Introduction: Uveitis is a well--known extra--rheumatological manifestation of juvenile idiopathic
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
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, p<0.001), BASRI spine (5.97 vs 2.91, p<0.001), and mSASSS (16.24 vs 5.80, p:0.001). However, no association was found between HLA-B27 and hip involvement (50% vs 28.6%, p=0.099).A 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 (p<0.001), sex ratios (F/H) were 0.23 versus 3.62 (p<0.001), 54% versus 73% (p=0.033) of patients were overweight or obese, 4% versus 18% (p=0.014) of patients had type 2 diabetes, 4% versus 13% (p=0.099) of patients had dyslipidaemia while 9% versus 20% (p=0.108) of patients had hypertension.Active 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
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
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
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