Chronic Inflammatory Rheumatism Research Articles

Effect of Argentine tango sessions on total physical activity time in patients with chronic inflammatory rheumatism: randomized, controlled, pilot study.

The aim of this study was to evaluate the effect of an Argentine Tango (AT) program on total physical activity (PA) time in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Prospective randomized controlled pilot study with two parallel groups. Participants were randomized 1:1 to attend a 24-week AT program from baseline to month6 for the immediate tango group (ITG) and a 12-week AT program from month3 to month6 for the wait-list control group (WLCG). Total PA time was measured at baseline, month3, and month6 using the Global Physical Activity Questionnaire-ONAPS and an accelerometer. Twenty-seven participants (15 RA and 12 SpA) were enrolled in the study. Thirteen participants in the WLCG and 14 in the ITG. At month3, there was no significant difference in the total PA time between the two groups. Longitudinal analyses revealed no significant difference between the two groups regarding PA, sedentary, fatigue, anxiety, depression, balance, physical performance, pain, and stress. However, body appreciation improved significantly in the ITG compared with the WLCG. Both groups showed improved physical abilities at 6month, including improvements in the 6-min walk test and timed up and go test. The ITG also reported reduced pain at months 3 and 6, while the WLCG exhibited improved balance at month 6. Although the AT program did not significantly increase total PA time in patients with CIR, it positively impacted body appreciation and physical abilities suggesting its potential as a complementary therapy. Key Points • Body appreciation significantly improved after a 24-week AT program, emphasizing the positive impact of dance on self-perception. • Both groups exhibited improved physical abilities at month 6, indicating a positive influence on participants' overall mobility and functional capacity. • The 24-week AT group reported reduced pain at months 3 and 6, and the 12-week AT group exhibited improved balance at month 6.

E056 Particularities of the lipid profile in rheumatoid arthritis

Abstract Background/Aims Rheumatoid arthritis (RA), like all autoimmune diseases, is associated with a high cardiovascular risk. This risk is essentially linked to the chronic inflammation and dyslipidaemia engendered by this chronic inflammatory rheumatism. The objective of this work was to study the particularities of the lipid profile in RA. Methods We conducted a retrospective study including patients with RA according to ACR- EULAR 2010 criteria, followed in an internal medicine department between 2015 and 2022. Lipid profile data (total cholesterol (TC), high-density lipoproteins (HDLc), low-density lipoproteins (LDLc), and triglycerides (TG)) were collected. Results Eighty patients with RA were studied. The mean age was 60.79 years [range 30-91]. The sex ratio (F/H) was 4.33, with a clear female predominance. The mean age of disease onset was 46.34 years [extremes: 22-82]. A personal history of dyslipidaemia was noted in 19 patients: hypercholesterolemia, hypertriglyceridemia, and mixed dyslipidaemia were found in 8, 4 and 7 cases. Other comorbidities were arterial hypertension in 35% of cases (n = 28), diabetes in 30% of cases (n = 24), renal insufficiency in 6.25% of cases (n = 5) and a cardiovascular accident in 5% of cases (n = 4). Obesity was present in 15% of patients and smoking in 5%. 69 patients had a lipid panel. Dyslipidaemia was present in 66.7% of cases (n = 46). The mean TC level was 4.47 ± 1.0 mmol/L [range: 2.32 - 6.96 mmol/L], the mean TG level was 2.64 ± 0.81 [range: 0.90 - 4 mmol/L], the mean HDLc level was 1.106 ± 0.394 mmol/L [0.50 - 2] and the mean LDLc level was 1.38 ± 0.565 mmol/L [0.56 - 3.59 mmol/L]. Hypercholesterolemia (21.3%) and hypocholesterolaemia (21.3%) were the most common lipid abnormalities. Hypertriglyceridemia was observed in 10% of cases (n = 8). A low HDLc was observed in 20% of cases (n = 16). Only one patient had a high HDLc, with HDLc= 2 mmol/l. A low LDL was present in 10% of cases (n = 8). Conclusion In our study, hypolipidemia was the most common dyslipidaemia. This confirms the lipid paradox found in RA. Indeed, systemic inflammation is responsible for quantitative and qualitative alterations in lipoproteins. Stabilization of the disease leads to normalization of the lipid balance and improved control of cardiovascular risk. Disclosure I. Fenniche: None. M. Somai: None. I. Rachdi: None. I. Arbaoui: None. F. Daoud: None. S. Kochbati: None. B. Daoud: None. Z. Aydi: None. F. Boussema: None.

Emotional repression in patients with chronic inflammatory rheumatism

Background: A person’s psychological background may support and direct the inflammatory evolution of a disease toward a specific type of chronic inflammatory rheumatism (CIR). Aim: This study aimed to identify a particular emotional profile of patients with CIR, particularly rheumatoid arthritis (RA) and spondyloarthritis (SpA), based on psychological profile assessments between patients with and without CIR. Emotional repression, that is, a tendency to inhibit the expression of negative feelings and/or unpleasant thoughts, was particularly studied. Methods: This monocentric observational pilot study included patients from the rheumatology department of a university hospital. These patients were systematically assessed for different psychological parameters by an experienced psychiatrist, and their clinical and biological characteristics were collected accordingly. Data analysis was performed using the Chi-squared test or Fisher’s exact test. Results: Fifty-nine patients were assessed: 47 patients with CIR (i.e., 27 with RA and 20 with SpA) (CIR group) and 12 non-CIR patients (i.e., nine with osteoarthritis, one with viral disease, one with osteoporosis, and one with osteomalacia) (control group). Severe emotional repression and early life events were both significantly higher in the CIR group than in the control group (P = 0.02). In contrast, severe psychological and somatic complaints were significantly higher in the control group than in the CIR group (P < 0.01 and P = 0.01, respectively). Conclusion: Our findings suggested that emotional repression from traumatic life events could aggravate the etiology and/or course of CIR. Therefore, appropriate psychological care should have a relevant place within the current therapeutic options for the clinical management of CIR. Relevance for Patients: The management of CIR should include psychological support as learning coping mechanisms can facilitate the recovery of CIR patients.

Tumor Necrosis Alpha (TNF-α) Antagonists Used in Chronic Inflammatory Rheumatic Diseases: Risks and their Minimization Measures.

Tumor necrosis factor alpha (TNF- α) inhibitors are widely employed for the management of chronic inflammatory rheumatism. However, their usage carries significant risks, including site and infusion reactions, serious infections, malignancy, heart failure autoimmune and demyelinating disorders. These risks are comprehensively outlined in risk management plans (RMPs) associated with these molecules. RMP provides information on the safety profile of a medicinal product as well as the measures that will be taken to minimize risks; these are known as risk minimization measures. These measures are divided into routine measures related to elements, such as the summary of product characteristics, labeling, pack size, package leaflet, or legal supply status of the product, while additional measures may include educational programs, including tools for healthcare providers and patients, controlled access or pregnancy prevention programs, among others. Additional measures can consist of one or more interventions that need to be implemented in a sustainable way in a defined target group, while respecting the timing and frequency of any intervention and procedures to reach the target population. An evaluation of the effectiveness of these measures is required to determine whether or not an intervention has been effective. This comprehensive review offers an in-depth exploration of the current treatment, uses, and associated risks of TNF-α inhibitors. Additionally, it provides a detailed account of risk minimization measures and risk management practices while shedding light on their real-world implementation and effectiveness.

Disseminated tuberculosis after anti-TNF alpha treatment: Do not blindly trust the IGRA test

IntroductionInterferon gamma release assay (IGRA) is used to detect latent tuberculosis prior to biological treatments in the context of suspected inflammatory rheumatism. MethodsWe report the case of a 50-year-old woman with negative IGRA test before adalimumab introduction for presumed axial spondyloarthritis. ResultsThe worsening of symptoms under treatment led to further investigations and the diagnostic of disseminated tuberculosis (TB) was later established with miliary and multiple bone locations such as spondylitis and sacroilitis. The patient's history revealed past exposure to tuberculosis. This observation illustrates the limitations of IGRA in such situation due to its variable performance for active TB diagnosis. ConclusionMisdiagnosis is frequent in bone tuberculosis due to non-specific signs. We draw the attention to the importance of a global risk assessment prior to the introduction of biological treatment for suspected chronic inflammatory rheumatism and recall the risk factors for false-negative IGRA. An extended treatment course may be necessary after exposure to anti-TNF-alpha.

Infection prevention and vaccination in the rheumatic diseases.

Patients with chronic inflammatory rheumatisms (CIR) have a higher risk of infections compared to healthy subjects. Viral and bacterial pneumonia are the most frequent infections observed in CIR with targeted disease modifying anti-rheumatic drugs (DMARDs). Moreover, drugs used to treat CIR (especially biologic and synthetic targeted DMARDs) increase the risk of infection and expose CIR patients to opportunistic infections such as tuberculosis reactivation. To limit the risk of infection, the risk-benefit ratio should be evaluated for each patient based on their characteristics and comorbidities. To prevent infections, an initial pre-treatment work-up must be performed, especially before the initiation of conventional synthetic DMARDs or biological and synthetic targeted DMARDs. This pre-treatment assessment includes the case history, laboratory and radiology findings as well. The physician must make sure a patient's vaccinations are up-to-date. The vaccines recommended for patients with CIR being treated with conventional synthetic DMARDs, bDMARDs, tsDMARDs and/or steroids should be given. Patient education is also very important. During workshops, they learn how to manage their drug treatments in at-risk situations and learn which symptoms require treatment discontinuation.

E30 Sequelae of Juvenile Idiopathic Arthritis in a 20-year-old young woman

Abstract Background The long-term effects of Juvenile Idiopathic Arthritis are still largely unknown in our context. We set out to describe the long-term complications of a patient known to have Juvenile Idiopathic Arthritis who underwent follow up into adulthood. Methods Retrospective chart review Results We report a case of a female patient, now 20 years’ old who was diagnosed with Juvenile Idiopathic Arthritis since the age of 8 years. The patient initially received symptomatic treatment with paracetamol and non-steroidal anti-inflammatory drugs administered during flare-ups. After 12 years of follow up, she has failure to thrive (BMI 15.43 kg/m2) and delayed secondary sexual characteristics (menarche at 17, poorly developed chest). Other sequelae include bilateral boutonniere deformation of the 2nd and 3rd fingers, camel back deformity of the wrists, flexion contractures of the elbows, and bilateral coxopathy. She has tenderness and limited range of motion of shoulders, knees and ankles with bilateral thigh atrophy. She has a tender cervical spine painful and limited movement (C7-wall at 4.5 cm, tragus-acromion at 9 cm on the right and on the left). Conclusion This case highlights the importance of early control of the disease to mitigate against sequelae with negative impact on the academic and social life of the patient. The implication to policy, practice, research and advocacy The case illustrates the consequences of sub-optimal management of chronic inflammatory rheumatism in Africa, especially among children, due to lack of expertise and resources across the continent. Ethics We have no conflict of interest

Disseminated tuberculosis after anti-TNF alpha treatment: Do not blindly trust the IGRA test

IntroductionInterferon gamma release assay (IGRA) is used to detect latent tuberculosis prior to biological treatments in the context of suspected inflammatory rheumatism. MethodsWe report the case of a 50-year-old woman with negative IGRA test before adalimumab introduction for presumed axial spondyloarthritis. ResultsThe worsening of symptoms under treatment led to further investigations and the diagnostic of disseminated tuberculosis (TB) was later established with miliary and multiple bone locations such as spondylitis and sacroilitis. The patient's history revealed past exposure to tuberculosis. This observation illustrates the limitations of IGRA in such situation due to its variable performance for active TB diagnosis. ConclusionMisdiagnosis is frequent in bone tuberculosis due to non-specific signs. We draw the attention to the importance of a global risk assessment prior to the introduction of biological treatment for suspected chronic inflammatory rheumatism and recall the risk factors for false-negative IGRA. An extended treatment course may be necessary after exposure to anti-TNF-alpha.

Effectiveness of Shiatsu on Fatigue in Patients with Axial Spondyloarthritis: Protocol for a Randomized Cross-Over Pilot Study.

Spondyloarthritis (SpA) is a serious chronic inflammatory rheumatism implying different painful and crippling symptoms that require a multidisciplinary approach for the patient. Fatigue is one of the less well treated symptoms, even if its repercussion on everyday life is noticeable. Shiatsu is a Japanese preventive and well-being therapy that aims to promote better health. However, the effectiveness of shiatsu in SpA-associated fatigue has never been studied yet in a randomized study. We describe the design of SFASPA (Etude pilote randomisée en cross-over évaluant l'efficacité du Shiatsu sur la FAtigue des patients atteints de SPondyloarthrite Axiale), a single-center, randomized controlled cross-over trial with allocation of patients according to a ratio (1:1) evaluating the effectiveness of shiatsu in SpA-associated fatigue. The sponsor is the Regional Hospital of Orleans, France. The two groups of 60 patients each will receive three "active" shiatsu and three sham shiatsu treatments (120 patients, 720 shiatsu). The wash-out period between the active and the sham shiatsu treatments is 4months. The primary outcome is the percentage of patients responding to the FACIT-fatigue score. A response to fatigue is defined as an improvement, i.e., an increase of ≥ 4 points in the FACIT-fatigue score, which corresponds to the "minimum clinically important difference" (MCID). Differences in the evolution of activity and impact of the SpA will be assessed on several secondary outcomes. An important aim of this study is also to gather material for further trials with higher proof of evidence. NCT05433168, date of registration, June 21st, 2022 (clinicaltrials.gov).

Ankylosing Spondylitis and Right Lower Limb Lymphoedema A Rare Association: A Case Report and Review of the Literature

Introduction: Ankylosing spondylitis or rheumatic pelvispondylitis is a chronic inflammatory rheumatism characterized by an axial localization predominantly in the spine and sacroiliac joints, an involvement of the entheses and a tendency to bone ankylosis by ossification of these entheses. We report an observation of right lower limb lymphedema associated with ankylosing spondylitis. Observation: This was a 63-year-old patient with a history of inflammatory rheumatism (his older sister) and osteoporosis (his mother), He was diagnosed with ankylosing spondylitis based on enthesis involvement (bilateral tilted gluteal pain and low inflammatory back pain) with a positive HLA-B27 antigen by the 8-point Amor criteria for spondyloarthritis (right unilateral sacroiliitis, low inflammatory back pain, bilateral tilted gluteal pain, HLA-B27+ and NSAID sensitivity). The unilateral lymphedema with positive Stemmer's sign affected the lower 2/3 of the right lower limb. It occurred one year after the onset of ankylosing spondylitis. The echo-Doppler scan showed no signs of thrombosis or venous infiltration of the lower limbs, and diffuse infiltration of the subcutaneous tissue of the right leg without inflammatory character. Treatment of ankylosing spondylitis gradually improved the lymphedema. Conclusion: Lymphedema is a rare complication of ankylosing spondylitis. Dermatologists should be alert to early swelling of the extremities in patients with ankylosing spondylitis so as not to delay specific multidisciplinary treatment and measures to avoid irreversible lymphatic damage.

Managing Inflammatory Bowel Disease in Spondyloarthritis

Spondyloarthritis is a chronic inflammatory rheumatism associated with a variety of extra-articular manifestations, including chronic inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Subclinical gastrointestinal manifestations in patients with spondyloarthritis are common, and clinical involvement exists in a number of patients. The pathophysiology remains poorly understood and involves genetic and immunological factors, as well as the gut microbiome. Screening for inflammatory bowel disease in patients with spondyloarthritis is important because its occurence modifies the therapeutic management of these patients.

Epidemiology of rheumatic diseases: a cohort of 23,550 patients in rheumatology clinics in Burkina Faso.

The aim of this work is to study the epidemiological characteristics of rheumatic conditions in a cohort of 23,550 patients followed up in Ouagadougou, Burkina Faso. This was a descriptive observational study on records conducted from February 2006 to December 2019 in Ouagadougou (Burkina Faso). All patients seen in rheumatology consultation in the city of Ouagadougou were included. The diagnosis of mechanical and degenerative osteoarthropathies was based on clinical and radiological findings; osteoarticular infection was based on clinical and biological findings. The diagnosis of gout was based on the clinical findings, uricemia, and/or the presence of sodium urate crystals in the synovial fluid on microscope. The diagnosis of rheumatoid arthritis and systemic lupus erythematosus was based on the ACR/EULAR criteria. In total, 23,550 patients were included in the study. These were 14,995 female patients (63.70%) and 2555 male patients (36.30%). The average age of patients was 49.61 ± 15.36years with extremes of 9months to 120years. Degenerative osteoarthropathies were the most common presentation (13,377 patients; 59.35%) followed by tendinopathies (2199 patients; 9.34%); chronic inflammatory rheumatism was in third place (841 patients; 3.57%) led by rheumatoid arthritis (434 patients); 51.61% of chronic inflammatory rheumatism, systemic lupus erythematosus and ankylosing spondylitis accounted for 71 patients (0.4%) and 63 patients (0.27%), respectively. The epidemiology of rheumatic conditions is characterized by its diversity in hospital setting. The scarcity of some conditions such as systemic lupus erythematosus, psoriatic arthritis, and ankylosing spondylitis has been confirmed in this cohort. Key Points • Twenty-three thousand five hundred and fifty patients were included in the study • Rheumatoid arthritis was the most frequent (51.61%) chronic inflammatory rheumatism • Contrary to studies from Europe and America, systemic lupus seems rare in our series.

18F-FDG PET molecular imaging: A relevant tool to investigate chronic inflammatory rheumatisms in clinical practice?

18F-Labeled Fluorodeoxyglucose-Positron Emission Tomography (18F-FDG PET) is a molecular imaging tool commonly used in practice for the assessment of many cancers. Thanks to its properties, its use has been progressively extended to numerous inflammatory conditions, including chronic inflammatory rheumatism (CIR) such as rheumatoid arthritis (RA), spondylarthritis (SpAs) and polymyalgia rheumatica (PMR). 18F-FDG PET is currently not recommended for the diagnostic of CIRs. However, this whole-body imaging tool has emerged in clinical practice, providing a general overview of systemic involvement occurring in CIRs. Numerous studies have highlighted the capacity of 18F-FDG PET to detect articular and extra articular involvements in RA and PMR. However, the lack of specificity of 18F-FDG limits its use for diagnosis purpose. Finally, the key question is the definition of the best way to integrate this whole-body imaging tool in the patient's management workflow.

10 Impact of the month of birth on the development of juvenile idiopathic arthritis among Tunisian children

BackgroundJuvenile idiopathic arthritis (JIA) is the most common inflammatory disease influenced by genetic as well as environmental factors. Prior studies from Israel and USA suggested that JIA had a seasonality of birth, with birth peaking in winter and especially in January.ObjectivesThe aim of the study was to evaluate the impact of month of birth and season, and the onset of JIA in Tunisian children.MethodsWe conducted a case-control study including 27 children with JIA compared with a homogeneous control group of 27 children hospitalized in a pediatric orthopedic unit for traumatic reasons and healthy for any chronic inflammatory rheumatism. Statistical differences between groups were also analyzed by non-parametrical tests.ResultsFifty-four patients (25 females and 29 males) were enrolled. The mean age was 11.04 ± 5.58 years and the mean duration of the diseases was 5.29 ± 3,18 years. The frequency of each JIA subset was at follows: polyarticular rheumatoid factor positive (n = 2), polyarticular rheumatoid factor negative (n = 5), psoriatic arthritis (n = 1), enthesitis-related arthritis (n = 11) and oligoarthritis (n = 8). Although the majority of children with JIA were born in November (22.2%) and December (18.5%), there was no significant difference in month of birth distribution between the cases and the controls. Likewise, there was no significant correlation between season of birth and the onset of the disease (p = 0,6).ConclusionThis study didn’t show any correlation between season and month birth, and the onset of JIA. Our result may be explained by the weather in Tunisia which is relatively warm with little variation in temperature between seasons compared with the country where they found a significant correlation. It also may be due to the limited number of our cases.

25 Impact of early feeding on the occurrence of juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA) is considered to be an autoimmune disease, which is a result of an immune reaction caused or triggered by environmental factors in a genetically susceptible individual. However, interactions between early feeding and risk Juvenile idiopathic arthritis (JIA) remains largely unexplored.ObjectivesTo determine the impact of early alimentation on the occurrence of JIA in Tunisia.MethodsWe conducted a case-control study including 26 children with JIA fulfilling the international league against rheumatism (ILAR) 2010 criteria compared with a homogeneous control group of 21 children hospitalized in a paediatric orthopedic unit for traumatic reasons and healthy for any chronic inflammatory rheumatism. Parents of patients were asked after having their consent to participate. We collected the following data: Type of JIA, juvenile disease activity score (JADAS), type of feeding, total duration of breastfeeding, duration of exclusive breastfeeding and age at introduction of gluten. Patients were divided into two groups: group 1 (G1): JIA patients, group 2 (G2): control group. Data were analyzed using the SPSS statistical package. A p-value < 0.05 was considered significant.ResultsForty-seven children (26 diagnosed with JIA and 21 controls) with a mean age of 10.07 years ± 4.96 were enrolled. JIA subtypes were in decreasing order of frequency: oligoarticular (45.8%), enthesitis-related arthritis (20.8%), undifferentiated JIA (12.5%), seronegative polyarticular JIA (8.3%), juvenile psoriatic arthritis (8.3%), and seropositive polyarticular JIA (4.2%). The mean JADAS was 6.966 ± 5.38. There was no significant difference between the G1 and G2 with regard to the duration of breastfeeding (12.23 ± 3.8 months vs 8.14 ± 4.1 months, p = 0.09), exclusive breastfeeding (3.8 ± 3.6 vs 4.1 ± 2.62, p = 0.40) and age at introduction of gluten (G1: 8.48 ± 5.30 months vs G2: 7.48 ± 1,2 months, p = 0.35)ConclusionOur study didn’t show any impact of early alimentation on the occurrence of JIA in Tunisia. However, more studies are necessary to conclude these issues.

38 Spectacular improvement of refractory calcaneal enthesitis with anti TNF alpha

BackgroundSpondyloarthritis is a heterogeneous group of chronic inflammatory rheumatism, of which enthesitis is the most common. Achilles involvement is frequent and can be disabling, resisting various treatments (non-steroidal anti-inflammatory drugs and local treatment). Only anti TNF alpha drugs are effective.We report the case of a patient with extremely painful achilles enthesitis causing functional disability who responded dramatically to anti TNF alpha.ObservationChild A.N, 13 years old, followed for juvenile idiopathic arthritis in the form of psoriatic arthritis evolving since the age of 4 years, treated with methotrexate at a rate of 7.5 mg/week, well balanced for 7 years.Three years later, the patient consulted us for disabling right inflammatory heel pain with the impossibility of putting his shoes on.The clinical examination revealed a painless position with the inability to put the heel on the ground; difficulty in walking requiring the use of crutches; pain on palpation of the Achilles tendon up to its insertion on the calcaneus, with painful limitation of dorsiflexion. Skin and mucous membrane examination revealed psoriasis lesions on the dorsum of the foot and on the nails.Laboratory tests: CBC without abnormality, ESR= 25mmH1 CRP =12mg/lX-ray of the rear feet: no abnormalities.Ultrasound of the right ankle: enthesitis taking colour doppler at the insertion of the Achilles tendon with erosion within the calcaneus.Magnetic resonance imaging of the right ankle: medullary oedema in the calcaneus with hyper signal on the DP sequence associated with retro calcaneal bursitis.The patient was put on NSAIDs without improvement, two ultrasound-guided cortisone injections were performed, followed by total failure. Treatment with an anti TNF alpha (Etanercept 0.8 mg/kg/week 25 mg) was started, the improvement was spectacular after 8 weeks with disappearance of the pain, including when standing, walking and putting shoes on. On the ultrasound (disappearance of the retro calcaneal bursitis and negativation of the doppler signal) no recurrence was noticed.ConclusionEnthesitis is an essential lesion in spondyloarthritis. Generally resistant to conventional DMARDs, anti TNF alpha is a treatment of choice.

Assessing central sensitization with quantitative sensory testing in inflammatory rheumatic diseases: A systematic review.

The major therapeutic challenge in inflammatory rheumatic diseases is the persistence of pain despite good responses to specific therapies. Central sensitization, which can be assessed clinically by psychophysical measurements, including quantitative sensory testing (QST), is a widely proposed mechanism for chronic pain. In this systematic review, we explored the scientific literature addressing quantitative sensory testing in inflammatory rheumatic diseases. We searched Pubmed and Embase for publications up to December 2021 concerning studies on quantitative sensory testing focusing on pain thresholds, temporal summation (TS) and conditioned pain modulation (CPM), in adult patients with chronic inflammatory rheumatism (e.g. rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, juvenile idiopathic arthritis). The exclusion criteria were reviews, inclusion of children and no reported pain threshold. Data quality was assessed with the National Institutes of Health (NIH) Quality Assessment tools. We identified 27 studies (18 controlled, 9 uncontrolled) including 1875 patients with inflammatory rheumatic diseases and 795 controls. A decrease in pressure pain threshold, in favor of allodynia, was found in 12 of 14 controlled studies on patients with rheumatoid arthritis and spondyloarthritis. The results of other psychophysical tests, including TS and CPM, were inconsistent due to population heterogeneity and a lack of standardization of the patients' disease duration, activity and treatment. Our review shows that pain in chronic inflammatory rheumatism is associated with pressure allodynia. However, given the heterogeneous quality and discrepant results of studies of other QST outcome measures, the hypothesis of central sensitization involvement in pain processing in these patients cannot be confirmed.

Prévention des infections et vaccination dans les rhumatismes inflammatoires chroniques

Patients with chronic inflammatory rheumatisms (CIR) have a higher risk of infections compared to healthy subjects. Viral and bacterial pneumonia are the most frequent infections observed in CIR under targeted DMARDs. Moreover, drugs used to treat CIR and especially biologic and synthetic targeted disease modifying anti-rheumatic drugs (DMARDs) increase this risk of infection and expose CIR patients to opportunistic infections such as tuberculosis reactivation. In order, to limit the risk of infection, the benefit and risk ratio has to be evaluated for each patient according to characteristics and comorbidities. To prevent infections, an initial pretreatment work up has to be performed especially before initiation of conventional synthetic DMARDs or biological and synthetic targeted DMARDs. This pre-therapeutic assessment is based on questioning, biological and morphological explorations as well. Vaccination's update has to be checked and recommended vaccines for patients with auto-immune diseases and treated with conventional synthetic DMARDs, bDMARDs, tsDMARDs and/or steroids should be done. Information and education of patients are very important. During specific workshop, they learn how to manage drugs in situations at risk and they learn symptoms that require drug discontinuation.

Prévenir les complications cardiovasculaires dans les rhumatismes inflammatoires chroniques

Cardiovascular disease is the main comorbidity of chronic inflammatory rheumatisms. This increase in prevalence is directly related to systemic inflammation, which increases athematosis processes, but also to the high prevalence of cardiovascular risk factors associated with chronic inflammatory rheumatisms. The rheumatologist has a central role in the management of patients with chronic inflammatory rheumatism and has to know how to assess the cardiovascular risk, to choose the most adapted disease modifying anti-rheumatic drug, to limit the use of long-term NSAIDs and to initiate corticosteroid withdrawal. He should be able to give lifestyle advices, adapted to the level of risk and the capacities of the patients and refer to the specialist high cardiovascular risk patients.

AB0866 Women spondyloarthritis: epidemiological, clinical and paraclinical characteristics

BackgroundSpondyloarthritis (SPA) is a chronic inflammatory rheumatism characterized by sacroiliitis and spinal involvement, affecting both genders but more frequent in males.ObjectivesThe aim of this study is to analyze the epidemiological, clinical and paraclinical characteristics of Spondyloarthritis in women.MethodsRetrospective study included 333 patients followed up for SPA at the Rheumatology Department between 2004 and 2021.ResultsOur study involved 153 women and 180 men. In the female population, the mean age was 45.1 years, 12.4% had high blood pressure, 4.8% had a psychiatric comorbidity and none of the patients were smokers, versus a mean age of 36.4 years, 5% of high blood pressure’s patients, 1.7% having a psychic comorbidity and 25% of the smokers for the male with SPA. The age of onset of symptoms was 36.5 years for women versus 28 years for men (p =0.001). Axial involvement was 84.3% in women and 85% in men, while peripheral and enthesial involvement was present in 73.8% and 56.8% of female subjects and 58.8% and 46.6% of male subjects (p at 0.004 and 0.064 respectively). Coxitis was present in 13.1% and syndesmophytis in 15.3% of females versus 36.1% and 18.3% of males (p at 0.001 and 0.4 respectively). Mean erythrocyte sedimentation rate was 45.7, mean CRP 28.5 and mean calcemia 92 in the 1st group versus 43, 40.6 and 93.4 in the 2nd (p at 0.4; 0.03 and 0.03 respectively). Relapse was 26.8% in female with SPA and 12.6% in male (p =0.025)ConclusionIn our study, females SPA patients developed symptoms later than did males, peripheral and enthesial involvement is more common in females while coxitis is more common in males with statistically significant higher CRP and calcemia.