International League Of Associations For Rheumatology Research Articles

Artritis idiopática juvenil

Juvenile idiopathic arthritis (JIA) encompasses a heterogeneous group of chronic arthritis of unknown origin that appear before 16 years of age and persist for more than six weeks, once other causes are excluded. They are characterized by the presence of joint inflammation and are accompanied to a greater or lesser extent by systematic manifestations. It is the most frequent chronic inflammatory rheumatic disease in childhood. The currently accepted classification groups are those described by the International League of Associations for Rheumatology (ILAR). However, new modifications to these criteria have recently been proposed. JIA has a multifactorial etiopathogenesis, immunological mechanisms, and environmental mechanisms that act on a genetically predisposed individual. Except for the systemic JIA subtype, which has an autoinflammatory basis, the remaining JIA forms have a clear autoimmune component. Early diagnosis and adequate treatment are crucial for avoiding complications. This treatment must be individualized based on clinical manifestations and the degree of organ involvement. In addition to glucocorticoids and synthetic disease-modifying drugs (DMDs), the prognosis of JIA has notably improved since the introduction of biological DMDs.

A Study Protocol for the Management of Children With Juvenile Idiopathic Arthritis Based on ePROs.

BackgroundJuvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease with no known cures, affecting children with the age of onset under 16 years. Patient-reported outcome (PRO) measures are an important basis for evaluating the impact of JIA and associated therapies, however, which is particular challenge in the pediatric setting. At present, no randomized controlled studies have investigated the effect and usability of ePROs symptom management for children with JIA.MethodsThis longitudinal, randomized, controlled trial will be carried out at outpatient and pediatric wards of the Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine. A total of one hundred children with JIA diagnosed according to the International League of Associations for Rheumatology (ILAR) patients are randomized to receive individualized symptom management based on ePROs or routine management. The primary outcome is the mean C-Ped-PROMIS T-scores of patients in the ePROs-based group and the control group. The secondary outcomes are the trajectories of C-Ped-PROMIS T-scores and HRQOL scores, and changing relationship between them. Data were collected at 5 time points: at enrollment (“baseline”) and at the time of follow-up visits scheduled at 1, 3, 6, and 12 months.DiscussionThe findings are expected to conclude that the symptom management based on ePROs for children with JIA can improve the symptom of JIA, and it is a feasible and effective way to monitor and intervene children with JIA.Clinical Trialhttp://www.chictr.org.cn/showproj.aspx?proj=132769; (ChiCTR2100050503)

A Comparison of International League of Associations for Rheumatology and Pediatric Rheumatology International Trials Organization Classification Systems for Juvenile Idiopathic Arthritis Among Children in a Canadian Arthritis Cohort.

The aim of the Paediatric Rheumatology International Trials Organisation (PRINTO) juvenile idiopathic arthritis (JIA) classification criteria, which is still in development, is to identify homogeneous groups of JIA patients. This study was undertaken to compare International League of Associations for Rheumatology (ILAR) JIA classification criteria and PRINTO JIA classification criteria using data from the ReACCh-Out (Research in Arthritis in Canadian Children, Emphasizing Outcomes) cohort. We used clinicobiologic data recorded within 7 months of diagnosis to assign a diagnosis of JIA and identify subcategories of JIA among 1,228 patients according to the 2 JIA classification systems. We compared the proportions of patients classified and the alignment of classification categories with clinicobiologic subtypes and adult arthritis types. The PRINTO criteria classified 244 patients (19.9%) as having early-onset antinuclear antibody-positive JIA, 157 (12.8%) as having enthesitis/spondylitis-related JIA, 38 (3.1%) as having systemic JIA, and 10 (0.8%) as having rheumatoid factor-positive JIA. A total of 12% of patients were unclassifiable using the ILAR criteria, while 63.3% were unclassifiable using the PRINTO criteria (777 with other JIA and 2 with unclassified JIA). In sensitivity analyses, >50% of patients remained unclassifiable using the PRINTO criteria. Compared to the PRINTO criteria, ILAR JIA categories aligned better with clinicobiologic subtypes in 131 patients (χ2 = 44, P = 0.005, versus χ2 = 15, P = 0.07 for PRINTO), and ILAR categories aligned better with adult types of arthritis in 389 evaluable patients. Currently identified PRINTO disorders can only be used to classify a minority of JIA patients, leaving a large proportion of JIA patients with other disorders requiring further characterization. Current PRINTO JIA classification criteria do not align better with clinicobiologic subtypes or adult forms of arthritis compared with the older ILAR classification system.

B Cells on the Stage of Inflammation in Juvenile Idiopathic Arthritis: Leading or Supporting Actors in Disease Pathogenesis?

Juvenile idiopathic arthritis (JIA) is a term that collectively refers to a group of chronic childhood arthritides, which together constitute the most common rheumatic condition in children. The International League of Associations for Rheumatology (ILAR) criteria define seven categories of JIA: oligoarticular, polyarticular rheumatoid factor (RF) negative (RF-), polyarticular RF positive (RF+), systemic, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. The ILAR classification includes persistent and extended oligoarthritis as subcategories of oligoarticular JIA, but not as distinct categories. JIA is characterized by a chronic inflammatory process affecting the synovia that begins before the age of 16 and persists at least 6 weeks. If not treated, JIA can cause significant disability and loss of quality of life. Treatment of JIA is adjusted according to the severity of the disease as combinations of non-steroidal anti-inflammatory drugs (NSAIDs), synthetic and/ or biological disease modifying anti-rheumatic drugs (DMARDs). Although the disease etiology is unknown, disturbances in innate and adaptive immune responses have been implicated in JIA development. B cells may have important roles in JIA pathogenesis through autoantibody production, antigen presentation, cytokine release and/ or T cell activation. The study of B cells has not been extensively explored in JIA, but evidence from the literature suggests that B cells might have indeed a relevant role in JIA pathophysiology. The detection of autoantibodies such as antinuclear antibodies (ANA), RF and anti-citrullinated protein antibodies (ACPA) in JIA patients supports a breakdown in B cell tolerance. Furthermore, alterations in B cell subpopulations have been documented in peripheral blood and synovial fluid from JIA patients. In fact, altered B cell homeostasis, B cell differentiation and B cell hyperactivity have been described in JIA. Of note, B cell depletion therapy with rituximab has been shown to be an effective and well-tolerated treatment in children with JIA, which further supports B cell intervention in disease development.

Relationship between juvenile idiopathic arthritis and periodontal diseases

Background: Juvenile idiopathic arthritis (JIA) is an arthritis of unknown etiology that begins before the 16th birthday and persists for at least six weeks with other known conditions excluded. In JIA, there is a destructive inflammatory process in the border between bone and connective tissue of the joint similar to the inflammatory process of the supporting tissue around the tooth in periodontitis. Objective: To emphasize the role of a pedo-dentist in the multidisciplinary management of JIA (to treat this detrimental disease before it becomes irreversible). Patients and Methods: A case-control study was conducted among JIA patients at Baghdad Teaching Hospital, Rheumatology Unit and private rheumatology clinic during the period September 2020 to May 2021. Twenty Iraqi patients diagnosed with JIA by rheumatologist (after fulfilling International League of Associations for Rheumatology (ILAR) criteria), compared with 20 healthy control individuals matched age. All patients were sent to specialized pediatric dental clinic in Baghdad where dental examination was applied. The examinations were conducted by two certified specialist pedo-dentist to indices Dental findings (dmf-s/DMF-S), Gingival inflammation (GI), Plaque index (PI). The surfaces of Ramfjord teeth were examined with diagnostic instruments (mirror and periodontal probe) and scored for all indices. Results: According to joint numbers involved, the polyarticular manner was the most common in 40% of patients, followed by oligoarticular in 35% of patients, and systematic manner in 20% of patients. In addition, one case presented with enthesitis related arthritis. The mean of gingival index (GI) in patients’ group (0.88±0.623) was higher than that of control group (0.61±0.53), without any significant difference (p=0.0545). However, the plaque index (PI) results showed high statistically significant difference (p=0.0162), similarly, the dmfs demonstrated a high significant difference (p=0.026) between patient and control groups. The DMFs was statistically significant (p=0.015), CRP level in relation to the indices, all indices have a significant high level association level (≥5mg/L) over normal level of CRP (<5 mg/L), effect of Prednisolone was statistically significant for GI (p=0.0245), and dmfs (p=0.0015). However, it was not significantly different in the value of PI (p=0.098), and DMFs (p=0.0627). In our study DMARDs (MTX) had a direct effect on GI and PI with a statistically significant difference (p=0.0164), and (p=0.017), respectively. Finally, the role of MTX on dmfs and DMFs was not significant. Conclusions: The indices used in this study to evaluate oral health in JIA children were GI has no significant difference compared to healthy children; PI was significantly higher compared to healthy children; the dmfs/DMFS both showed significantly higher compared to healthy children. The high CRP level has a significant association with GI, PI and dmfs, but no significant association with DMFs. Regarding the JIA treatment, Prednisolone has significantly modified all indices (in particular GI and DMFs), NSAIDs has significantly modified PI only, DMARDs (MTX) had direct effect on GI and PI, but no role on dmfs and no significant effect on DMFs.

Changing Patterns in Treatment, Remission Status, and Categories in a Long-Term Nordic Cohort Study of Juvenile Idiopathic Arthritis.

To explore sustainability of achieved remission off medication and defined International League of Associations for Rheumatology (ILAR) categories in juvenile idiopathic arthritis (JIA) and describe the trajectory of disease course over time by comparing treatment, disease activity, and ILAR categories from baseline, 8 years, and 18 years after disease onset. A total of 373 of the 510 included patients were initially recruited consecutive cases of JIA from the prospective, longitudinal, population-based Nordic JIA cohort with disease onset during 1997-2000 from Denmark, Norway, Sweden, and Finland in an 18-year follow-up study. Clinical data were collected consecutively at baseline, 8 years, and 18 years after disease onset and were evaluated regarding treatment, disease activity, and ILAR category. Significantly more patients (70%) were off medication after 18 years of follow-up compared to after 8 years (59.7%); nevertheless, the number of patients in remission had not increased (52% off medication versus 51% on medication). Twelve percent of patients changed ILAR category between 8 years and 18 years after disease onset. Almost half of the changes were due to updated information about heredity in a first-degree relative. In the same period, the psoriatic arthritis group increased significantly in number (P < 0.001), in contrast to the oligoarticular category, which decreased (P=0.02). The undifferentiated group increased 24% from 8 to 18 years of follow-up; however, this increase was not significant (P=0.06). In this Nordic JIA cohort study, the remission rate did not increase even though significantly more patients were off medication at the 18-year follow-up compared to at the 8-year follow-up after disease onset. The distribution of patients in the ILAR categories continued to change significantly throughout the 18-year study period.

The performances of the ILAR, ASAS, and PRINTO classification criteria in ERA patients: a comparison study.

Enthesitis-related arthritis (ERA) could be considered the pediatric equivalent of ankylosing spondylitis in adults albeit with certain significant differences. We aim to evaluate the sensitivity and specificity of the International League of Associations for Rheumatology (ILAR), the Assessment of Spondyloarthritis International Society (ASAS), and the preliminary Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria in ERA patients. The medical records of ERA patients who were followed up between January 2005 and September 2020 have been analyzed. The control group consisted of patients with oligoarticular JIA (n = 146), polyarticular JIA (n = 55), and psoriatic arthritis (n = 20). This retrospective study included 108 ERA (73.1% male) and 221 control patients (25.8% male). The median age at diagnosis for ERA and control patients were 12.5 and 4.0years, respectively (p < 0.001). Arthritis was observed more frequently in the control group at diagnosis and in the follow-up (p < 0.001 for both), while enthesitis, sacroiliac joint tenderness, and inflammatory back pain were more common in the ERA group both at diagnosis and in the follow-up (p < 0.001 for all). In sacroiliac imaging, 70.1% of ERA patients had positive findings suggestive of sacroiliitis at diagnosis and 78% in the follow-up. The sensitivities of ILAR, PRINTO, ASAS criteria for axial SpA, and peripheral SpA at diagnosis were 74.0%, 57.4%, 21.3%, and 85.1%, respectively which increased to 82.4%, 78.7%, 35.1%, and 92.5%, respectively at follow-up. The specificities were 100%, 100%, 99.1%, and 90.9%, respectively at both diagnosis and follow-up. The ASAS criteria for peripheral SpA were the most sensitive while ILAR and the preliminary PRINTO criteria were the most specific criteria for classifying ERA patients. The ASAS criteria for peripheral SpA were the most sensitive criteria for classifying ERA patients. The use of ASAS axial SpA criteria may provide early detection of axial involvement.

EVALUATION OF SERUM CALPROTECTIN AS A PROGNOSTIC MARKER OF DISEASE SEVERITY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS AT A TERTIARY CARE HOSPITAL IN BIHAR

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and one of the more common chronic illnesses during childhood. Calprotectin (S100A8/S100A9 protein) is known as a damage-associated molecular pattern (DAMP) protein and reects neutrophil activation during inammation. This study aims to evaluate the role of serum calprotectin as a marker to monitor the disease activity in children from Bihar, India with JIA. 107 children with JIA as per International League of Associations For Rheumatology (ILAR) criteria were recruited into the study, out of which 56 had active disease and 51 had inactive disease. Mean calprotectin value in children with active disease was found 2-fold higher than those with inactive disease. Also, calprotectin levels were analysed in 10 normal healthy children and it was observed that mean calprotectin value in children with active disease was 16-times higher than those who were normal healthy controls. Evidently, serum calprotectin levels were found to be a good marker of disease activity in children with JIA.

Temporomandibular joint in juvenile idiopathic arthritis: magnetic resonance imaging measurements and their correlation with imaging findings.

The aim of this study was to investigate the TMJ components in patients with juvenile idiopathic arthritis (JIA) and to compare them with a control group based on magnetic resonance imaging (MRI) measurements. This study comprised an assessment of MRI measurements of 96 temporomandibular joints (TMJ) following classification criteria set by the International League of Associations for Rheumatology (ILAR). Three measurements were considered for study: condyle excursion angle (CEA), height of articular eminence (HAE) and inclination of articular eminence (IAE). All TMJs were assessed by linear measurements made by using the OnDemand 3D software. The comparison between the groups was performed by using Mann-Whitney's test. Lower measurement values were found for IAE, HAE and CEA in JIA patients (P-values < 0.001, 0.005 and < 0.001, respectively). The study showed the differences in MRI measurements between JIA patients and controls, with the former with the lowest indices.

P039 Evolutionary course of Juvenile Idiopathic Arthritis

Abstract Background Juvenile idiopathic arthritis (JIA) is a heterogeneous group of rare conditions that begin before the age of 16. Seven categories have been defined by the International League of Associations for Rheumatology (ILAR) classification. The aim of our work is to describe the demographic, clinical, and radiological characteristics and therapeutic of patients with JIA. Materials and methods A retrospective, descriptive study of patients followed for AIJ in the rheumatology department of Mohamed LamineDebaghine during a period of 15 years (2005–2020). Patients were included if satisfied ILAR criteria. Results Ten patients with JIA were included, 5 of whom were females. The mean age of onset was 9.20 ± 3.15 (range: 5–14 years). The subtypes were as follows: 4 patients had RF-negative polyarthritis, one case had RF-positive polyarthritis, one with systemic arthritis form, 2 cases of oligoarthritis, 1 case of psoriatic arthritis, and enthesitis-related arthritis. Three children have coxitis. ACPA was positive in one case and antinuclear antibodies were negative. Eight patients have developed osteoarticular destruction. Pulmonary involvement was noted in a patient who had RF-positive polyarthritis. Corticosteroid therapy was prescribed in 9 patients, 5 of whom developed complications related to steroids, including growth retardation, which was observed in 3 cases. Nine JIA patients received methotrexate. The use of etanercept and IL-1 inhibitors were required in 7 and 1 cases, respectively. Corticosteroid infiltrations were performed in 9 patients. Total hip replacement was indicated in 3 patients. Conclusion Through our study, we note a predominance of the polyarticular form. Osteoarticular destruction seems to be frequent, particularly in the hip. The use of biotherapy and the total hip prosthesis proved the severity of juvenile idiopathic arthritis in our patients.

P023 Impact of Juvenile Idiopathic Arthritis on schooling and family life

Abstract Background Juvenile Idiopathic Arthritis (JIA) and its related symptoms have been associated with interference in the daily life of children and adolescents with JIA including their friendships, their school attendance and sometimes their family life. The aim of the study was to describe the impact of JIA on schooling, social and family life from the point of view of children. Methods We interviewed 23 children and adolescents, diagnosed with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR). Results The mean age of our group was 16 years, with a sex ratio of 3. Eight percent of the children were in elementary school, 21.7% in high school and 8.7% in university. Eighty-seven per cent reported school absenteeism due to JIA (pain, being hospitalized,) with a mean of 8 missed school days. Forty-three per cent failed in their schooling at some point. Thirty percent thought it was related to the consequences of their disease. Only 47.8% found the school staff to be helpful and supportive. Seventy eight percent felt understood and supported by their family in dealing with the different aspects of JIA. Twenty-six per cent felt more spoiled than their other siblings, creating tension sometimes. Fifty two percent felt different and not accepted by their peers because of the JIA. Conclusions Children with JIA are already suffering from the physical aspect of their disease. Initiating an open discussion with them might reduce the burden these children are carrying often in silence, and improve long-term outcomes in terms of schooling, social and, family life.

P031 Adherence with Methotrexate in Tunisian Juvenile Idiopathic Arthritis Patients

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in the pediatric population. Methotrexate (MTX) has been considered as the cornerstone of treatment of poly and oligoarticular subtypes of JIA. However, this treatment is supposed to be for long term, which may involve an obstacle for adherence. The aims of the study were to evaluate adherence of Tunisian JIA patients to MTX and to identify factors associated with high adherence to MTX. Methods A cross-sectional study including patients with confirmed JIA diagnosis, according to the International League of Associations for Rheumatology (ILAR) criteria, was performed. Demographic data as well as disease characteristics were obtained from medical records. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. Adherence was measured, for patients under MTX for &amp;gt;3 months, using the 5-item Compliance Questionnaire Rheumatology (CQR5) (1). Patients were divided into two groups: group 1: High adherence (HA) for patients having a CQR5 ≥ 80% and group 2: low adherence (LA) for patients having CQR5 &amp;lt; 80%. A p inferior to 0.05 was considered statistically significant. Results The study included 29 patients (10 males and 19 females) with a mean age at disease onset of 9.1 ± 3.4 years. The mean disease duration was 61 ± 79 months [7–336]. JIA subtypes were in decreasing order of frequency as follows: enthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular without rheumatoid factor (n = 4), Polyarticular with rheumatoid factor (n = 2), systemic (n = 1) and, psoriatic arthritis (n = 1). A biologic inflammatory syndrome was found in 48.3% (n = 14) of cases. The mean ESR and CRP were 20 mm/h ± 11.3 [3–98] and 5 ± 17.8 mg/l [0–56] respectively. Nineteen (65.5%) patients had coxitis. Overall, 55.17% of patients (n = 16) were treated with MTX with a mean weekly dose of 9.2 ± 3.2 mg [5–15]. MTX was orally administrated in all patients. NSAIDs and prednisone were prescribed in 51.7% (n = 15) and 17.2% (n = 5) of cases respectively. The MTX was associated with biological DMARDs in five patients (17.2%). It was about Etanercept in 4 patients and Tocilizumab in 1 patient. Mean CQR5 score was 70.8% ± 18 [25–100]. Only seven patients (43.8%) showed high adherence to MTX. The statistical study revealed no difference between HA and LA in term of gender (P = 0.84), age at disease onset (P = 0.39), disease duration (P = 0.9), prednisone use (P = 0.22), the occurrence of coxitis (P = 0.2), ESR (P = 0.83) and CRP (P = 0.033) rates. Conclusion In this study, less than one half of JIA patients were highly adherent to MTX according to CQR5. Low adherence should be considered before declaring MTX treatment failure.

P057 Uveitis in enthesitis-related arthritis: what are the predictive factors?

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Uveitis is its most common extra-articular manifestation [1]. It is a potentially sight-threatening condition with a considerable risk of morbidity. This study aimed to describe the prevalence and characteristics of JIA-related uveitis in enthesitis-related arthritis (ERA) patients. Methods We conducted a retrospective study including 40 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR). All selected patients presented with ERA. A screening of uveitis was conducted in all patients. Clinical, radiologic and, biologic features of JIA were collected. We evaluated the association between these features and the presence of uveitis. Results The mean age of our patients was 24 years, with a sex ratio of 3. The mean age at the onset of JIA was 11 years. Upon screening, fifteen percent of the patients had active uveitis. Nine percent of the patients presented with an acute onset of JIA. Forty-six percent had initial spinal symptoms, while 26% presented with peripheral onset. Upon examination, 4% of the patients presented with monoarthritis, 20.4% with oligoarthritis and 34.8% with polyarthritis. Thirteen percent had enthesitis. Fifty-seven percent of the patients had coxitis. Sixty-eight percent had sacroiliitis. The mean CRP and ESR levels were respectively 16 mg/l and 34. Human leucocyte antigen (HLA) B27 screening came back positive in 11% of the cases. The mean BASDAI and BASFI levels were both at 4.7. The mean MASES was 0.44. Twenty percent of the patients received NSAIDs. Eleven percent received methotrexate, 18% salazopyrine and, 5.6% biologics. A significant association was established between the presence of uveitis and a polyarticular onset of JIA (P = 0.036). However, no significant associations were established with the sex of patients (P = 0.457), age of onset (P = 0.828), activity of the disease as evaluated by BASDAI (P = 0.40) and MASES (P = 0.87), inflammatory markers (CRP P = 0.946, and ESR P = 0.662), the use of NSAIDS (P = 1), methotrexate (P = 0.318), salazopyrine (P = 0.170) and biologics (P = 1). Conclusion In conclusion, uveitis associated with JIA is a serious and sight-threatening disease. Several factors associated with a more severe disease development have been identified [2–4]. Our study showed a significant association between the polyarticular onset of JIA and the occurrence of uveitis. Also, our study showed no significant association with male gender and HLA-B27 in children, unlike previous studies of spondyloarthritis conducted in adults [5–6]. We conclude that the screening of uveitis should be performed in all JIA patients, especially those presenting initially with polyarthritis.

P038 Let’s look at coxitis features in enthesitis-related arthritis population

Abstract Background Enthesitis-related arthritis (ERA) is a defined juvenile idiopathic arthritis subtypes, which presents with enthesitis, arthritis and axial skeleton involvement. ∼20–50% of JIA patients have hip involvement within 1–6 years of diagnosis onset [1]. The frequency of coxitis in ERA category is not recognized. The aim of this study was to assess coxitis features and its management in ERA population. Methods A retrospective study including children with ERA according to the International League of Associations for Rheumatology (ILAR). Data recorded included sociodemographic features, disease characteristics (disease duration, extra-articular manifestations, and presence of HLAB27) as well as treatment modalities. Regarding coxitis, we collected radiographs, ultrasound (US) and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema). Results The study included 51 patients with ERA. There was a male predominance (78.4%). The mean age of onset of the disease was 12.2 years [6–16]. The mean current age was 24.3 years old [9–59]. A family history of spondyloarthritis was found in 26.8% of cases. A positive HLAB27 was reported in 85.7% of cases. The distribution of extra-articular manifestations (37.5%) was as follows: ocular (n = 8), cardiovascular (n = 2), gastrointestinal (n = 1), pulmonary (n = 4). A peripheral onset was found in 39% and a peripheral and axial onset was reported in 42% of patients. Hip involvement was found in 78.4% of the patients and revealed the disease in 43% of cases. The mean delay between disease onset and coxitis was 4.5 years [0–34]. Coxitis was bilateral and destructive in 82.5% and 51% of cases respectively. The most limited range of motion was the internal rotation (68%), followed by hip flexion (48%) and the external rotation (43.2%). In patients with normal hip radiography (n = 8), US or MRI depicted early changes in 75% of cases. Hip replacement was noted in ten patients and was bilateral in 70% of cases. Regarding treatment modalities, NSAIDs and csDMARD (MTX n = 14, SLZ n = 8, biologics n = 2) were prescribed in 76.4% and 52% respectively. Most of the patients had physical therapy (88%) and 23.5% of them had intra-articular corticoid injection. Twenty-six percent of the patients had hip replacement. Conclusion Our study showed a high prevalence of coxitis among ERA patients. There is a need to further optimize therapeutic strategies for such patients.

P020 The male gender predicts the hip involvement among JIA patients

Abstract Background Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of chronic arthritides that affect children aged 16 years and under. Regardless of the clinical presentation, hip involvement ranges between 20% to50% of cases [1]. The aim of the present study was to examine the role of gender and disease onset in coxitis involvement. Methods We conducted a cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR)). Transcribed data included age, sex and the characteristics of the disease (subtype of JIA, disease duration). Regarding coxitis, we collected radiographs, ultrasound (US) and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema). We divided patients into two groups: G1: presence of coxitis and G2: absence of coxitis. Results The study included 62 patients with a male perdominance: sex ratio was 2.3. The mean age of onset of the disease was 11.4 years [3–16]. The frequency of each JIA subset was as follows: polyarticular with rheumatoid factor (n = 2), polyarticular without rheumatoid factor (n = 4), systemic (n = 1), enthesitis-related arthritis (n = 44), oligoarthritis (n = 8), psoriatic arthritis (n = 3). A Hip involvement was reported in 71% of cases and was bilateral in 81% of patients. Coxitis was not correlated with the disease duration (P = 0.7). A positive correlation was found between the age of onset of the disease and the presence of coxitis (12.2 vs 9.6, P = 0.005). However, hip involvement was higher among males without significant difference (76.7% vs 58%, P = 0.132). Conclusion Unlike the literature data, our study showed a high frequency of hip involvement in Tunisian children with JIA. We found an association between the male gender and coxitis involvement without significant difference. However, coxitis was more frequent in later onset of the disease.

P021 Children living with Juvenile Idiopathic Arthritis: their views about online resources and social media

Abstract Background Adolescents and children nowadays are quite accustomed to using the Internet for personal, social, and educational purposes. The purpose of our study was to determine the point of view of children with juvenile idiopathic arthritis (JIA) regarding the impact of social media on their lives. Methods We interviewed 23 children and adolescents, diagnosed with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR). Results The mean age of our group was 16 years, with a sex ratio of 3. Ninety-seven of our participants confirmed that they’re using social media, for a mean of 3 h per day. YouTube and Facebook came back as the first two preferred platforms: 82.6% and 69.6% respectively, followed by Instagram 30.4%, Tiktok 21.7, Snapchat 17.4% and Whatsapp 8.7%. Seventeen percent of children viewed these platforms as a positive and helpful in dealing with JIA, specially taking their mind of pain, dealing with the stress resulting from the lack of mobility and facilitating interactions with others. Interestingly, none of the participants considered online resources as a place to interact with health professionals or have access to information about JIA. Conclusions According to their perceptions, children with JIA can benefit from an online resource, which helps them cope with some aspects of their disease, especially taking their mind of pain. Therefore, if used properly by health professionals, these online sources may be a great opportunity to deliver simplified and useful medical information for children with JIA.

P033 Impact of breastfeeding on Juvenile Idiopathic Arthritis outcomes

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common, chronic rheumatic disease of childhood. The aetiology is still unclear. Over the past few years, several studies have investigated the association between JIA and environmental exposures such as infections and parental smoking. However, data concerning the influence of past breastfeeding on the presentation and the severity of JIA remain scarce and still a matter of debate (1, 2).The aim of this study was to determine the influence of breastfeeding history on the pattern and severity of JIA. Methods A cross-sectional monocentric study was carried out on JIA patients according to International League of Associations for Rheumatology (ILAR). Demographic, clinical and biological data were collected from medical records. Breastfeeding data were obtained by interviewing mothers. Patients were divided into two groups: group 1 (G1) stands for JIA patients breastfed over 6 months and group 2 (G2) stands for JIA non-breastfed patients or patients breastfed &amp;lt;6 months. Data were analyzed using the SPSS statistical package. A p-value &amp;lt; 0.05 was considered significant. Results Twenty-nine patients (10 male and 19 female) were enrolled. Mean age at disease onset was 9.1 ± 3.4 years [2–15]. Median diagnosis delay from symptoms onset was 3.5 ± 21. 1 SD months [1–72]. Median disease duration was 36 ± 79 SD months [7–336]. JIA subtypes were in decreasing order of frequency: enthesitisenthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular RF- (n = 4), Polyarticular RF + (n = 2), systemic (n = 1) and psoriatic arthritis (n = 1). Inflammatory markers were raised in 48.3% (n = 14) of cases. Median ESR (raised in 41.3% of the cases) and CRP (raised in 34.4% of the cases) were 17 ± 25.1 SD mm/h [3–98] and 3 ± 18 SD mg/l [0–56]. Among patients with enthesitis-related arthritis, median BASDAI and BASFI scores were 1.8 ± 1.6 SD [0.3–6.3] and 2.5 ± 1.7 SD [0–6] respectively. Only 16 (55.2%) patients had bone densitometry. Osteoporosis and osteopenia were found in 10.3% and 13.8% of cases, respectively. Coxitis was found in 65.5% of patients (n = 19). Overall, 82.8% of children (n = 24) were breastfed. Breastfeeding was exclusive in 55.2% of cases (n = 16). Median breastfeeding duration was 12 ± 10.3 SD months [1.5–48]. Over two-thirds (n = 19) of patients were breastfed for &amp;gt;6 months. The statistical study revealed that G1 had significantly lesser occurrence of coxitis than G2 (57.9% vs 80%; P = 0.032). Age at disease onset (P = 0.26), diagnosis delay (P = 0.9), raised inflammatory markers (P = 0.76) and the frequency of osteoporosis (P = 0.87) were comparable between the two groups. No correlation was noted between breastfeeding duration and the following parameters: age at disease onset, ESR rate, CRP rate, BASDAI and BASFI. Conclusions In this study, JIA patients breastfed over 6 months had fewer coxitis occurrence. Further investigations with larger sample sizes are still required to assess the benefits of breastfeeding on JIA outcomes.

P035 Hip involvement in Tunisian Juvenile Idiopathic Arthritis patients

Abstract Background Juvenile idiopathic arthritis (JIA) is characterized by a widely variable clinical course and outcome. If uncontrolled, joint damage may occur. In this context, coxitis is a feared complication. The aim of our study was to determine the prevalence and patterns of hip involvement in Tunisian JIA patients. Methods A retrospective study including children with JIA according to the International League of Associations for Rheumatology (ILAR)) was conducted between 2012and 2021. Sociodemographic data as well as disease characteristics were collected. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Hip involvement was assessed clinical exam and imaging (standard radiograph, ultrasound or magnetic resonance imaging (MRI)). We compared these parameters between the two groups: G1: presence of coxitis and G2: absence of coxitis. Results The study included 40 patients with a male predominance: sex ratio was 1.6. The mean age was 11.1 years-old [3–16]. The mean age at onset of the disease was 18.1 years old [8–30]. The distribution of the different subsets was as follows: polyarticular with rheumatoid factor (n = 1), polyarticular without rheumatoid factor (n = 2), enthesitis-related arthritis (n = 29), oligoarthritis (n = 7), psoriatic arthritis (n = 1). Extra-articular manifestations were found in 21.2% of cases: ocular (n = 4), pulmonary (n = 2) and cardiovascular (n = 1). The mean ESR and CRP was 30.9 mm/h [2–90] and 15.8 mg/l [1–70] respectively. A high ESR or CRP were found in 67% of cases. Hip involvement concerned 70% of the patients and was bilateral in 67.9% of them. Hip radiographs were normal in 50% of cases. Ultrasound was performed in 9 patients and revealed a positive Doppler synovitis (n = 2), a negative Doppler synovitis (n = 7) and joint effusion (n = 2). MRI was performed in 20% of cases and revealed synovitis (67%) and joint effusion (33%). Overall, 79.3% of patients had medical treatment combining NSAIDs and rehabilitation, 39% of the patients had had local infiltration with Hexatrione and only two patients had hip replacement. Hip involvement was not correlated with age at onset (P = 0.2), subtype (P = 0.8), sex (P = 0.7), extraarticular manifestations (P = 0.4). Similarly, there was no correlation between the presence of coxitis and ESR (P = 0.07) as well as CRP (P = 0.5). Conclusion Our study showed that hip involvement is frequent among Tunisian patients with JIA. Although not correlated with disease characteristics, hip involvement should be assessed frequently and carefully.

P022 Genetic background predicts the extra-articular involvement in patients with enthesitis related arthritis

Abstract Background Enthesitis-related arthritis (ERA) represents 20% of all juvenile idiopathic arthritis subtype. Among the genetic risk factors for the development of ERA, HLA-B27 has been implicated as a major contributor. The frequency of HLA-B27 varies among population. HLA-B 27 status in ERA may influence the clinical phenotype and prognosis of the disease. The main objective of this study is to determine whether genetic background including HLA B27 and familial history of spondylarthritits (SpA) may influence the clinical features of ERA patients. Methods We conducted a retrospective study including patients with ERA, all fulfilling the International League of Associations for Rheumatology (ILAR) criteria. For all patients, we collected the following data: Age, family history of rheumatic inflammatory diseases, inflammatory bowel diseases (IBD), the presence of HLA-B27 antigen, the inflammatory biomarkers: Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP), the disease activity assessed by morning stiffness, night awakenings, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the current treatment. We assessed, as well, the functional impact using the Bath Ankylosing Spondylitis Functional Index (BASFI) the Lequesne index. The population was divided into two groups: a group including patients positive to HLA-B27 antigen and/or with family history of rheumatic inflammatory diseases, psoriasis or inflammatorybowel diseases. The second group was defined as control group with patients negative to HLA-B27 antigen and without any family history of the diseases above. Results We included 40 ERA patients, mean age of onset 12,43 ± 3,003 years (6–16). The majority of them were male (n = 34). Twenty-eight patients had a genetic background. Among them, 7,5% of patients had a positive family history, 42,5% were positive to HLA-B27 antigen and 20% of them met both criteria. As shown in table 1, clinical manifestations were similar between the 2 groups. Enthesitis was more frequent in patients with HLAB27 without a significant difference. Regarding the disease activity, the number of night awakenings and the morning stiffness duration were comparable in the two groups. Six patients had a BASDAI score &amp;gt; 4 with no difference between the two groups. Extra-articular manifestations were present in 15 patients. Among them 14 had a genetic background, reaching the significance threshold with P = 0,013. We counted 8 cases of uveitis, one case of IBD, 5 cases of lung disease and 1 case of cardiac involvement. Inflammatory markers were higher in the group with familial history of SpA and/or positive HLAB27. Indeed, the mean ESR value was 42,73 vs 29.9, P = 0,01. There were no correlations between BASFI score and a positive genetic background (P = 0,283). Only one patient was put on biologics. He has no family history and is negative to HLA-B27 antigen. Conclusion The frequency of HLAB27 was in line with the literature data. The genetic background did not influence the disease activity or the functional impairment in our population. However, a positive correlation was found between a positive familial history of SpA, HLAB27, and the presence of extra-articular manifestations as well as with a higher ESR value.

P025 Risk assessment of covid 19 in patients with Juvenile Idiopathic Arthritis

BackgroundOn March 11th, 2020 the World Health Organization declared the coronavirus outbreak a global pandemic. Since then, the world has faced multiple flares. In March 2021, the third wave hit Tunisia, resulting in a total of 331 674 confirmed cases and 12 089 Covid-19 related deaths (on May 19th, 2021). Among these reported cases, >6000 were children under the age of 18.Patients with inflammatory rheumatic diseases undergoing immunosuppressive treatment are considered immunocompromised. Therefore, it is only fair to question whether children suffering from juvenile idiopathic arthritis (JIA) are specially at risk during this pandemic. Our objective was to assess the impact of the Covid -19 pandemic on patients with JIA.MethodsWe conducted a cross-sectional study including patients with JIA, all fulfilling the International League of Associations for Rheumatology (ILAR) criteria. We prepared a questionnaire evaluating the clinical data of our patients during the outbreak. We asked whether the child had been infected with the virus or whether he had contact histories with confirmed cases, and if so, had the child developed any symptoms (such as fever, respiratory, digestive or osteoarticular symptoms, myalgia, asthenia) or required any specific care.For all patients, we collected the following data: age, age of onset, the duration of the disease, JIA subtype, and the current treatment.ResultsWe included 25 JIA patients, mean age at disease onset was 7.6 +/- 3.8 years [1–11]. Among them, 17 were female. The mean duration of the disease was 4.9 +/- 3 years [0–15]. Three patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs) and six on conventional synthetic DMARDs (csDMARDs). Sixteen patients had no background treatment.None of the children had a positive PCR test nor symptoms suggestive of Covid-19.There were only 2 children with contact histories with confirmed cases: one with his cousin and one with his grandfather. Both patients were on NSAIDS with no DMARDS, and both followed social distancing rules. Neither one of them developed any symptoms.There have been no reports of absenteeism from school or medical checkups or disruption of treatment due to this pandemic, outside of the government-imposed lockdown period.ConclusionNone of our patients contracted the corona virus or developed any symptoms, during the deadliest wave in Tunisia to date. These results align with different research and the hypothesis that children with JIA under treatment do not have an increased susceptibility to COVID-19 compared with healthy children. Our study, however, had its limitations due to the small number of patients. Further research with larger sample size are, therefore, required.