[Show abstract][Hide abstract] ABSTRACT: Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the axial skeleton and can lead to complete ankylosis of the involved joint. Unfortunately, involvement of the facet joints (FJ) is not evaluated by the available scoring methods that are supposed to quantify the structural damage of the spine.
[Show abstract][Hide abstract] ABSTRACT: Background Spondyloarthritis (SA) is a chronic inflammatory disease affecting young and active patients and often affects their work productivity.
Objectives To describe professional characteristics of Tunisian patients affected by SA and to determine work conditions that may expose to work productivity impairment.
Methods We performed a cross-sectional monocentric study of 99 patients with SA recruited during 1 year at the Department of Rheumatology. Disease parameters and professional characteristics were recorded. Patients were asked if they have missed work time during the last three months because of their disease. For statistical analysis, we used Khi2 -test, a p value ≤0.05 was considered significant.
Results Eighty-three man and 16 women were included. Among these patients 65.6% were eligible to a professional activity (aged between 18 and 65 years and having ended their studies or vocational training). Their average age was 40.02 years ±11.7. Disease mean duration was 11.85±10.29 years. Mean BASFI score was 40.3% and mean BASDAI score was 42.3%.
Manual labor has been noted in 55.4% and a hard physical work in 23.1%. Concerning the conditions of work, prolonged sitting was adopted in 44.6%; bad posture was adopted in 36.9% and 23.1% of cases were carrying heavy loads. Manipulation of vibrant engine was noted in 9.2% and work in cold environment in 32.3%. The mean number of working hours per day was 5.57±4 h and the mean day rest duration was 39min. Almost one third of patients (32.8%) accused having a stressful work and, while 29.2% judged that the day rest duration was insufficient. The mean distance between the place of work and home was of 4.7 km ±9.12 crossed at mean in 17 min using a means of transportation.
Twenty-three percent of employees missed work time during the last three months because of their health condition. Statistical analysis showed that factors significantly associated with absenteeism were: high number of working hours (p=0.037), bad posture (0.001), stress at work (0.035) and insufficient day rest duration (0.007). Carrying heavy loads was more frequent in patients on sick leave but not statistically significant (p=0.076). Risk of absenteeism was independent of SA activity scores.
Conclusions Absenteeism is frequent in SA Tunisian patients and it is essentially related to work conditions. High number of working hours, insufficient day rest duration, stress at work and bad postures are its predicting factors.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1161.1-1161. DOI:10.1136/annrheumdis-2015-eular.5018 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Spondyloarthities primarily manifest in the axial skeleton, with a majority of patients having manifestations in the sacroiliac (SI) joints.
Objectives To assess the efficacy of TNF inhibitors in reducing sacroiliac (SI) joint progression in patients with Axial Spondyloarthities (AS)
Methods AS patients (satisfying ASAS criteria 2009) with at least two sets of Antero-posterior X-rays of the pelvis at a minimum gap of 2 years were included and were divided into two groups: Group1: received TNF-inhibitors and group 2 received non-steroidal antiinflammatory and/or scDMARDs. Radiographic severity was assessed by Forrestier classification at beseline, at 2years and after an average of 5 years. Patients with grade 4 SI joints were excluded. Bath AS Disease Activity Index (BASDAI), BASFI, ESR, CRP, HLA-B27 and age of onset were included in the model
Results Group 1 included 46 patients. The median age of onset of the disease was 25 years [16-49ans], HLA B27 was positive in 53% of cases. The median BASDAI and BASFI scores were respectively 5,8 and 5,4. The average ESR and CRP were respectively 49 and 35. Patients received Infliximab 48%, Adalimumab 14% and Etanercept 36%. Twenty two patients received csDMARDs and 24 NSAID. The mean SI joint grade at baseline was 3. Sixty four percent of patients had SI joint grade 3 and 36% had SI joint grade2. Group 2 included 38 patients. There were no significant differences between the two groups for the mean age of onset, the mean CRP and ESR level and SI joint grade at baseline, however BASDAI and BASFI scores at baseline were significantly higher in Group1. In the group of study 30% of patients with SI joint grade 3 progressed to grade 4 and 22% o of patients with SI joint grade2 progressed to grade 3.There were no significant difference between the two groups
Conclusions TNF inhibitors do not seem to prevent radiographic progression of the sacroiliac joints.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):273.3-274. DOI:10.1136/annrheumdis-2015-eular.6287 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Work and socio economic related factors have a great impact on patient's quality of life.
Objectives To explore the effect of work-related and socio-economic factors on quality of sleep in patients with Axial Spondyloarthritis (AS).
To explore the effect of work-related and socio-economic factors on quality of sleep in patients with Axial Spondyloarthritis (AS).
Methods A cross sectional case-control study was conducted between August 2012 and August 2013 in the department of Rheumatology of Charles Nicolle Hospital.
Only patients with Axial Spondyloarthritis according to the 2009 Eular criteria were included. The 100 age- and sex-matched healthy controls were included in this case-control study. The patients and controls who had malignancy, fibromyalgia, serious infections or systemic diseases, and other chronic diseases were excluded from the study.
Demographic characteristics, disease specific variables, years of education, marital status, disease duration, occupation and absenteeism during the three last months were documented for each patient. They answered a self-assessing: sleep quality the Medical outcome study sleep scale (MOS-SS).
Results One hundred patients with AS and 100 control group patients age and sex matched participated in this study. Patients were divided into 71 men and 29 women. Their average age is 41.72 years [16-74].The majority of patients belonged to an average socioeconomic class (70%). 16% had a higher education, 68% secondary education, and 16% were illiterate. One-half of patients were unemployed and 26% displayed a disability related to their disease. Absenteeism was noted in 23% cases. The duration of the disease is on average 11.7 years and the age of disease onset is 28.9 years on average.
In the group of women through, there were many more disruption sleep (p=0.016), headache/breathlessness on waking (p=0.008), and a fewer sleep hours amount (p=0.037). There was no difference between the sexes in terms of adequacy, sleepiness, snoring and sleep index I and II.
Age was significantly correlated with sleepiness and areas snoring (p=0.002, p=0.001). The age of onset of the disease was significantly correlated with the areas drowsiness (p=0.015) and snoring (p=0.01)
Comparison of sleep disorders by socio economic level showed that sleep adequacy, headache and breathlessness are more observed in disadvantaged class (p=0.022). Workplace absenteeism was related to sleep disorders in the area sleep disturbance with p=0.002.
Conclusions Socio economic and professional status affects greatly the quality of life of patients and especially their sleep quality.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1292.3-1293. DOI:10.1136/annrheumdis-2015-eular.4605 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Brucellosis incidence has declined in developped countries, nevertheless it remains endemic in certains regions. Spondylodiscitis is the most frequent localisation of brucellosis infections complications, ranging from 30% to 85% according to cases series.
Objectives The aim of our study is to report the clinical and bacteriological features of this disease as well as its therapeutic profile.
Methods Retrospective study witch included medical records of patients treated for brucellar spondylodiscitis during the fifteen past years (2000–2014).
Results Nineteen cases were collected (12 males/ 7 females). Mean age was 52 years [rang 36 to 75]. All patients had at least a risk factor: exposed occupation in 6 cases, and unpastorized milk consumption in 12 cases). The following symtoms were observed: inflammatory back pain (14 cases), inflammatory dorsal pain (4 cases), raduculalgia with neurological signs were (1 cases), weight loss (13 cases), fever (14 cases), night sweating (4 cases), C Reactive protein was increased in 2 cases. Lymphopenia was noted in 1 case. Wright serology was positive in all cases. Standard X-ray showed narrowing in disc space in 5 cases, endplate destuction in 9 cases and bone condensation in 3 cases. MRI performed in 14 cases, showed Low signal on T1 weighted images and high signal on T2 weighted images of the vertebral bodies and intervertebral disc. Moreover it revealed epidural extension (5 cases) abcess formation (2 cases) and psoas abcess (6 cases). All patients were treated by association of antibiotics (doxycicline and rifampicin) for 2 to 3 months. Evolution was farorable with resolution of pain, normalization of biological inflammation and slow radiologic reconstruction in 10 cases. For one patient treatment was prolongated to one year due to the persistance of an epiduritis in the follow-up MRI.
Conclusions Prognosis of brucellar spondylodiscitis seems good under appropriate treatment. Nevertheless primary prevention is still necessary especially in countries where brucellosis is endemic.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):290.1-290. DOI:10.1136/annrheumdis-2015-eular.6083 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background For over 10 years, rheumatologists have TNF inhibitors that revolutionized the treatment of various rheumatic and inflammatory disorders. This biotherapy may in some cases give intercurrent infections sources of stopping treatment and reactivation of rheumatic diseases.The objective of this study is to evaluate these characteristics in patients with Spondyloarthritis (SPA) compared to Rhumatoid Arthritis (RA).
Methods Retrospective analysis of 46 Tunisian SPA and 46 Tunisian RA database. SPA and RA patients initiating an anti-TNF (adalimumab (ADA), etanercept (ETA) or infliximab (INF)) or Riuximab (RTX) were identified and followed forward in time. Baseline demographics included disease duration and pain visual analogical scale evaluations (VAS), DAS28 ESR and BASDAI
Results The analyzed cohort comprised patients with average age of begining of 25,65 years (82% male) for SPA group and 42,21 years (78% female) for RA group. The average duration of evolution is of 10,63 years for SPA group and 12,65 years for RA group. 11 cases of SPA group had an HLA B27. 41% for SPA group and 86% for RA group were under disease-modifying antirheumatic drugs (DMARD's) (whose Methotrexate (n=9, SPA/35, RA), and association of Methotrexate and Salazopyrine (n=1, SPA/ 25, RA). The reason for starting biotherapy was therapy failure (n=39, SPA/ 5, RA) and adverse effects (n=2, SPA/ 40, RA). Biotherapy were as follows: INF (n=22, SPA/ 12, RA), ETA (n=18, SPA/ 14, RA), ADA (n=6, SPA/ 3, RA) and RTX (n=17, RA). Adverse effects were noted in 7 cases for SPA group and 12 for RA group, 4 cases (SPA) and 3 cases (RA) of repeatedly urinary infection, 3 cases (SPA) of reactivation of latent tuberculosis, 1 case (SPA) of liver damage, 5 cases (RA) of allergic reaction, 2 cases (RA) of infection of mild parts,1 case (RA) of septic arthritis, 1 case (SPA) of uveitis and in 1 case (RA) a tumor of the ovary. Clinically significant differences in baseline variables were observed between adverse effects in SPA group compared to RA group for the reactivation of latent tuberculosis (Log-rank p=0.002) and for allergic reaction (log-rank p=0.001).
Conclusions The most important adverse effect of TNF inhibitors is infection, which is significantly higher than the non-biologic treatment group. A reactivation of latent tuberculosis is twice times more frequent in patients using biotherapy. Paradoxical reactions do occur during anti-TNF treatment mainly in SPA, such as acute uveitis. Although biotherapy has changed the lives of patients with chronic inflammatory rheumatism, it can bring not only an infection risk, but also a neoplastic risk that requires rapid diagnosis. Only the non-melanoma skin cancer has been registered with TNF inhibitors in RA and SPA. A tumor of the ovary was noted in our study.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):290.2-290. DOI:10.1136/annrheumdis-2015-eular.6444 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Tuberculous spondylodiscitis still frequent in our country. Biologic aspects can help diagnosis in some cases.
Objectives Our objective is to describe laboratory features of tuberculous spondylodiscitis among monocentric experience.
Methods This is a retrospective study which included medical records of patients treated for tuberculosis spondylodiscitis during the ten past years [2002-2012]. Biologic data were recorded and analysed.
Results Fifty seven cases of 29 women and 28 men of tuberculous spondylitis were treated during the ten past years. The mean age was 56.6 years (range 20 to 86 years). A contact history of tuberculosis was reported by 2 patients. The predisposing conditions were present in the third of cases: diabetes mellitus (13 cases), hepatic cirrhosis (5 cases) and high-dose corticosteroid intake (2 cases). It was a progressive starting of disease in two thirds of cases with median duration from the onset of symptoms to the diagnosis about 5.4 months (0.7 range to 24 months). Fever was observed in 29% of cases. Night sweats were present in 40% of cases Anorexia and weight loss were present in 71.9% of cases. Stiffnes was noted in 70% of cases. Pulmonary tuberculosis was associated in 3 cases and cutaneous tuberculosis was noted in 1 case. Biological inflammatory tests were rised in 91% of cases with a mean erythrocyte sedimentation rate of 93mm (range 2 to 150) and an average value of c Reactive protein of 55mg/l (range 0,2 to 331). The blood count showed leukocytosis (15 cases), lymphocytosis (9 cases), leukopenia and anemia in one case each. Disturbance of liver function tests was noted in 5 cases: hepatic cholestasis (n=3), hepatic cytolisis (n=2). Hyerglycemia was noted in the 13 cases of diabetes mellitus. Identification of mycobacterium tuberculosis in sputum was positive in 1 case.
Conclusions Inflammatory blood tests were rised in major of cases and leukocytosis was frequent among patients with tuberculous spondylodiscitis in this study.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):1084-1084. DOI:10.1136/annrheumdis-2014-eular.2758 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Joint and bone infections are a therapeutic emergency that may occurs at any age but is particular among elderly patients.
Objectives The aim of this study is to identify different features of joint and bone infections in elderly patients.
Methods We performed a retrospective study of medical records of patients hospitalized for management of osteoarticular infections and who were aged more than 65 years old between 2000 and 2012. Clinical, paraclinical and therapeutic characteristics were recorded and analysed.
Results Forty four cases were collected (20 males/24 females). Mean age was 73.8 years (range 65 to 90). The predisposing factors were present in 54,4% of cases (n=24): diabetes mellitus (n=9), renal failure (n=5), cirrhosis (n=3), rheumatoid arthritis (n=2), psoriatic arthritis (n=1), high dose corticoid intake (n=4). Tuberculous and brucellar contage were reported by 4 and 2 patients respectively. Infectious gateway were found in 5 cases: pulmonary (n=2), cutaneous (n=2) and urinary (n=1). Pain was present in all cases. The following symptoms were observed: fever (n=25), impaired general condition (n=20), night sweat (n=13), radiculalgia with neurological signs (n=6). Inflammatory blood tests were rised in all cases with mean CRP of 113.2mg/l (range 4 to 331) and mean ESR of 101.3mm (range 2 to 195). Blood culture was positive in 2 cases and wright serology was positive in 2 cases. Radiological abnormalities were found in 38 of cases. It was an infectious spondylodiscitis in 25 cases, an association of spondylodiscitis and septic arthritis of sternocostal joint in 1 case and a septic arthritis in 18 cases. In the last cases, it was: polyarthritis (n=1), oligoarthritis (n=2) and monoarthritis (n=15). The arthritis involved the: Knee (n=12), elbow (n=2), shoulder (n=2), ankle (n=3) and hip (n=1). The germ was identified in 10 cases: Specific germ in 1 case (Mycobacterium Tuberculosis), and pyogenic germ in 9 cases: Staphylococus (n=3), Pseudomonas (n=1), Escherichia coli (n=1), Streptococcus (n=1), Serratia (n=1), Lactococcus (n=1) Enterobacter (n=1). All patients received antibiotics according to the bacterial agents. Complications were observed in 6 cases: endocarditis (n=1), cauda equina syndrome (n=1), medullar cord compression (n=1) and side therapy effects (n=3). Five patients died.
Conclusions Osteoarticular infections in elderly patients were dominated by spondylodiscitis, characterised by blood inflammation and may cause several complications.
Disclosure of Interest : None declared
Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):283-283. DOI:10.1136/annrheumdis-2014-eular.2755 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background The clinical and radiological diagnosis of osteoarticular brucellosis is not always easy owever essential for early and effective treatment.
Objectives The aim of this study is to study radiological findings of osteoarticular brucellosis which were reported and confirmed in a rheumatological department.
Methods This is a retrospective study which included medical records of patients treated for osteoarticular brucellosis during the ten past years [2002-2012]. Radiological data were recorded and analysed.
Results Twelve cases of osteoarticular brucellosis were treated during the ten past years. All patients had spondylodiscitis. One patient had elbow bursitis associated. We had no case of peripheral arthritis or sacroiliitis. The mean age was 55 years (range 33 to 79 years) with a male to female ratio about 1. The predisposing conditions were present in 2 cases: diabetes mellitus and cirrhosis. Consumption of raw milk products was noted in 8 cases. The median duration from the onset of symptoms to the diagnosis was 3.6 months (range 1.5 to 6 months). The following symptoms were observed: inflammatory back pain (12 cases), sciatalgia with neurological signs (4 cases), weight loss (11 cases), fever (9 cases) and night sweating (n=7). One patient had symptom of spinal cord compression. C Reactive protein level was increased in 8 cases. Lymphopenia was noted in 4 cases. Wright serology was positive in all cases. Spondylodiscitis was uni-staged in all cases: the lumbar spine was the most commonly involved (8 cases). Standard X-ray showed narrowing of the intervertebral space (10 cases), endplate destruction (8 cases), bone condensation (1 case) and were normal in one case. MRI performed in all cases, had showed low signal intensity on T1-weighted images and high signal intensity on T2 weighted images of the vertebral bodies, endplates and intervertebral disc in all cases. Indeed the following findings were observed: paravertebral abcess formation (3 cases), epidural extension (8 cases), posterior longitudinal ligament elevation (1 case) and psoas abcess (2 cases).
Conclusions MRIduring osteoarticular brucellosis and especially spondylodiscitis provides early diagnosis and well demonstration of paravertebral soft tissue spreading more than standard X-ray.
Disclosure of Interest : None declared
Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):282-282. DOI:10.1136/annrheumdis-2014-eular.2759 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Behçet’s disease is an inflammatory disorder of unknown aetiology, characterized by recurrent painful oral ulcer and genital ulcer, skin diseases and uveitis. It may involve cardiovascular, gastrointestinal and central nervous system, as well as joints
Objectives To define the epidemiology and clinical features of Behçet’s disease, giving special attention to the rheumatic manifestations.
Methods We retrospectively reviewed the medical records of the patients who met the International Study group criteria of Behçet disease and were treated during the last ten years [2002-2012].
Results Twenty three patients were treated. The mean age at the diagnosis was 41 years (range 20 to 58 years) with a female to male ratio of 1.5. Mean disease duration was about 4,4 years (range 6 to 14 years). Joint manifestations were present in 22 cases and were inaugural in 18 cases. Patients presented with inflammatory arthralgia (14 cases) and arthritis (8 cases). It was a monoarthritis in 4 cases, oligoarthritis in 3 cases and polyarthritis in one case. The knee and ankles were the joint most commonly affected. Oral Ulcers and genital ulcers were noted in all cases. Skin lesions were seen in 5 cases: including erythema nodosum-like eruption (2 cases) and pseudofoliculitis (3 cases). Ocular involvement was observed in 11 cases: anterior uveitis, posterior uveitis and retinal vasculitis. Deep venous thrombosis was noted in 3 cases and neurological involvement such (convulsion and cognitive impairement) in 2 cases. Biologic inflammatory syndrome was observed in 16 cases. HLA B51 was positive in 4 cases among the 7 tested.
Conclusions This series confirms the heterogeneity of the Behçet disease in Mediterranean countries. Uveitis and joint manifestations were frequent and inaugural in most cases
Disclosure of Interest None Declared
Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A928-A928. DOI:10.1136/annrheumdis-2013-eular.2779 · 10.38 Impact Factor