improvement in the 2 groups.ConclusionDry rehabilitation has its place in the management of knee osteoarthritis, but rehabilitation in water has better results. The aquatic environment makes it possible, by reducing the weight of the body, to reduce the stresses exerted on the knee joints, allowing better joint mobility with the added effect of heat on the reduction of pain and muscle relaxation.References[1]Erika Ferreira Nascimento, Paulo Henrique Altran Veiga, Rogério Azevedo Antunes Pereira, Antônio Nery de Araújo Neto. Analysis of quality of life and function in the elderly with overweight gonarthrosis submitted to aquatic physical therapy. Geriatrics gerontology and aging. 2012;6(1).Disclosure of InterestsNone declared

BackgroundThe deleterious effect of smoking is frequently studied in inflammatory diseases such as spondyloarthritis (SA) [1].ObjectivesThe objective of our study was to identify the consequences of smoking during AS.MethodsWe conducted a cross sectional study including patients followed for spondyloarthritis meeting the ASAS 2009 criteria. For each patient we collected the following parameters: age, age at onset of the disease, duration of progression, disease activity using BASDAI and ASDAS-CRP scores and structural damage using BASRI and mSASSS scores. We also measured sedimentation rate (ESR) and C-reactive protein (CRP).Statistical analysis was performed using SPSS software.ResultsWe included 140 patients. Seventy-three percent were male (n=102). The mean age was 43 ± 12.9 years. The age of onset of the disease was 34.28 ± 12 years. The mean disease duration was 110 ± 107.8 months.Sixty patients were smokers (43%) at an average of 20.75 ± 16.09 pack-years.Mean ESR and CRP were 36.49 ± 27.22 mm and 29 ± 44.27 mg/L, respectively.The mean BASDAI and ASDAS-CRP were 3.68 ± 1.86 and 2.99 ± 0.98, respectively.The mean BASRI and mSASSS were 4.12 ± 3 and 10.26 ± 15.41, respectively.Smokers had significantly higher BASRI and mSASSS scores (BASRI: 5.02 ± 3.32 vs 3.47 ± 2.6; p=0.005 and mSASSS: 14.07 ± 17.56 vs 7.02 ± 12 .62; p=0.03).In addition, the number of packets year was correlated to mSASSS (r=0.399; p=0.01).On the other hand, we did not find any association between smoking and the following parameters: ESR, CRP, BASDAI or ASDAS-CRP.ConclusionAs reported in other studies, ours’ showed that structural damage was correlated with the number of pack-years [2]. Smoking was associated with this structural damage in SA regardless the inflammatory biomarkers and the disease activity. This suggests that control of structural damage in SA requires smoking cessation.References[1]Zhao SS, Goodson NJ, Robertson S, Gaffney K. Smoking in spondyloarthritis: unravelling the complexities. Rheumatology. 1 juill 2020;59(7):1472‑81.[2]Wendling D, Prati C. Spondyloarthritis and smoking: towards a new insight into the disease. Expert Rev Clin Immunol. juin 2013;9(6):511‑6.Disclosure of InterestsNone declared

BackgroundThe management of rheumatoid arthritis (RA) was revolutionized by the use of biologic therapies (bDMARD). Nevertheless, bDMARDs may carry some specific risks such as infection. However, data about self-care safety skills are poor [1]. An assessment of the level of information and education is therefore essential for patients followed for RA.ObjectivesThe purpose of our study was to assess knowledge and safety skills of RA patients under bDMARDs.MethodsWe conducted a descriptive, bi-centric, and cross-sectional study, including RA patients receiving intravenous (IV) or subcutaneous (SC) bDMARD for at least 3 months. Sociodemographic, clinical, and paraclinical data were collected. Knowledges and self-care safety skills were assessed by a pre-specified questionnaire.The questionnaire was divided into three domains:- Five questions about general theoretical knowledge domain: assessing patient’s knowledge of the name of the current bDMARD, duration and rate of intake, and a question on annual cost estimation.- Three questions about the current bDMARD management: assessing cold chain compliance and management of the biologic in SC emphasizing adherence to the steps to be taken prior to giving the injection.- Tow questions about knowledge regarding safety skills in special situations: infection, cough, contraception, surgery, vaccination, and regarding the need to inform others about the use of bDMARD.Based on the data analysis, patients were divided into 3 groups according to their knowledge level:- Group A (low knowledge level: percentage of correct answers - Group B (moderate knowledge level: percentage of correct answers >40% and - Group C (high level of knowledge: percentage of correct answers > 60%).ResultsSeventy-five patients with RA were collected. Their mean age was 56.92 ± 9.06 years [34-80]. The mean duration of bDMARD was 37.17 ± 39.44 months [4-248] with a mean rank of 1.41 ± 0.9 [1-5]. The SC route was used in 41 patients (54.7%) followed by the IV route in 34 patients (45.3%)The most prescribed molecules were Infliximab, Certolizumab and Tocilizumab (22.7% respectively). The average order of the current biologics was 1.41 ± 0.9 [1-5] in combination with a csDMARD in 48 patients (64%).Safety skills were low in 24 patients (32%), moderate in 36 patients (48%), and high in 15 patients (20%).The mean percentage of correct answers for each domain was respectively: 56.53 ± 18.4% [20-100] for general theoretical knowledge domain, 68.44 ± 26.21% [0-100] for the management of current biologic treatment domain, and 40.8 ± 16.87% [6.67-80] for knowledge regarding safety skills in special situations.Safety skills levels were significantly related to occupational status (p=0.001), DAS28 CRP (p=0.04), joint deformities (p=0.01) and radiographic erosions (p=0.006), number of previous bDMARDs (p=0.009), and the rank of the current bDMARD (p=0.009).ConclusionThe major finding of our study was the insufficient level of knowledge and safety skills of RA patients under bDMARDs. We highlight the importance of involving patients in the decision-making process and emphasize the role of the therapeutic patient education programs.References[1]Orefice D, Beauvais C, Gossec L, Flipon E, Fautrel B, Marguerie L, et al. Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease. Joint Bone Spine. 2014;81(6):502‑7Disclosure of InterestsNone declared

BackgroundKnee osteoarthritis presents a heavy financial burden due to disability and supported care. Gonalgia is the main symptom leading patients to consult. For some clinicians, this is a warning signal that correlates with the extent of joint degradation [1]. The management of pain in knee osteoarthritis is multidisciplinary comprising pharmacological and non-pharmacological means including classical rehabilitation and aquatic gymnastics.The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis.ObjectivesThe objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis.MethodsProspective, evaluative and comparative study about 120 patients with knee osteoarthritis carried out over 15 months (September 2016- December 2017) in the Department of Physical Medicine and Functional Rehabilitation.The patients were divided into two groups of 60. The first group (G1) benefited from a classic rehabilitation program, the second group (G2) benefited from aquatic gymnastics.The 2 programs were carried out at the rate of three sessions per week for two months. The study was based on the assessment of pain by the following scales: VAS pain and the Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC) questionnaire for the lower limbs (pain section).ResultsThe mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).The pain was mechanical in 89 % of cases. Positional nocturnal pain was noted in 72% of cases. Hydarthrosis was associated in 46% of cases. A daily intake of palliative I analgesics was noted in 56 % of patients.The mean pain VAS at rest of 33.4±18 in G1 vs 27.3±23.2 in G2 (p=0.13). On exertion, it was 72.3±19 in G1 vs 83.3±20 in G2 (p = 0.72).After the rehabilitation treatment, an improvement in the two groups was objectified, which was significantly more marked in G2:Resting VAS improved by 57 % for G1 and by 84% for G2 (p = 0.015). Exercise VAS improved 20% in G1 and 43% in G2 (p The mean WOMAC pain score was 14.3 in G1 and 10.3 in G2 (p = 0.006).There was an improvement in the WOMAC pain score of 24% in G1 and 58% in G2 (p ConclusionFunctional rehabilitation in the water or in the dry has a marked effect on pain in gonarthrosis patients. The aquatic environment can also bring many benefits on pain by lightening the weight of the body and the analgesic effect of the heat.References[1]Trouvin A-P, Perrot S. Douleur dans l’arthrose : comprendre les mécanismes pour améliorer la prise en charge. Revue du Rhumatisme. 2018 Jun;85(4):324–30.Disclosure of InterestsNone declared

BackgroundMethotrexate (MTX) is recommended as a first-line disease-modifying antirheumatic drug for treating rheumatoid arthritis (RA) in monotherapy or combinational therapy. A concern about MTX-related liver fibrosis in patients with rheumatoid arthritis (RA) is still unsolved.ObjectivesThe aim of the study cutoff of cumulative dose discriminating patients with normal from those with abnormal liver stiffness.MethodsWe conducted a cross-sectional study including consecutive RA patients diagnosed according 2009 ACR-EULAR criteria. Liver stiffness (LS) was assessed by Fibroscan in the gastroenterology department by an experienced operator.The LS is measured in kilopascals (kPa). It is normal when < 6.2 kPa. Above this rate it is considered pathological. Substantial liver fibrosis was defined as liver stiffness of greater than 8 kPa.We collected the following parameters: age, disease duration, disease activity assessed by DAS28, cumulated dose of MTX and duration of this treatment, and the body mass index (BMI). Patients underwent blood testing exploring hepatic function: alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl tansferase (GGT), total bilirubin (TB), albumin (ALB) and prothrombin time (PT).Statistical analysis was performed using SPSS software.ResultsThere were 18 men and 36 women. The mean age was 51.9 + 11.49 [22-83]. The mean BMI was 27.27 + 3.40. The mean disease duration 8.08 + 6.28 years. The mean DAS28CRP was 3.96 + 1.49.The mean cumulative dose of MTX was 3670 + 3432.61mg and mean MTX duration was 55.75 + 50.89 months. The mean of LS was 4.6 + 1.64 kPa.The means of the liver blood tests are as follows: AST 20.83 + 8.58 UI/L, ALT 19.60 + 9.39 UI/L, ALP 84.65 + 38.68UI/L, TB 9.50 + 4.79 UI/L, GGT 25.88 + 14.26UI/L, ALB 35.19 + 5.47 g/L, PT 94.60 + 9.02.Eight patients had abnormal LS values and two patients had advanced liver fibrosis. However, hepatic blood tests (AST, ALT, GGT, TB, ALB, PT) were normal in these patients.A correlation was found between LS and following parameters: cumulative dose of MTX (r: 0.347, p: 0.013), the methotrexate duration (r: 0.363, p: 0.010) and total bilirubin rate (r:0.390, p: 0.005).Receiver Operator Curve (ROC) analysis showed the cutoff point of cumulative dose of MTX with the best accuracy in distinguishing patients with normal LS from those with LS higher than 6.2 kPA was 7330 mg, with a sensitivity of 50% and specificity of 91.3% (air under the curve (AUC) value: 0.732 (p=0.03).ConclusionOur study showed that LS correlated to both MTX duration and cumulative dose. Patients with a cumulative dose of MTX higher than 7330 mg required a close follow up of liver elastometry and monitoring of hepatic function.Disclosure of InterestsNone declared

BackgroundGonarthrosis is a benign knee condition, but it can become disabling if poorly managed. The evaluation of the functional impact of gonarthrosis is based on Lequesne’s algofunctional index [1], thus judging the effectiveness or failure of the proposed treatment.Water gymnastics is increasingly prescribed in the management of this pathology.ObjectivesThe main aim of our work was to compare the efficacy of aquatic gymnastics with conventional rehabilitation in patients with gonarthrosis using Lequesne’s algofunctional index.MethodsThis is a prospective, comparative study conducted over a period of 15 months, between September 2016 december 2017, including 120 patients recruited at the outpatient clinic of the Physical Medicine and Functional Rehabilitation Department of The HMPIT, in whom the diagnosis of gonarthrosis was made according to the ACR criteria.The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a conventional rehabilitation program. The second group, called G2, received water gymnastics.Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.ResultsThe mean age of the general population was 54.85 ± 9.501 years [40- 81 years]. The mean age of G1 was 59.07 ± 10.275 years versus 50.63 ± 6.425 years for G2.Thus, there was a female predominance with a sex ratio M/F of 0.11 in G1 and 0.57 in G2.Lequesne’s algofunctional index was initially 11.46 ± 3.2 in G1 patients and 8.7 ± 1 in G2 patients with a statistically significant difference between the 2 groups (pConclusionThe effectiveness of functional treatment whether aquatic or classic was well demonstrated by Lequesne’s algofunctional index, with better result for aquatic rehabilitation. The best would be to combine the two according to the initial functional capacities of the patient to ensure his adherence to the rehabilitation program.References[1]Guermazi M, Mezganni M, Yahia M, Poiraudeau S, Fermanian J, Elleuch MH, et al. Translation and construct validity of the Lequesne index for Arab speaking North African patients with osteoarthritis of the knee. Ann Readapt Med Phys. 2004;47(5):195-203.Disclosure of InterestsNone declared

BackgroundPhysipathological mechanisms of spondyloarthritis (SA) are very complex. The role of the interleukin (IL)- 8, which is an angiogenic chemokine, has been suggested [1].ObjectivesWe aimed to evaluate the discriminative value of interleukin 8 in SA.MethodsWe conducted a cross-sectional study during two years (2019-2020) including 144 subjects divided into two groups: a group G1 that included 72 patients followed for spondyloarthritis meeting the Assessement of SpondyloArthritis international Society (ASAS) criteria and a group (G2) including 72 healthy controls. The two groups were matched by age and sex.IL-8 was measured for each participant using chemiluminescence.We performed a ROC analysis and computed the air under the curve (AUC) at IL-8 to assess the ability of this chemokine to diagnose SA and to distinguish between SA patients from healthy controls. Statistical analysis was performed using SPSS.ResultsWe included 57 men and 15 females in each group. The mean age was 44.84 ± 13.42 years. In G1, the mean disease duration was 10.25 ±7.7 years. Axial and peripheral involvements were found in 85% of cases (n=65) and 50% of cases, respectively.The mean BASDAI and ASDAS-CRP were 3.21 ± 1.87 and 2.92 ±1.55, respectively.IL-8 was able to distinguish SA patients from healthy controls with a cutoff of 4.5 pg/mL. The AUC was good at 0.855 (pFigure 1.AUC at IL-8 between SA patients and healthy controls 0.855 (pConclusionSeveral studies have found that IL-8 was significantly higher in SA patients comparing to controls [2,3]. Our study showed that IL-8 could distinguish SA patients from controls with a cutoff of 4.5 pg/mL. This suggests that IL-8 could play a role in the pathophysiology of SA.References[1]König A, Krenn V, Gillitzer R, Glöckner J, Janssen E, Gohlke F, et al. Inflammatory infiltrate and interleukin-8 expression in the synovium of psoriatic arthritis--an immunohistochemical and mRNA analysis. Rheumatol Int. 1997;17(4):159‑68.[2]Limón-Camacho L, Vargas-Rojas MI, Vázquez-Mellado J, Casasola-Vargas J, Moctezuma JF, Burgos-Vargas R, et al. In vivo peripheral blood proinflammatory T cells in patients with ankylosing spondylitis. J Rheumatol. avr 2012;39(4):830‑5.[3]Sonel B, Tutkak H, Düzgün N. Serum levels of IL-1beta, TNF-alpha, IL-8, and acute phase proteins in seronegative spondyloarthropathies. Joint Bone Spine. 1 oct 2002;69(5):463‑7.Disclosure of InterestsNone declared

BackgroundMadrid Sonographic Enthesis Index (MASEI) is an ultrasound (US) score for the evaluation of enthesis including inflammatory abnormalities and chronic damage in spondyloarthritis (SpA) [1]. This score includes bilaterally: plantar aponeurosis, Achilles tendon, distal and proximal patellar ligament, distal quadriceps, and brachial triceps tendons.ObjectivesWe aimed to study the diagnosis value of MASEI score in axial spondyloarthritis.MethodsWe conducted a case-control study including 74 subjects divided into 2 groups:-G1: 37 patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria for axial SA.-G0: 37 healthy controls matched for age and sex.Eight hundred eighty-eight entheses were assessed by a musculoskeletal experienced sonographer who was blinded to the clinical data concerning patients and controls.The MASEI was calculated for the 2 groups.For G1, we collected the following parameters: disease activity using Bath Ankylosing Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS-ESR).Statistical analysis was performed using “IBM SPASS Statistics” software version 21.A Receiver Operator Curve (ROC) analysis was performed to determine the cutoff of MASEI able to discriminate G0 from G1.ResultsThe study included 29 men (78%) and 8 women (22%) in each group. The mean age was 44.51 ± 12.08 years. The mean age of onset was 38.06 ± 11.36 years. The mean disease evolution of 9.02 ± 7.83 years.The mean BASDAI and ASDAS-ESR were 4.47 ± 2.21 and 3.26 ± 1.31.MASEI score was significantly higher in patients compared to healthy controls (25.76 ± 9.8 versus 8.32 ± 6.65, p A cutoff of 18 of the MASEI was able to distinguish G1 from G0 with a sensitivity of 81.1% and specificity of 91.9%. The air under curve (AUC) value was 0.920 (pNo correlation was found between MASEI and BASDAI, and ASDAS-ESR.ConclusionOur study showed that MASEI score is significantly higher in SpA patients and seems to have a diagnostic accuracy. Besides, MASEI was able to distinguish between SpA patients and healthy controls with a cut-off of 18. Those results agree with the findings of other researchers in the field [2].References[1]de Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. févr 2009;68(2):169‑74.[2]Ebstein E, Coustet B, Masson-Behar V, Forien M, Palazzo E, Dieudé P, et al. Enthesopathy in rheumatoid arthritis and spondyloarthritis: An ultrasound study. Joint Bone Spine. oct 2018;85(5):577‑81.Disclosure of InterestsNone declared

BackgroundGonarthrosis is a very common condition and a real public health problem [1]. One of the pillars of its management is pain management. In addition to drug treatment, rehabilitation is part of the therapeutic arsenal.ObjectivesThe main objective of our work was to compare the contribution of balneotherapy versus dry rehabilitation in the control of pain triggers.MethodsWe carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis (KOA) was made according to the criteria of the ACR [2].The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a standard rehabilitation program. The second group, called G2, received water gymnastics. Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.ResultsThe mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of KOA was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).Pain was triggered by standing in 92% of cases in G1 versus 98% in G2 with a mean delay of 17.2 min for G1 and 20.1 min for G2. There was no statistically significant difference between the two groups (p=0.452). After rehabilitation, 22% of the patients in G1 and 43% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).Prolonged sitting in 62% of cases in G1 versus 38% in G2 with a mean delay of 6.2 min for G1 and 52.3 min for G2 awakened pain. There was a statistically significant difference between the two groups (p=0.02). After rehabilitation, 23% of the patients in G1 and 30% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).Pain was awakened by squatting in 93% of cases in G1 versus 97% of G2. There was no statistically significant difference between the 2 groups (p=0.554). After rehabilitation, 13% of the patients in G1 and 30% in G2 had noted a complete disappearance of pain with a statistically significant difference between the 2 groups (p=0.001).All patients in G1 and 92% of patients in G2 reported pain when climbing/descending stairs. There was no statistically significant difference between the 2 groups. An improvement in symptomatology was noted in both groups with disappearance of pain in 18% of G1 and 27% of G2.An adjustment on the parameters by which the 2 groups differed was made without impact on the results obtained.ConclusionRehabilitation has an important role in the control of pain triggers by ensuring, in addition to analgesic means, good muscle balance, joint gain and good proprioception. Balneotherapy has proven to be more effective.References[1]Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5-15.[2]Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-49.Disclosure of InterestsNone declared

BackgroundIn addition to its multiple functional, social and economic consequences, knee osteoarthritis is responsible for a significant deterioration in the quality of life (QOL)[1]. Studies examining the impact of osteoarthritis on quality of life have been made possible through the development of validated measurement questionnaires. The SF-12 score with its aspects (physical, mental and social) is a valid and reliable instrument for the assessment of QOL.ObjectivesThe main aim of our study was to make a comparison between the contribution of aquatic rehabilitation and classic rehabilitation in patients with knee osteoarthritis using the SF-12 score.MethodsWe carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis was made according to the criteria of the ACR.The patients were randomly divided into 2 groups of 60 patients each. The first group called G1 received a classic rehabilitation program. The second group called G2 benefited from aquatic gymnastics. The study was based on the SF-12 quality of life assessment. Two evaluations were made, the first (T1) before the start of rehabilitation and the second (T2) at the end of the eight weeks of care.ResultsThe mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).Initially, the mean of SF12-P in G1 patients was 31.2 ± 6.5 compared to 35.4±6.2 in G2 patients. In our patients, the SF12-P score was less than 50 in 100% of cases in G1 and in 98% of cases in G2. There was a statistically significant difference between the 2 groups (p = 0.04).After classical rehabilitation, the SF12-P had increased on average by 2.3 against 6.1 after aquatic gymnastics with a statistically significant difference between the 2 groups (p = 0.012).Initially, the mean of SF12-M in G1 patients was 32.5 ± 10.2 and 35.3 ± 8.9 in G2 patients. In our patients, the SF12-M score was less than 50 in 94% of cases in G1 and in 98% of cases in G2. There was no statistically significant difference between the 2 groups (p = 0.652).After classical rehabilitation, the SF12-M increased on average by 6.9 and 12.1 after aquatic gymnastics with a statistically significant difference between the 2 groups (p = 0.005).ConclusionThe effectiveness of functional rehabilitation, whether aquatic or dry, has been well demonstrated by the study of quality of life, with better results for balneotherapy. The physical properties of water and heat have a positive short-term impact on quality of life by acting on several parameters, including pain, contractures and anxiety. Further studies evaluating this long-term effectiveness will be required.References[1]Gabriel SE, Crowson CS, Campion ME, O’Fallon WM. Indirect and non-medical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol. 1997;24(1):43–8.Disclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease requiring a long-term follow-up and the use of chronic therapies. The management of this disease is based on a multidisciplinary care, requiring total patient involvement. Previous personal experiences, the experiences of others and the daily impact of the disease on patients fuel their perceptions of the treatment especially biologic one. There are few studies evaluating patient’s beliefs about these drugs [1,2].ObjectivesThe aim of our study was to investigate beliefs about biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) among patients with RA and to identify factors related to specific beliefs.MethodsWe conducted a bi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARDs associated or no to conventional synthetic (sc) DMARDs. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ).ResultsThere were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. The mean age was 56.92 ± 9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed. Sixty-four patients (85.3%) were married. The mean disease duration was 14.85 ± 8.5 years [2-39]. Thirty-three patients had joint deformities. Twenty-seven patients had extra-articular manifestations and thirty-six patients had comorbidities. The mean disease activity scale (DAS28 CRP) was 3.94 ± 1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low disease activity, and 19% were in remission. The mean functional impairment scale (HAQ) was 0.64 ± 0.48 [0-2.2]. Twelve patients had moderate to severe disability and only one patient had severe to very severe disability. The mean duration of the current bDMARD was 37.17 ± 39.44 months and the mean rank of the current biotherapy was 1.41 ± 0.9 [1-5].Regarding the BMQ, the mean score for General Overuse was 14 ± 2.37 [6-20]. The mean score for General Harm was 10.82 ± 4.42 [4-20].The mean score of patients’ specific beliefs regarding the necessity of taking the current bDMARD (Specific Necessity) was 20.62 ± 5.71 [5-25]. The mean Specific Concerns score regarding the current bDMARD was 10.33 ± 3.29 [5-25]. Necessity about taking bDMARD was reported by 77.3% patients in the present and 61.3 % patients consider maintaining the bDMARD in the future.There were 4% of patients who reported concerns about taking bDMARD. Twenty four percent of patients reported concerns about long term effects, and 16% about becoming too dependent on bDMARD.Beliefs about the necessity to stop occasionally chronic therapies were reported by 13.3% of patients.Specific necessity was correlated to the current bDMARD duration (p=0.01), Patient Global Evaluation (p=0.03), VAS pain scale (p-3), the number of nocturnal awakenings (p=0.01), tender joint count (p-3), swollen joint count ((p-3), HAQ (p=0.005), DAS28 (CRP) (p-3). Specific concerns were correlated to the actual bDMARD rank (p=0.01).ConclusionOur study showed stronger beliefs in the necessity of taking biologic drugs if indicated. Disease activity parameters and functional impairment influence those beliefs. Further studies are required to evaluate the impact of beliefs on biologic drug adherence.References[1]Cea-Calvo L, Raya E, Marras C, Salman-Monte TC, Ortiz A, Salvador G, et al. The beliefs of rheumatoid arthritis patients in their subcutaneous biological drug: strengths and areas of concern. Rheumatol Int. 2018;38(9):1735‑40.[2]Heuckelum M van, Linn AJ, Vandeberg L, Hebing RCF, Dijk L van, Vervloet M, et al. Implicit and explicit attitudes towards disease-modifying antirheumatic drugs as possible target for improving medication adherence. Plos One. 2019;14(8):e0221290.Disclosure of InterestsNone declared

BackgroundPatients with chronic rheumatic diseases play an important role in their disease management. Adherence to their long-term therapies may depend on their therapeutic beliefs [1].ObjectivesThe purpose of our study was to investigate the relationship between beliefs and adherence among patients with rheumatoid arthritis (RA) on biologic therapies (bDMARDs).MethodsWe conducted a multi-centric cross-sectional study, including patients with RA fulfilling the ACR/EULAR 2010 criteria. All patients were on bDMARD. Sociodemographic, clinical, biologic, and therapeutic data were collected. Patients were interviewed about their medication beliefs using the Beliefs about Medicines Questionnaire (BMQ) and about their therapeutic adherence.ResultsThere were 75 RA patients: 60 female (80%) and 15 males (20%). The sex ratio was about 0.25. Their mean age was 56.92±9.06 years [34-80]. Thirty-three percent of patients were illiterate. Twenty patients were employed (15%). The mean disease activity scale (DAS28 CRP) was 3.94±1.32 [1.21-7.15]. Fifteen patients (20%) had high disease activity, 11% had low activity, and 19% were in remission. The mean duration of the current bDMARD was 37.17±39.44 months [4-248]. The mean Specific Necessity score was 21.02±5.38 [5-25] for adherent patients and 13.5±7.54 [5-19] for non-adherent patients.The mean Specific Concerns score was 10.07±3.13 [5-15] for adherent patients and 15±2.82 [5-20] for non-adherent patients.A statistically significant association was found between Specific Concerns beliefs and adherence behavior (p=0.009) and between Specific Concerns beliefs and adherence behavior (p=0.003). No statistically significant association was noted between general beliefs (General Harm and General Overuse) and adherence behavior (p=0.4 and p=0.6 respectively).ConclusionBeliefs about therapeutic were identified as a key factor of adherence among rheumatic disease patients. Practitioners should detect negative patient beliefs and perceptions earlier to prevent nonadherence.References[1]Suh YS, Cheon YH, Kim HO, Kim RB, Park KS, Kim SH, Lee SG, Park EK, Hur J, Lee SI. Medication nonadherence in Korean patients with rheumatoid arthritis: the importance of belief about medication and illness perception. Korean J Intern Med. 2018 Jan;33(1):203-210.Disclosure of InterestsNone declared

BackgroundMuslim prayer, also known as salat, includes a series of postures and movements, concomitant with a spiritual meditation and Quran recitations, performed at least 5 times a day by Muslim worshipers [1]. Each prayer includes a specific number of rakaa which consists of a single iteration of movements [2].ObjectivesWe aim to assess the effects of the Muslim prayer movements on the lower limb entheses, using ultrasonography (US).MethodsWe performed a cross-sectional study including asymptomatic healthy individuals. Each subject was asked if they performed prayer (G1) or not (G0). People who performed prayer were asked about the age and year when they started praying, number of rakaa performed daily and duration of each rakaa. US of lower limb entheses was performed. We explored the entheses of quadricipital tendon (QT), proximal patellar tendon (PPT), distal patellar tendon (DPT), calcaneal tendon (CT), and plantar aponeurosis (PA) looking for thickening, hypoechogenicity, loss of fibrillar pattern, presence of doppler signal and structure damage lesions (calcifications, cortical irregularity, erosions and enthesophytes). The highest value of enthesis thickness of both sides was considered.Ultrasonographic enthesitis assessment tools were used: the Spanish Enthesitis Index (SEI) [3] and the Glasgow Ultrasound Enthesitis Scoring System (GUESS) [4]. Data analysis was performed using the IBM SPSS software version 26.ResultsA total number of 370 entheses was evaluated. There were 29 males (78%) and 8 females. The mean age was 44.73±12.7 years. Twenty-five subjects (68%) practice prayer. The mean prayer starting age of 28.58±13.345 years. The mean number of years since prayer was started of 20±16.32 years. The mean daily number of rakaa was 19.16±4.16. The mean total daily prayer duration was 35.28±65.58 minutes.The mean enthesis thickness was 5.98±0.72 mm (QT), 3.69±0.48 (PPT), 4.1±0.64 (DPT), 4.83±0.62 (CT) and 4.89±0.75 (PA). Structural damage lesions were found in 43.2% of subjects (QT), 8.1% (PPT), 13.5% (DPT), 64.9% (CT) and 21.6% (PA).Structure damage lesions of CT enthesis were significantly more frequently found in people who performed prayer (G0: 41.6%, G1: 76%, χ2=4.194, p=0.041). Furthermore, they are significantly more likely to have thickened PA enthesis (G0: 50%, G1: 84%, χ2=4.752, p=0.029).The mean SEI was 17.83 in G0 and 19.56 in G1, p=0.647. The mean GUESS was 18.29 in G0 and 19.34 in G1, p=0.781. A positive correlation was found between total daily duration of prayer and PPT enthesis thickness (r=0.575, pConclusionOur study showed that lower limb enthesis US abnormalities are frequent in asymptomatic and healthy subjects who perform Muslim prayer. This finding suggests that lower limb enthesis US should be carefully interpreted in these subjects.References[1]AlAbdulwahab SS, Kachanathu SJ, Oluseye K. Physical Activity Associated with Prayer Regimes Improves Standing Dynamic Balance of Healthy People. J Phys Ther Sci. 2013 Dec;25(12):1565–8.[2]Kamran G. Physical benefits of (Salah) prayer - Strengthen the faith & fitness. Journal of Novel Physiotherapy and Rehabilitation. 2018 May 29;2(2):043–53.[3]Alcalde M, Acebes JC, Cruz M, González-Hombrado L, Herrero-Beaumont G, Sánchez-Pernaute O. A Sonographic Enthesitic Index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis. 2007 Aug;66(8):1015–9.[4]Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002 Oct;61(10):905–10.Disclosure of InterestsNone declared

Introduction Le vieillissement dans la population Tunisienne est un phenomene preoccupant et devenu de plus en plus accelere [1] . Cette periode de vie est riche en facteurs depressogenes. Nous rapportons dans ce travail, la frequence de la depression chez les sujets âges hospitalises en service de rhumatologie en periode du coronavirus COVID-19. Patients et methodes C’est une etude transversale, descriptive faite en deux semaines au cours de la periode COVID-19. L’etude a ete portee sur 50 patients, âges de plus de 60 ans, hospitalises dans le service de rhumatologie de l’hopital militaire de Tunis. Le score utilise dans ce travail est Hospital Anxiety and Depression Scale (HADS, Zigmond et Snaith, 1983). C’est un autoquestionnaire facile et rapide, utilise dans la litterature internationale. Il evalue l’etat anxieux et depressif des patients suivis pour une pathologie somatique. Ce score est fait de 14 items cotes de 0 a 3. Sept questions evaluant l’anxiete et sept autres evaluant la depression, d’ou l’obtention de deux scores avec une note maximale de 21 pour chacun. Si le score est inferieur a 7 : pas de symptomatologie, entre 8 et 10 la symptomatologie est douteuse et superieur a 11 la symptomatologie est certaine. Resultats Cette etude est faite de 50 patients, 36 sont de sexe feminin et 14 de sexe masculin. L’âge moyen etait de 72 ans avec des extremes de 60 et 90 ans. Trente-neuf patients sont maries, 6 sont veufs, 4 sont divorces et 1 patient est celibataire. Le motif d’hospitalisation etait une atteinte articulaire peripherique handicapante dans 58 %, une osteoporose dans 22 % des cas, une lombalgie dans 12 % des cas et une spondylarthrite dans 8 % des cas. La duree d’hospitalisation etait entre 1 et 15 jours chez 60 % des patients, entre 16 et 30 jours chez 36 % des patients et au-dela de 30 jours chez 4 % des malades. Les antecedents etaient comme suit : hypertension arterielle chez 60 % des cas, un diabete chez 46 % des cas et des antecedents psychiatrique chez 10 % des patients. Le score HADS a montre que 44 % des patients ont une symptomatologie depressive certaine, dans 10 % la symptomatologie etait douteuse et 46 % etait indemne de symptomatologie depressive. Cette depression etait plus frequente chez les sujets ayant une tranche d’âge entre 70 et 79 ans. Discussion La depression est aujourd’hui un des problemes de sante public le plus frequent chez les sujets âges, souvent meconnu, et insuffisamment traite devant la symptomatologie atypique. Dans notre serie, la prevalence d’une depression certaine est de 44 % ce qui rejoint les donnees de la litterature avec une prevalence comprise entre 2 et 61 % [2] . La pandemie du COVID-19 constitue une realite particuliere et inhabituelle. Celle-ci peut affecter les personnes sur le plan physique, mais egalement sur le plan psychologique. En effet, dans un tel contexte, de nombreuses personnes vivront des reactions de stress, d’anxiete et de deprime. L’association de plusieurs facteurs comme le vieillissement, une periode de stresse par un virus inconnu, le COVID-19, et un sejour dans un milieu hospitalier, les pathologies sous-jacentes contribue facilement a une depression. Conclusion La psychogeriatrie est de plus en plus developpee au cours de la derniere decennie. La prise en charge des troubles mentaux a beneficie du developpement d’equipes geriatriques multidisciplinaires capables d’avoir une approche globale de la personne âgee afin d’eviter les complications.

Introduction La pandemie COVID-19 est une realite particuliere et inhabituelle. Elle affecte les personnes aussi bien sur le plan physique mais aussi psychologique. Un etat de stresse, d’anxiete et de depression s’instaure. Nous rapportons dans ce travail, la frequence de l’anxiete et sa correlation avec le motif d’hospitalisation chez les sujets âges admis en service de rhumatologie en periode du coronavirus COVID-19. Patients et methodes C’est une etude transversale, descriptive faite en deux semaines au cours de la periode du confinement general pour cause de COVID-19 en fevrier 2020. L’etude a ete portee sur 50 patients, âges de plus de 60 ans, hospitalises dans le service de rhumatologie de l’hopital militaire de Tunis. Le score utilise dans ce travail est Hospital Anxiety and Depression Scale (HADS, Zigmond et Snaith, 1983). C’est un autoquestionnaire facile et rapide, utilise dans la litterature internationale. Il evalue l’etat anxieux et depressif des patients suivis pour une pathologie somatique. Ce score est fait de 14 items cotes de 0 a 3. Sept questions evaluant l’anxiete et sept autres evaluant la depression. D’ou l’obtention de deux scores avec une note maximale de 21 pour chacun. Si le score est inferieur a 7 : pas de symptomatologie, entre 8 et 10 la symptomatologie est douteuse et superieur a 11 la symptomatologie est certaine. Resultats Cette etude est faite de 50 patients, 36 sont de sexe feminin et 14 de sexe masculin. L’âge moyen etait de 72 ans avec des extremes de 60 et 90 ans. Trente-neuf patients sont maries, 6 sont veufs, 4 sont divorces et 1 patient est celibataire. Le motif d’hospitalisation etait une atteinte articulaire peripherique handicapante dans 58 %, une osteoporose dans 22 % des cas, une lombalgie dans 12 % des cas et une spondylarthrite dans 8 % des cas. La duree d’hospitalisation etait entre 1 et 15 jours chez 60 % des patients, entre 16 et 30 jours chez 36 % des patients et au-dela de 30 jours chez 4 % des malades. Les antecedents etaient comme suit : hypertension arterielle chez 60 % des cas, un diabete chez 46 % des cas et des antecedents psychiatrique chez 10 % des patients. Le score HADS a montre que 36 % des patients ont presente une symptomatologie anxieuse certaine, 18 % ont presente une symptomatologie douteuse et 44 % des patients n’ont presente aucune symptomatologie. Pour la relation entre le motif d’hospitalisation et l’anxiete, on a constate que la moyenne de score d’anxiete des personnes enquete presentant une lombalgie est egale a 13,1 et pour les atteintes rhumatologiques handicapantes peripheriques egale a 14,63. Ces deux motifs ont le score d’anxiete les plus eleve. Discussion L’anxiete est souvent accompagnee de depression chez les sujets âges [1] , [2] . Les resultats des etudes scientifiques ont montres qu’entre 5,6 % et 14,5 % des personnes âgees souffrent de troubles anxieux [3] , [4] , [5] . Notre etude a montre que 36 % des patients ont presente une symptomatologie anxieuse certaine. Ces resultats vont dans le sens de la litterature. Selon l’enquete PAQUID, enquete de reference dans le champ de la gerontopsychiatrie, la prevalence de l’anxiete atteint 15,9 % chez les personnes dont la tranche d’âge est entre 65–74 ans, alors que chez les personnes qui sont plus que 75 ans elle atteint 12,7 % d’ou un taux globale d’anxiete chez les personnes plus que 65 ans egale a 28,6 %. Conclusion Il est classiquement admis que la vieillesse s’accompagne d’un repli sur soi generant un etat anxieux. Seule la connaissance des mecanismes physiopathologiques des maladies mentales du sujet âge permettra de developper des traitements curatifs et surtout preventifs.

Background: Over the years, drug monitoring-such as Anti-Drug Antibodies (ADA) dosage- has witnessed major transformations. In fact, ADA are more and more used in rheumatology and gastro-enterology in monitoring chronic inflammatory disease therapeutic response. The main purpose of those researches is to produce less immunogenic drugs and, in consequences, to improve tolerance and efficiency since immunogenicity of those drugs still is the main constraint to their long-term use. The aim of this review was to highlight anti-drug-antibodies potential effects on the pharmacokinetics and bioavailability of biotherapies as well as their clinical implications. Methods: For this purpose, we collected and summarized published data on PubMed using keywords “Biologics, Rheumatoid Arthritis, Spondyloarthritis, Crohn disease, Anti-drug antibodies, residual rate, immunogenicity, efficacy, tolerance”. The time-period selected for this study was 2000-2019. Results: Anti-Drug-antibodies decrease the pharmaco-availability of drugs and, in consequences, its efficiency and high risk of refractory diseases and side effects. Conclusion: Recent literature is consistent with the fact that drug monitoring using ADA dosage coupled with residual drug concentration offers reliable options to comfort practitioner’ therapeutic management decisions. This is particularly interesting in failure of treatment or in side effects onset situations.

Introduction La polyarthrite rhumatoide (PR) est un rhumatisme inflammatoire chronique touchant avec predilection la femme [1] . Le but de notre travail etait d’etudier les particularites cliniques de la forme masculine. Patients et methodes Une etude transversale monocentrique a ete menee au service de rhumatologie. Cent quinze patients atteints de polyarthrite rhumatoide repondant aux criteres ACR 1987 ou ACR EULAR 2010 suivis de 2010 a 2020 ont ete inclus. Les donnees cliniques, biologiques, radiologiques, l’activite de la maladie (DAS28) et les modalites therapeutiques ont ete collectees et comparees entre la population masculine et feminine. Resultats Notre population d’etude comportait 26 hommes (23 %) et 89 femmes (77 %). L’âge moyen etait de 56,4 ± 12,6 ans. La PR etait immunopositive chez 76,5 % des patients et erosive chez 65,2 %. Elle etait active dans 78 % des cas avec un DAS28 VS moyen a 3,5 ± 1,4 et un DAS28 CRP moyen a 3,17 ± 1,3. Les manifestations extra-articulaires etaient presentes dans 67 % des cas. Les DMARDs en cours etaient : methotrexate (80 %, n = 92), sulfasalazine (5 %, n = 6), leflunomide (4 %, n = 5) et un traitement biologique (38 %, n = 44). Une corticotherapie etait associee dans 38 % des cas avec une dose moyenne de 9,02 ± 3,9 mg. L’âge moyen au diagnostic etait de 49 ± 12,4 ans chez les hommes et de 43,7 ± 13,2 ans chez les femmes (p = 0,07). Une difference significative etait notee concernant le mode de debut qui etait oligoarticulaire chez 26,9 % des hommes versus 13,4 % des femmes et polyarticulaire chez 69 % des hommes versus 85 % des femmes (p = 0,04). Concernant la presence d’auto-anticorps (Facteur rhumatoide et Anti-CCP), leurs taux ainsi que le caractere erosif, il n’y avait pas de difference statistiquement significative entre les deux populations masculine et feminine. La prevalence des manifestations extra-articulaires etait aussi similaire chez les deux groupes (65 % chez les hommes et 67,4 % chez les femmes ; p = 0,5). Pour le syndrome inflammatoire biologique, il n’y avait pas de difference significative concernant la VS. En revanche, la CRP etait significativement plus elevee chez les hommes (48,8 versus 27,6 ; p = 0,04). Paradoxalement, la maladie etait moins active chez les hommes (DAS28 VS moyen : 2,73 versus 3,72 ; p = 0,025 et DAS28 CRP moyen : 2,59 versus 3,33 ; p = 0,039). Sur le plan therapeutique, la dose moyenne de la corticotherapie etait de 7,5 mg chez les hommes et 9,35 mg chez les femmes (p = 0,07). Le recours aux biotherapies etaient similaire chez les deux populations (34,6 % chez les hommes, 39,3 % chez les femmes ; p = 0,49). Conclusion Bien que le la CRP soit significativement plus elevee chez l’homme, l’activite de la maladie evaluee par le DAS28 etait plus importante chez la femme. Ce resultat peut etre explique par le nombre d’articulations touchees qui semble etre plus important chez la femme. Le debut plutot oligoarticulaire chez l’homme et polyarticulaire chez la femme soutient cette explication.

Introduction Les adipocytes interviennent dans la production des cytokines pro-inflammatoires. L’effet de l’obesite sur les cytokines de l’inflammation au cours de la spondyloarthrite (SPA) est peu etudie. L’objectif de notre travail etait d’etudier l’effet de l’obesite sur les interleukines pro-inflammatoires SPA. Patients et methodes Nous avons mene une etude transversale incluant les patients ayant une spondyloarthrite repondant aux criteres ASAS 2009 (Assessement SpondyloArthritis International Society 2009). Pour chaque patient nous avons recueilli les parametres suivants : âge, phenotype de la SPA, tour de taille (TT), indice de masse corporelle (IMC) et l’activite de la maladie en utilisant les scores Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) et l’Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP). Nous avons aussi dose les taux des parametres inflammatoires : la vitesse de sedimentation (VS) et la proteine C-reactive (CRP) ainsi que les interleukines de l’inflammation : interleukine 1 (IL-1), IL-6, IL-8, IL-17, IL-22 et IL-23. L’obesite est definie par un IMC superieur ou egale a 30 kg/m2. L’obesite androide est definie par un tour de taille >94 cm pour les hommes et > 80 cm pour les femmes. Resultats Il s’agissait de 33 hommes 5 cinq femmes. L’âge moyen etait de 45,43 ± 12,47 ans. L’âge moyen au debut de la maladie etait de 35,57 ± 11,64 ans. La duree d’evolution moyenne de la SPA etait de 9,54 ± 8,7 ans. Une spondyloarthrite axiale radiographique a ete note dans 80,6 % des cas (n = 58), une atteinte peripherique a ete associee dans 26,4 % des cas (n = 19) et isolee dans 19,4 % des cas (n = 14). Un psoriasis a ete note dans 36,1 % des cas (n = 26). Le BASDAI et l’ASDAS-CRP moyens etait a 3,76 ± 2,12 et 2,89 ± 1,24, respectivement. L’IMC moyen etait de 25,09 ± 4,9 kg/m2 le TT moyen etait de 87,5 ± 11,51 cm. Une obesite a ete objectivee dans 7 cas et une obesite androide dans 13 cas. La VS et la CRP moyennes etaient 41,03 ± 33,93 mm/h et 29,61 ± 40,34 mg/L, respectivement. Les concentrations seriques moyennes des interleukines 1 et 6 etaient a 11,64 ± 25,08 pg/dL et 25,27 ± 47,98 pg/dL. Le taux moyen de l’IL-8 etait a 15,2 ± 22,2 pg/dL. Les concentrations moyennes des interleukines 17 et 22 etaient a 11,36 ± 85,33 pg/dL et 39,56 ± 29,31 pg/dL, respectivement. Le taux moyen de l’IL-23 etait a 20,36 ± 16,7 pg/dl. Le taux serique de l’IL-8 etait significativement plus eleve chez les patients obeses (18,48 ± 11,6 vs 14,46 ± 24,04 pg/dL, p = 0,019). De meme, les patient ayant une obesite androide avaient un taux d’IL-22 significativement plus eleve (55,65 ± 38,2 vs 31,2 ± 19,54 pg/dL, p = 0,011). Neanmoins, aucune correlation n’a ete retrouvee entre le taux des interleukines et ces parametres suivants : le poids, la taille, l’IMC, le tour de taille et l’activite de la maladie. Conclusion Notre etude concordait avec celle de Kanimaru et al. Qui avaient montre que les taux d’IL-22 etaient associe a l’obesite au cours des spondyloarthrite [1] . Nous avons aussi mis en evidence l’association de l’obesite au taux serique d’IL-8. Nos resultats suggerent que l’obesite contribue dans l’inflammation via les adipocytes au cours de la SPA [2] .

Introduction La spondyloarthrite axiale radiographique (SA) est un rhumatisme inflammatoire chronique responsable d’ankylose et d’handicap fonctionnel. Aucun marqueur biologique n’a prouve son efficacite pour refleter l’atteinte structurale au cours de la SA. L’objectif de notre etude etait de determiner une correlation entre le ratio fibrinogene/albumine (RFA) et l’atteinte structurale au cours de la SA. Patients et methodes . Nous avons mene une etude transversale, incluant 51 patients atteints de SA. Un dosage de la CRP, la VS, l’albumine (ALB) et le fibrinogene (Fg) a ete effectue. Le RFA a ete ensuite calcule. L’atteinte structurale a ete evaluee par le score Bath Ankylosing Spondylitis Radiology Index (BASRI), calcule a partir des cliches suivants (rachis cervical et lombaire, bassin). Nous n’avons pas inclus les patients ayant une atteinte hematologique, un syndrome de malabsorption ou une maladie infectieuse evolutive. Le coefficient de correlation de Pearson a ete ensuite calcule. Resultats Il s’agissait de 43 hommes et de 8 femmes. L’âge moyen etait de 41,25 ± 10.97 ans. La duree moyenne d’evolution de la maladie etait de 9,82 ± 7.11 ans. Le taux moyen de fibrinogene etait de 3,94 + 1,24 g/L, celui de l’albumine etait de 36,94 + 5,89 g/L. Une hyper fibrinogenemie a ete notee dans 45 % des cas et une hypo albuminemie dans 51 % des patients. Le BASRI moyen etait de 8.25 ± 3.85. 25 patients avaient plus que 3 syndesmophytes au niveau du rachis cervical et lombaire correspondant a un BASRI≥ 3. Les patients ayant un BASRI ≥ 3 avaient un RFA moyen plus eleve (0,14 + 0,04 vs 0,10 + 0,04; p = 0.009). Le RFA est correle positivement au nombre de syndesmophytes (p = 0,02). Discussion Une etude anterieure a montre que le RFA est plus eleve dans les formes actives de la SA [1] . Une forte activite de la maladie entraine a long terme des dommages structuraux au niveau du rachis et une progression radiographique dans la SA [2] . Ceci pourra expliquer la capacite du RFA a refleter l’atteinte structurale de la SA. Conclusion Notre etude a montre que le RFA etait correle a l’atteinte structurale. Les patients ayant plus que 3 syndesmophytes avaient un RFA plus eleve. Nos resultats suggerent que ce ratio peut refleter les dommages structuraux au cours de la SA.

Introduction La polyarthrite rhumatoide (PR) est un facteur de risque cardiovasculaire aussi important que le diabete. L’inflammation chronique, le syndrome metabolique et la dyslipidemie jouent un role atherogene majeur. L’objectif de notre travail etait d’evaluer les perturbations lipidiques au cours de la PR et d’etudier. Patients et methodes Etude retrospective descriptive colligeant 82 patients atteints de PR. Tous les patients ont beneficie du dosage de la proteine C reactive (CRP), du cholesterol (CT) et du triglyceride (TG). Le dosage du HDL-cholesterol (HDL) et du LDL-cholesterol (LDL) etait realise chez 22 patients. L’indice atherogene (CT/HDL) a ete calcule (eleve si > 4,85). L’activite de la maladie a ete evaluee par le score DAS28(CRP). Resultats Il s’agit de 62 femmes et de 20 hommes (sex ratio = 0,32). L’âge moyen etait 54 ans [27–79 ans]. La duree moyenne de l’evolution de la maladie etait de 9 ans [0,1–37 ans]. Les facteurs de risque cardiovasculaires etaient : diabete dans 22 % des cas (n = 18), obesite dans 18 % des cas (n = 15), hypertension arterielle dans 15 % des cas (n = 12), tabagisme dans 11 % des cas (n = 9). Le taux moyen de la CRP etait 27 ± 33 mg/dl. Le score de DAS28(CRP) moyen etait de 4,72 ± 1,5. Le bilan lipidique avait conclu a une dyslipidemie dans 74,4 % des cas (n = 61). L’hypolipidemie etait le trouble le plus frequent (48,8 %). L’hyperlipidemie etait retrouvee dans 20 cas (25,6 %) : 14 cas d’hypercholesterolemie (17,1 %),17 cas d’hypertriglyceridemie (20,7 %). Parmi eux, 15 patients ne recevaient aucun traitement anti-lipidique. Onze cas avaient une diminution du HDL et 2 cas avaient une augmentation du LDL. Six patients parmi 22 avaient un indice atherogene eleve. Les patients ayant un DAS28(CRP) > 3,2 avaient un indice atherogene moyen plus eleve (4,25 vs 3,7 ; p = 0,5). Les patients sous une biotherapie (n = 38) avaient un indice atherogene moyen plus bas que ceux sous traitement non biologique (3,8 vs 4,31 ; p = 0,6).Il existe une correlation significative entre la CRP et le cholesterol (r = -0,25, p = 0,02) et la CRP et le HDL (r = -0,052, p = 0,01). De meme le LDL est correle avec la duree d’evolution de la maladie (r = 0,44 p = 0,04). En revanche il n’existe pas de correlation significative entre la dose de la corticotherapie et les differents parametres du bilan lipidique. Discussion L’hypocholesterolemie et la diminution du HDL sont frequentes au cours de la PR avec une augmentation de l’indice atherogene. Ceci peut etre explique par la diminution du transport du cholesterol et par le HDL qui devient pro-inflammatoire lors d’une maladie active [1] . Conclusion La perturbation des parametres lipidiques au cours de la PR est un veritable paradoxe lipidique avec une diminution du cholesterol total et du HDL. Une maladie ancienne et un score d’activite eleve sont les principaux facteurs.

Introduction Les plaquettes contribuent a la regulation de l’inflammation dans certaines maladies inflammatoires. Leur role au cours de la spondyloarthrite (SA) est peu etudie. Le but de notre travail etait de determiner le lien entre les plaquettes et des cytokines pro-inflammatoires au cours de la SA. Patients et methodes Nous avons mene une etude transversale incluant des patients suivis pour spondyloarthrite repondant aux criteres Assessment of SpondyloArthritis international Society (ASAS) 2009. Pour chaque patient nous avons collecte les donnees suivantes : âge, duree d’evolution, l’activite de la maladie en utilisant les scores ASDAS-CRP pour l’atteinte axiale et le DAS44-CRP pour l’atteinte peripherique. Nous avons realise une numeration de la formule sanguine (NFS) et nous avons mesure les concentrations de l’interleukine (IL)-6 et du TNFα par Chimiluminescence et celle de l’IL-17 par la methode enzyme-linked immunosorbent assay (ELISA). Resultats Soixante-douze patients ont ete inclus (57 hommes et 15 femmes). L’âge moyen etait de 44,84 ± 13,42 ans. L’âge moyen de debut de la maladie etait de 35,97 ± 12,88 ans. La duree moyenne d’evolution de la maladie etait de 102,56 ± 92,45 mois. Une atteinte axiale a ete notee dans 85 % des cas (n = 61). Une atteinte peripherique etait associee dans 50 % des cas (n = 36) : articulaire dans 42 % des cas (n = 30) et enthesitique dans 15 % des cas (n = 11). L’ASDAS et le DAS44-CRP moyens etaient de 2,92 ± 1,55 et de 3,51 ± 1,34, respectivement. Le taux moyen des plaquettes etait de 235 000 ± 809 000/mm3. Les concentrations moyennes de l’IL-6 et du TNFα etaient de 15,13 ± 47,14 et de 20,48 ± 38,25 pg/mL, respectivement. La concentration moyenne de l’IL-17 etait de 102,23 ± 103,14 pg/mL. Le taux des plaquettes etait correle aux concentrations des cytokines suivantes : IL-6 (r = 0,398 ; p = 0,001) et TNFα (r = 0,274 ; p = 0,03). De plus, nous avons trouve une correlation du taux des plaquettes avec l’ASDAS-CRP (r = 0,326 ; p = 0,014) et le DAS44-CRP (r = 0,403 ; p = 0,037). Conclusion Nos resultats sont en accord avec ceux de la litterature qui avaient montre une correlation entre l’IL6 et le taux des plaquettes [1] . Ce dernier correlait aussi le TNFα (r = 0,274 ; p = 0,03). Nous avons aussi trouve une correlation entre le taux des plaquettes et l’activite de la maladie. Ces resultats suggerent que les plaquettes interviennent dans la liberation des cytokines pro-inflammatoires et dans la regulation de l’activite des cellules immunitaires [2] .

Introduction Le tabagisme contribue dans la physiopathologie des spondyloarthrites (SPA) et dans le maintien d’une forte activite de la maladie en aggravant l’inflammation. L’effet du tabagisme sur les cytokines pro-inflammatoires et anti-inflammatoires n’est pas bien etudiee. Patients et methodes Il s’agit d’une etude transversale sur une periode de deux ans [2019-2020] incluant 72 patients suivis pour SPA. Pour chaque patient nous avons evaluer l’activite de la maladie en utilisant le BASDAI et l’ASDAS-CRP et le retentissement structural par le BASRI. Nous avons aussi dose la VS, CRP et le taux serique des cytokines pro-inflammatoire : interleukine (IL)-1, IL-6, IL-17, IL-22 et IL23 et une cytokine anti-inflammatoire : IL-10. Resultats Le sex-ratio homme sur femme etait de 57/15. Le tabagisme a ete note dans 47 % des cas (n = 34) avec une moyenne de 19,83 paquets/annee. La CRP etait plus elevee chez les tabagiques (p = 0,046). De meme, le tabagisme etait associe a un BASRI significativement plus eleve (p = 0,001). Les concentrations des interleukines suivantes etaient significativement plus eleves chez les patients tabagiques : IL-1 (p = 0,006) et l’IL-10 (p = 0,015). Conclusion Notre etude suggere que le tabagisme contribue dans l’inflammation au cours de la SPA. De surcroit, les concentrations de l’IL-10 etaient plus elevees chez les tabagiques. En effet, la liberation des cytokines proinflammatoires au cours de la SPA est responsable d’une elevation des concentration de l’IL-10 en reponse a cette inflammation. Notre etude souligne egalement l’effet du tabagisme sur l’atteinte structurale au cours de la SPA.

Objectif Determiner les modifications des habitudes alimentaires adoptees par les patients suivis pour rhumatisme inflammatoire chronique. Patients et methodes Etude transversale incluant des patients suivis pour polyarthrite rhumatoide (PR) et spondyloarthirte (SpA). Tous les sujets inclus ont repondu a un auto-questionnaire evaluant leur comportement alimentaire apres le diagnostic du rhumatisme. Resultats Il s’agissait de 57 patients : 47 % PR et 53 % SpA. La moyenne d’âge etait 49,40 + 12,43 ans. La duree moyenne d’evolution etait 9,18 + 12,43 ans. La valeur moyenne de l’IMC etait 26,43 + 5,18 Kg/m2. Quinze patients (26 %) avaient un surpoids (IMC : 25-30) et quinze etaient obeses (IMC > 30). Dix-sept patients (30 %) ont change leurs habitudes alimentaires apres le diagnostic du rhumatisme. Ce changement n’a pas retenti sur l’activite de la maladie (maladie active vs remission, p = 0,37). L’augmentation de la consommation de fruits et legumes, l’eviction des aliments sucres et la reduction de l’apport en sel etaient rapportees par 74 %, 49 % et 60 % des patients respectivement. La reduction de l’apport en sel etait plus frequent dans le groupe PR (p = 0,003). Vingt-deux patients ont avoue avoir utilise des remedes naturels. La majorite des patients interroges (84 %) jeunaient le ramadan et n’ont pas note aucune poussee inflammatoire de leur rhumatisme au cours du jeune. L’utilisation des complements alimentaires etait plus marquee dans le groupe PR (p Conclusion Notre etude a montre que le changement des habitudes alimentaires est variable et interesse plus fruits, legumes, sel et sucre.