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Objective: To evaluate the effects of the COVID-19 pandemic on the pain experienced by patients with CIRD and to analyze the associated factors. Methods: A cross-sectional study was conducted amongst patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Patients were asked to assess the level of pain they had experienced before and during the pandemic, 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 multivariate analysis to search for any related factors to pain perception during the COVID-19 pandemic. 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 tests (Mann–Whitney U) when the measures were not normally distributed (the Kolmogorov–Smirnov test was used to test normality). Results: Amongst the 350 patients who answered the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3%, and undifferentiated CIRD 3.4%. CIRD-related pain was reported by 79.1% of the 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 pandemic; p In the multivariate analysis, the factors causing the pain were: the negative impact of the coronavirus on accessing rheumatology care, the discontinuation of treatment, the disturbed sleep, and the negative psychological impact. Conclusion: This survey showed that the COVID-19 pandemic had increased CIRD-related pain in patients. Factors influencing this pain should be considered to help patients cope with their chronic rheumatism in this global health crisis.

ObjectivesTo characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.MethodsCross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.ResultsA total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).ConclusionThese results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

Objectives: To evaluate oral hygiene status in Rheumatoid arthritis (RA) patients, to analyse possible related factors, and to investigate the role of the rheumatologist in information about importance of adequate oral hygiene status in RA patients. Methods: A cross-sectional study that included 100 consecutive RA patients (89% female, mean age 46.7 ± 11.7 years). For each patient, we recorded oral symptoms, oral hygiene status and role of rheumatologist in information on the oral hygiene status. Factors associated with regular brushing (≥2/day) were also analysed. Results: Median disease duration was 8 years (4;2). Dental pain was reported by 74% of patients and bleeding by 51% of them. Regular brushing was noted in 45% of patients. The use of a correct brushing method was noted in 14% of cases. Two patients reported visiting a dentist regularly. Information explaining that poor oral hygiene has a negative impact on RA was delivered by rheumatologist to 11 patients. Regular brushing of teeth was recommended by rheumatologist to 8 patients and 10 patients were advised by their rheumatologist to consult a dentist. Regular brushing was more important in women (48,3% vs 18,2%; p=0.05) and in the literate patients (57,6 vs 31,2%, p

To assess the modalities and current practices in gout management reported by Moroccan rheumatologists. We performed a cross-sectional online survey using a questionnaire e-mailed to 360 rheumatologists included 30 multiple-choice questions. 105 rheumatologists responded to the survey with 29% of response rate. The number of gout patients seen per month was five (3–9); they were referred in 58.7% by a general practitioner. The clinical presentation of gout patients was dominated by gout crisis in 71%, and the association gout crisis and gouty arthropathy accounted for 19% of severe forms. 40% of rheumatologists apply the 2015ACR/EULAR classification criteria. Obesity accounted for 85.7% of the associated comorbidities. The most commonly prescribed Urate-lowering therapy (ULT) was allopurinol in 81.3% (± 12). 48% of rheumatologists reported starting allopurinol at 200 mg daily and associated it with colchicine during the first 6 months by 33.3%. The determination of uric acid levels was monitoring in 76.2% every 3 months. Administration of ULT to asymptomatic hyperuricemia was found in 69.5% when patients had renal complications, while only 14.3% recommended dietary and lifestyle measures. The median duration for therapeutic education was 15 min (10, 20). In 96.2%, the education of the patient was done orally. 93.3% of rheumatologists inform their patients on how to manage a gout attack, and 96.2% on the measures of hygiene and diet has adopted. Our survey gives an insight into the elements that should be improved in the management of gout by the Moroccan rheumatologists. It highlights the need to standardize the management of gout, hence the importance of developing Moroccan recommendations on gout.

Purpose: The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. Methods: World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwide; thus, global representation was essential. A series of meetings established the initiative’s mission and goals. Electronic surveys collected contributorship and demographic information, and experiences with spinal conditions to better understand perceptions and potential biases that were contributing to the model of care. Results: Sixty-eight clinicians and scientists participated in the deliberations and are authors of one or more of the GSCI articles. Of these experts, 57 reported providing spine care in 34 countries, (i.e., low-, middle-, and high-income countries, as well as underserved communities in high-income countries.) The majority reported personally experiencing or having a close family member with one or more spinal concerns including: spine-related trauma or injury, spinal problems that required emergency or surgical intervention, spinal pain referred from non-spine sources, spinal deformity, spinal pathology or disease, neurological problems, and/or mild, moderate, or severe back or neck pain. There were no substantial reported conflicts of interest. Conclusion: The GSCI participants have broad professional experience and wide international distribution with no discipline dominating the deliberations. The GSCI believes this set of papers has the potential to inform and improve spine care globally. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

Introduction Les patients avec un diagnostic clinique de spondyloarthrite (SpA) (en incluant le rhumatisme psoriasique – Rhpso) peuvent avoir des symptomes principalement peripheriques ou principalement axiaux. Cependant, des chevauchements entre ces symptomes sont frequents et ils n’existent pas de sous-groupes clairement definis. L’objectif de cette etude a ete d’identifier des groupes des manifestations musculosquelettiques peripheriques selon leur localisation anatomique dans le spectre des SpA (en incluant le Rhpso). Patients et methodes Etude transversale et internationale avec 24 pays participants. Des patients consecutifs avec un diagnostic de SpA axiale (axSpA), SpA peripherique (pSpA), rhumatisme psoriasique (Rhpso), SpA associe a maladie inflammatoire de l’intestin (SpA-MICI), arthrite reactive (ReA) et SpA juvenile ont ete eligibles. Une analyse de cluster pour chaque manifestation peripherique musculosquelettique (affection articulaire peripherique, enthesite et dactylite) a ete realisee en utilisant des donnees sur la localisation anatomique de ces symptomes observes a n’importe quel moment de la maladie. La distribution de ces manifestations peripheriques et les caracteristiques cliniques ont ete comparees entre les differents clusters. Resultats Un total de 4465 patients ont ete inclus. Trois clusters ont ete trouves selon la localisation de l’affection articulaire, nommes « arthrite rare (a) », « principalement membres inferieurs (b) » et « principalement mains (c) ». Les patients du groupe « a » avaient, en comparaison avec les groupes « b » et « c », une prevalence plus importante d’hommes (63,9 % vs 51,3 % vs 41,5 %), de HLA-B27 (79,8 % vs 48,2 % vs 34,8 %) et de diagnostic de axSpA (67,2 % vs 20,9 % vs 23,7 %), mais une prevalence plus basse de psoriasis (23,2 % vs 67,8 % vs 59,6 %) et de diagnostic de Rhpso (17,2 % vs 61,7 % vs 58,5 %). Entre les clusters « b » et « c », l’uveite etait plus frequente chez le premier (15,7 % vs 8,7 %), tandis que la maladie inflammatoire de l’intestin etait plus frequente chez le deuxieme (3,5 % vs 6,7 %). Concernant la localisation de l’enthesite, nous avons trouve aussi 3 clusters, nommes « enthesite du talon (d) », « enthesite axiale (e) » et « polyenthesite (f) ». Les patients du cluster « f » avaient une frequence plus eleve de fibromyalgie concomitante (41,3 % vs 17,4 % vs 31,3 %), de psoriasis (48,3 % vs 28,4 % vs 23,4 %) et de Rhpso (40,8 % vs 22,7 % vs 21,5 %) en comparaison avec les groupes « d » et « e », mais une prevalence moindre d’hommes (40 % vs 61,9 % vs 56,2 %) et de diagnostic d’axSpA (37,5 % vs 61,4 % vs 64,1 %). Finalement, nous avons trouve 3 clusters selon la localisation des dactylites : « absence de dactylite (g) », « principalement orteils (h) » et « principalement doigts (i) ». Le groupe « g » a montre, en comparaison avec les groupes « h » et « i », la plus grande prevalence d’hommes (61,4 % vs 51,4 % vs 52,9 %), de HLA-B27 (66,6 % vs 52,5 % vs 50,0 %) et de diagnostic d’axSpA (62,6 % vs 20 % vs 11,8 %), mais la plus basse frequence de psoriasis (26,9 % vs 68,6 % vs 79,4 %) et de diagnostic de Rhpso (21,5 % vs 65,7 % vs 52,9 %). Conclusion Cette etude suggere la presence de groupes heterogenes d’affection peripherique chez des patients atteints de SpA (et Rhpso) sans groupes clairement definis, ce qui confirme un clair chevauchement entre les differents sous-types de SpA.

Objective To compare perceptions of patients with rheumatoid arthritis (RA) to those of their families regarding pain and subjective experience of the disease. Methods It was a monocentric study, including 120 RA patients (according to the American College of Rheumatology criteria). The questionnaires were developed during meetings of RA patients, rheumatologists, and methodologists while referring to the literature. The patient questionnaire comprised 22 items organized in 4 sections: pain, perceived experience of the disease, activity restrictions, and help received. Concordance among patients, family, and friends replies was evaluated using the kappa coefficient. Results The mean age was 42 ± 12 years with female predominance 110 (91.7%). The family member was usually the spouse (46.3%). Joint pain was described by patients as spontaneous (98.3%), unpredictable (95.9%), and variable (95.1%). RA had negatively affected work-related activities (100%), recreational activities (98.4%), family life (87.6%), relationships with friends (77.7%), sexual activities (50.4%), plans for having children (47.1%), and intimate relationships (46.3%). Concordance between patients and family perceptions was mediocre for pain severity (kappa: 0.3) and main joint-pain characteristics, excellent for majority items of experience of the disease (kappa > 0.80). Family tended to underestimate pain severity and to overestimate negative effects of RA on patient's life. Conclusion We found a good agreement between patients' and family members' perceptions. It is essential that any family support be in accordance with patients' needs. Our qualitative analysis objectified, in addition to a major physical impact of the disease, a negative psychosocial effect.

Background Tuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare. Case presentation We report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution. Conclusions To avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.

La polyarthrite rhumatoïde (PR) est le chef de file des rhumatismes inflammatoires chroniques (RIC). Elle touche environ 1% de la population mondiale. C’est une affection invalidante qui conduit plus ou moins rapidement à la destruction cartilagineuse et osseuse et, à long terme, en l’absence de traitement, à l’incapacité fonctionnelle et/ou au handicap sévères. L’importance de son diagnostic et de son traitement précoces est majeure.Au Maroc, le retentissement socio-économique de la maladie est important. Les difficultés à l’accès au traitement des patients, les conséquences sur leur vie personnelle et familiale ont été mises en évidence. Parmi elles, les conséquences négatives sur la scolarisation des petites filles sont significatives. De ce fait, la prévention et l’information sont majeures dans la prise en charge des patients de même que le recours à un traitement à « un coût raisonnable ». Par ailleurs, la comparaison des données, grâce à l’inclusion dans des études internationales mettent en évidence la sévérité de la maladie, essentiellement en raison du retard au diagnostic, du retard à la prise en charge en rhumatologie, du bas niveau socio-économique. La mise en place d’une cohorte de polyarthrites récentes suivies sur une période de deux ans, a mis en évidence l’importance d’un diagnostic et d’une prise en charge très précoces et l’amélioration significative du pronostic de la maladie qui en résulte. Elle a été suivie par la mise en place d’une cohorte de polyarthrites récentes dont l’objectif est un suivi de polyarthrites récentes évoluant depuis moins d’un an sur une période de dix ans et la constitution d’une base de données destinée à permettre des études sur le diagnostic, le pronostic, l’épidémiologie, l’impact socio-économique ainsi que le recours à un traitement économiquement accessible des polyarthrites récentes au Maroc.

La polyarthrite rhumatoide (PR) est le chef de file des rhumatismes inflammatoires chroniques (RIC). Elle touche environ 1% de la population mondiale. C’est une affection invalidante qui conduit plus ou moins rapidement a la destruction cartilagineuse et osseuse et, a long terme, en l’absence de traitement, a l’incapacite fonctionnelle et/ou au handicap severes. L’importance de son diagnostic et de son traitement precoces est majeure. Au Maroc, le retentissement socio-economique de la maladie est important. Les difficultes a l’acces au traitement des patients, les consequences sur leur vie personnelle et familiale ont ete mises en evidence. Parmi elles, les consequences negatives sur la scolarisation des petites filles sont significatives. De ce fait, la prevention et l’information sont majeures dans la prise en charge des patients de meme que le recours a un traitement a « un cout raisonnable ». Par ailleurs, la comparaison des donnees, grâce a l’inclusion dans des etudes internationales mettent en evidence la severite de la maladie, essentiellement en raison du retard au diagnostic, du retard a la prise en charge en rhumatologie, du bas niveau socio-economique. La mise en place d’une cohorte de polyarthrites recentes suivies sur une periode de deux ans, a mis en evidence l’importance d’un diagnostic et d’une prise en charge tres precoces et l’amelioration significative du pronostic de la maladie qui en resulte. Elle a ete suivie par la mise en place d’une cohorte de polyarthrites recentes dont l’objectif est un suivi de polyarthrites recentes evoluant depuis moins d’un an sur une periode de dix ans et la constitution d’une base de donnees destinee a permettre des etudes sur le diagnostic, le pronostic, l’epidemiologie, l’impact socio-economique ainsi que le recours a un traitement economiquement accessible des polyarthrites recentes au Maroc.

Syphilis is a chronic sexually transmitted infection due to the spirochetal bacterium Treponema pallidum (TP) subspecies Pallidum, the overall incidence of which is recently increasing among the sexually transmitted diseases. This increase concerns both congenital syphilis (early and late) and acquired syphilis. The natural history of the latter is stereotyped with a three-phase clinical evolution, primary, secondary, and tertiary, and can be also subdivided into early or “infectious syphilis” and late syphilis. This natural history includes not only the central nervous and the cardiovascular systems as well as gummatous infections but also many other sites, among them the musculoskeletal system. Syphilitic musculoskeletal manifestations (MSKM) remain rare. However they should be kept in mind because of the current recrudescence of the disease and because of their frequently misleading expression which contributed, among other syphilitic manifestations, to make the disease earn the name “great simulator.” Syphilitic MSKM are mainly related to the hematogenous dissemination of TP. The main lesions are bone involvement (osteochondritis, periosteitis and osteitis) and joint involvement, the pattern of which is in keeping with the clinical presentation of the disease. However, involvement of muscles, tendons, and their sheaths, as well as bursitis, although rare, has also been reported.

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:Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.Objectives:To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.Methods:Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.Results:4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).Figure 1.Distribution of the peripheral involvement across clustersThree clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.Conclusion:These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.Acknowledgements:This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.Disclosure of Interests:None declared

Introduction La distribution des manifestations peripheriques musculosquelettiques chez tous les sous-types de spondyloarthrite (SpA) et leurs caracteristiques ont ete peu etudiees. De plus, tres peu d’etudes ont evalue la distribution des manifestations peripheriques selon la region geographique. L’objectif de cette etude a ete de comparer la prevalence, les caracteristiques et les traitements des manifestations musculosquelettiques peripheriques chez les patients atteints de tous sous-types possibles de SpA ainsi que leur distribution selon la region geographique. Patients et methodes Etude transversale avec 24 pays participants. Des patients consecutifs avec un diagnostic de SpA axiale (axSpA), SpA peripherique (pSpA), rhumatisme psoriasique (Rhpso), SpA associe a maladie inflammatoire de l’intestin (SpA-MICI), arthrite reactive (ReA) et SpA juvenile etaient eligibles pour l’etude. La prevalence des manifestations peripheriques (affection articulaire peripherique, enthesite, dactylite, tarsite et affection des articulations racines) leur localisation et leur traitement ont ete evalues, ainsi que leur distribution dans les differentes regions du monde. Resultats Un total de 4465 patients (61 % hommes, âge moyenne 45 ans) ont ete inclus appartenant a quatre regions : Amerique Latine (n = 538), Europe et Amerique du Nord (n = 1677), Asie (n = 975), Moyen-Orient et Afrique du Nord (n = 1275). La prevalence des diagnostics etait axSpA (60,9 %), Rhpso (23,1 %), pSpA (9,7 %), SpA-MICI (2,5 %), ReA (1,3 %), et Juv-SpA (1,3 %). Parmi la totalite des patients, 78,3 % avaient eu au moins une manifestation peripherique ; 56,9 % au moins une affection articulaire peripherique, 44,3 % une enthesite, 33,7 % une affection des articulations racines, 15,3 % une dactylite et 7,7 % une tarsite. Les patients d’Amerique Latine avaient la prevalence la plus haute d’affection articulaire peripherique (79,9 %), d’enthesite (68,8 %), de dactylite (25,5 %) et de tarsite (23,6 %), tandis que la prevalence d’affection des articulations des racines des membres etait plus elevee chez les patients d’Asie (57,4 %). L’affection articulaire peripherique etait plus frequente chez les patients avec pSpA (94,7 %) et moins souvent chez les patients avec axSpA (36,0 %). Les patients atteints de Rhpso avaient plus souvent une atteinte polyarticulaire (58,9 %) tandis que les axSpA avaient une atteinte surtout mono-articulaire (20,1 %). L’atteinte des petites articulations des membres superieurs etait plus souvent observee chez les patients avec Rhpso (52,0 %) tandis que l’atteinte des grosses articulations des membres inferieurs etait plus souvent chez les MICI-SpA (55,9 %) et pSpA (51,2 %). Parmi les patients avec atteinte des articulations proximales, la hanche etait surtout observee dans les axSpA (86 %) tandis que l’epaule etait plus frequente au cours du Rhpso (60,9 %). Les patients atteints de axSpA avaient la prevalence la plus basse d’enthesite (40,9 %) et de dactylite (6,0 %) ; cependant, les dactylites etaient plus souvent localises aux pieds au cours de la axSpA et aux mains au cours des ReA et SpA-MICI. Conclusion Cette etude suggere que toutes ces manifestations musculosquelettiques peripheriques peuvent etre trouvees dans tous les sous-types de SpA (en incluant le Rhpso), avec seulement des differences quantitatives. Ces resultats confirment le chevauchement entre les differentes entites et suggerent que la probabilite de trouver ces manifestations depend de la maladie sous-jacente. En plus, ces resultats confirment la grande variabilite dans l’expression de la maladie entre pays.

ObjectivesRheumatoid arthritis (RA) is well known to affect many different organ systems. Previous work suggests that this includes the auditory system.The objectives of this work are to evaluate the pattern of hearing impairment in patients with rheumatoid arthritis and also to examine the possible associations between hearing impairment and related RA features especially disease activity.Materials and methodsThirty RA patients (mean age of 44.5 ± 9.9 years; female sex (90%)) and 17 healthy controls (mean age of 41.5±9.1 years; female sex (76.4%)) were included in our study. The 2 groups were matched for age and sex (p>0.05). Otoscopic examination was normal in all participants.No subject of the 2 groups has had any abnormalities at otoscopic examination. Hearing impairment was evaluated by pure tone audiometry and tympanometry including the static compliance, middle ear pressure, stapedial reflex threshold test. In all patients the clinical features, laboratory data, X-rays, disease activity index-DAS 28 were performed.ResultsHearing loss was more prevalent in RA patients compared to healthy controls (56.7 vs 11.8%; p=0.005). RA patients have conductive, sensorineural and mixed hearing loss in respectively 43.4, 3.3 and 10 % of cases. Association analysis between hearing characteristics and remission in RA patients shows that RA patients in remission have significantly lower mean hearing thresholds (12.8±5.2dB vs 18.8±6.9 dB ; p=0.04).ConclusionThis study suggests that hearing loss risk is higher in RA patients and seems to be associated to disease duration. Hearing loss in RA was directly proportional to the disease activity index-DAS 28. Audiological evaluation must be performed periodically to identify possible audiological damage.

Background:Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management.Objectives:To evaluate the impact of thermoformable foot orthoses on walking in rheumatoid arthritis (RA) patients.Methods:This is a open clinical trial, that included 14 consecutive patients (85,7% female, mean age 54,8 ± 10 years) with RA (median duration of progression of 9 [5-12] years), the average DAS28 was 2,7+/-1,2 and the functional impact objectified by the Health Assessment Questionnaire (HAQ) was on average 0.9 ± 0.7.The foot problem was bilateral in 100% and inaugural in 85.7% of the cases.The 14 rheumatoid subjects were examined and appropriate foot orthoses were prescribed according to each patient’s needs. All the patients were evaluated at baseline and 8 weeks after use of orthoses. Gait pain, difficulty walking and the 10 Meter Walk test were noted at each appointment.We used dynamic baropodometric analysis to assess postural evaluation. We calculated the lateral-medial index of each foot before and after the use of orthoses.Table 1.Assessment of walking before and after the use of orthosesBefore orthosesAfter orthosespPain when walking*(EVA 0-10)5 [3-5,2]0 [0-2]0,002Difficulty walking* (0-10)- In house4 [3-5,2]2 [0-2]0,002- Outside6 [4,7-7]2 [1,5-2,5]0,0210 Meter Walk test**(Normal comfortable speed)- Nomber of steps18,64 ± 3,716,9 ± 50,2- Duration (sec)11,9 ± 4,611,8 ± 5,20,9- Walking speed (m/min)56,4 ±17,758,6 ± 20,30,6latero-medial (L/M) index**- L/M index of the right foot1,18 ± 0,171,23 ± 0,230,1- L/M index of the left foot1,25 ± 0,171,26 ± 0,190,9*median and quartile**average and standard deviationp significant if< 0,05Results:A significant decrease in walking pain (p = 0.002) and difficulty walking (p = 0.02) was found with the use of orthoses. The variations in 10 meter walk test and dynamic baropodometric parameters were not significant (p>0,05).There were no significant correlations between pain and difficulty walking, the progression of RA, the duration of foot damage and the functional impact measured by the HAQ.Conclusion:Thermoformable foot orthoses significantly reduced pain and difficulty walking. The absence of factors associated with pain and difficulty walking could possibly be related to the small sample size.Disclosure of Interests:None declared

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:Orthoses and footwear can play an important role in managing foot pathology in patients whose systemic disease is controlled. Foot orthoses are frequently prescribed in clinical practice as an intervention for people with rheumatoid arthritis (RA).Objectives:The aim of our study is to evaluate the impact of thermoformable orthoses on the functional index of the foot (FFI) in patients with rheumatoid arthritis.Methods:We conducted an open clinical trial, having consecutively included 14 patients (85.7% female, average age 54.8 ± 10 years) suffering from rheumatoid arthritis (median progression time of 9 years [5 - 12]). The average DAS28 was 2.7 ± 1.2 and the functional impact objectified by the Health Assessment Questionnaire (HAQ) was on average 0.9 ± 0.7.The median deadline from the start of RA and the onset of the foot problem was 3 years [0 – 7,75]. The foot problem was bilateral in 100% of the cases and inaugural in 85.7% of the cases.We evaluated the functional impact of foot injury for all our patients at baseline and 8 weeks after the use of thermoformable orthoses, based on the FFI (Foot function Index) measuring the impact of foot pathology on function in terms of pain, disability and activity limitation.The comparison of the FFI domains before and after the use of orthoses was carried out using parametric or nonparametric paired tests using The SPSS statistical software.Results:With the use of foot orthoses, FFI values decreased in all subscales (p=0,024) (pain, disability and activity limitation). This reduction was significant for disability (0,011) but not for pain and activity limitation.There were no significant correlations between the global FFI and the progression of RA, the duration of foot damage and the functional impact measured by the HAQ.Table 1. The comparison of the FFI domains before and after the use of orthoses.psignificatif if< 0,05; Test used: Non-parametric test for two linked samples.Conclusion:Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced disability as measured by the FFI. The absence of factors associated with pain and limitation of activity could possibly be related to the small sample size.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

Purpose: Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI), which was convened to develop an evidence-based, practical, and sustainable, spinal healthcare model for communities around the world with various levels of resources. Methods: Leading spine clinicians and scientists around the world were invited to participate. The interprofessional, international team consisted of 68 members from 24 countries, representing most disciplines that study or care for patients with spinal symptoms, including family physicians, spine surgeons, rheumatologists, chiropractors, physical therapists, epidemiologists, research methodologists, and other stakeholders. Results: Literature reviews on the burden of spinal disorders and six categories of evidence-based interventions for spinal disorders (assessment, public health, psychosocial, noninvasive, invasive, and the management of osteoporosis) were completed. In addition, participants developed a stratification system for surgical intervention, a classification system for spinal disorders, an evidence-based care pathway, and lists of resources and recommendations to implement the GSCI model of care. Conclusion: The GSCI proposes an evidence-based model that is consistent with recent calls for action to reduce the global burden of spinal disorders. The model requires testing to determine feasibility. If it proves to be implementable, this model holds great promise to reduce the tremendous global burden of spinal disorders. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Purpose: The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. Methods: Contents from the Global Spine Care Initiative (GSCI) Classification System and GSCI care pathway papers provided a foundation for the resources list. A seed document was developed that included resources for spine care that could be delivered in primary, secondary and tertiary settings, as well as resources needed for self-care and community-based settings for a wide variety of spine concerns (e.g., back and neck pain, deformity, spine injury, neurological conditions, pathology and spinal diseases). An iterative expert consensus process was used using electronic surveys. Results: Thirty-five experts completed the process. An iterative consensus process was used through an electronic survey. A consensus was reached after two rounds. The checklist of resources included the following categories: healthcare provider knowledge and skills, materials and equipment, human resources, facilities and infrastructure. The list identifies resources needed to implement a spine care program in any community, which are based upon spine care needs. Conclusion: To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Purpose: The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. Methods: Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. Results: Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. Conclusions: An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

The ability to interpret scores from patient-reported outcome measures at the individual patient level depends on the availability of valid, clinically meaningful benchmarks of response and state attainment. The goal was to develop multinational estimates for minimal clinically important improvement (MCII) and patient acceptable symptomatic state (PASS). A multinational sample of patients with osteoarthritis (OA) was evaluated before and 4 weeks after treatment with nonsteroidal antiinflammatory drugs. Patients completed either the Western Ontario and McMaster Osteoarthritis Index (WOMAC) numerical rating scale 3.1 (hip and knee OA) or the Australian/Canadian Index (AUSCAN) numerical rating scale 3.1 (hand OA) before and after treatment. Patients rated the clinical importance of their response to treatment and their satisfaction with the health state achieved, from which multinational MCII and PASS estimates were calculated for both the WOMAC and AUSCAN indices. A total of 609 patients from 7 countries participated in the study. MCII and PASS estimates varied slightly by instrument and subscale. Absolute (percentage) change for MCII ranged 6-9 (10% to 17%) for WOMAC and 4-9 (8% to 15%) for AUSCAN. PASS estimates ranged 39-48 for WOMAC and 38-45 for AUSCAN. Some between-country variation was observed in MCII and PASS. Preliminary multinational estimates for MCII and PASS have been developed for several countries. Further research is required to evaluate the robustness, temporal consistency, and age- and sex-dependency of the preliminary estimates as well as their generalizability to other countries, languages, cultures, regions, and other condition-specific outcome measures.

The aim of this study was to assess the impact of tocilizumab on bone oedema in rheumatoid arthritis (RA) as shown by magnetic resonance imaging (MRI). In this longitudinal study, patients with rheumatoid arthritis according to the American College of Rheumatology (ACR) 2009 criteria with inadequate response or intolerance to disease-modifying anti-rheumatic drugs (DMARDs), treated with tocilizumab, were included. Sociodemographic characteristics and clinical and laboratory data for the disease were collected at baseline (M0) and 06 months (M6) of treatment. Disease activity was assessed using disease activity score in 28 joints (DAS28), simplified disease activity index (SDAI) and clinical disease activity index (CDAI). MRI of the dominant hand was performed at baseline and M6 of treatment. The primary outcome measure was the assessment of bone oedema by rheumatoid arthritis MRI scoring system (RAMRIS) bone oedema. Secondary outcomes included RAMRIS synovitis, DAS28, C-reactive protein (CRP) and SDAI at baseline and M6. Twenty-two patients with RA were included, 19 females (86.4 %), with a mean of age 42 ± 13.7. The mean disease duration was 8 ± 5.2 years. The mean DAS28 was 5.78 ± 0.87. The median CRP was 16 mg/l (6.7 to 36.3). The average SDAI was 90 ± 34. Three patients were excluded from the study for serious side effects. At baseline, bone oedema was present in 41 % of patients (N = 9), with a median bone oedema RAMRIS 0 (0 to 7.2). At M6, bone oedema decreased or disappeared in 32 % (N = 7) with a significant improvement in the RAMRIS bone oedema score (p = 0.04). Moreover, there is a significant improvement in RAMRIS synovitis (p < 0.0001) as well as in activity parameters: DAS28 (p < 0.0001), CRP (p < 0.0001) and SDAI (p < 0.0001). This study suggests that tocilizumab is associated with a significant improvement on MRI-determined bone oedema in the short term. This improvement in bone oedema is correlated with improved parameters of disease activity, in which early structural effect could be discussed. Further studies are needed to confirm these results.

The objective of this study was to evaluate sexual function in women with rheumatoid arthritis (RA) using an auto-questionnaire Female Sexual Function Index (FSFI) and study its correlation with disease activity. Sixty patients with RA and 40 healthy controls were included in this exploratory study. Sociodemographic, clinical, and laboratory characteristics were assessed. The disease activity was assessed by auto-questionnaires Routine Assessment of Patient Index Data 3 (RAPID3) and Rheumatoid Arthritis Disease Activity Index 5 (RADAI5) judged by 28 DAS ESR. Sexual function was assessed by an auto-questionnaire specific for female sexuality: FSFI during the last 4 weeks. The definition of sexual dysfunction was considered by FSFI score less than or equal to 26.5. The mean age of RA patients and controls was 45.95 ± 9.3 and 45.01 ± 9.2, respectively. According to FSFI, the percentage of FSD in women with RA was significantly higher than that in the control group. All dimensions of sexuality were affected (desire, arousal, lubrication, orgasm, and satisfaction) except pain. The multivariate linear regression analysis indicated that the swollen joints and the RADAI5 were the independent variables of disease activity associated with sexual dysfunction in women with RA. This study suggests that sexual dysfunction among women suffering from rheumatoid arthritis is found when a targeted questionnaire is used to identify it and that the increased disease activity has a negative effect of sexual function.

Objective: The aim of this study was to assess the vitamin D status and the factors that may influence this vitamin in Moroccan patients with pemphigus. Study Design: Case-control study.

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