Polyarticular Form Research Articles

Serum CS/DS, IGF-1, and IGFBP-3 as Biomarkers of Cartilage Remodeling in Juvenile Idiopathic Arthritis: Diagnostic and Therapeutic Implications

Cartilage destruction in juvenile idiopathic arthritis (JIA) is diagnosed, often too late, on basis of clinical evaluation and radiographic imaging. This case–control study investigated serum chondroitin/dermatan sulfate (CS/DS) as a potential biochemical marker of cartilage metabolism, aiming to improve early diagnosis and precision treatment for JIA. We also measured the levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) (using ELISA methods) in JIA patients (n = 55) both before and after treatment (prednisone, sulfasalazine, methotrexate, administered together), and analyzed their relationships with CS/DS levels. Untreated JIA patients [8.26 µg/mL (6.25–9.66)], especially untreated girls [8.57 µg/mL (8.13–9.78)] and patients with a polyarticular form of the disease [7.09 µg/mL (5.63–8.41)], had significantly reduced levels of serum CS/DS compared with the control [14.48 µg/mL (10.23–15.77)]. Therapy resulted in a significant increase in this parameter, but without normalization. We also found significantly lower levels of IGF-1 [66.04 ng/mL (49.45–96.80)] and IGFBP-3 [3.37 ng/mL (2.65–4.88)] in untreated patients compared with the control [96.92 ng/mL (76.04–128.59), 4.84 ng/mL (4.21–7.750), respectively]. Based on receiver operating characteristic (ROC) curve analysis, the blood concentration of CS/DS demonstrated the highest diagnostic power (AUC = 0.947) for JIA among all the tested markers. Untreated patients showed significant correlations between CS/DS and IGF-1 (r = −0.579, p = 0.0000), IGFBP-3 (r = −0.506, p = 0.0001), and C-reactive protein (r = 0.601, p = 0.0005). The observed changes in CS/DS during the course of JIA, influenced by both impairment of the IGF/IGFBP axis and inflammation, indicate the need for continued therapy to protect patients from potential disability. We suggest that CS/DS may be a useful biomarker of disease activity and could be employed to assess treatment efficacy and progress toward remission.

The Diagnostic Role of Skin Manifestations in Rheumatic Diseases in Children: A Critical Review of Paediatric Vasculitis.

Skin lesions are frequently observed in children with rheumatic diseases, particularly in conditions such as IgA vasculitis (IgAV) and Kawasaki disease (KD). In paediatric vasculitis, the presence of skin lesions serves as an early indicator, emphasising the importance of timely diagnosis to prevent complications, such as cardiac or renal involvement. Conversely, autoinflammatory disorders like juvenile systemic lupus erythematosus (SLE) and juvenile dermatomyositis (DM) may manifest with cutaneous manifestations either at the onset of disease or during its progression. Identifying these skin lesions prior to the appearance of systemic symptoms offers an opportunity for early diagnosis and treatment, which has a positive influence on the outcomes. Additionally, it is noteworthy that specific rheumatological conditions, such as acute rheumatic fever (ARF) or oligoarticular or polyarticular forms of juvenile idiopathic arthritis (JIA), may exhibit occasional, but significant skin involvement, which is strongly correlated with an unfavourable prognosis. The assessment of skin is important in the holist approach to assessing patients for potentially systemic/multisystem disorder and helps distinguish discrete conditions.

Assessment of Bone Mineral Density in a cohort of Juvenile Idiopathic Arthritis patients

Introduction: Low bone mass is encountered in patients with Juvenile idiopathic arthritis (JIA) as a serious long-term complication of this pediatric condition and may be associated with fractures and its complications.
 The present study aimed to evaluate the frequency of low bone mineral density (BMD) and fragility fractures in patients with JIA in its polyarticular or oligo articular forms. Secondary, our aim was to identify factors associated with low bone mass.
 Patients and methods: This is a retrospective study conducted on 26 patients with JIA meeting the ILAR criteria for poly or oligoarticular form. Patients were divided into two groups according to their age : group1 including patients aged over 16 years-old and group 2 including patients aged under 16 years-old. Sociodemographic, clinical, biological and functional data were collected by consulting patient’s medical records. Bone mineral density was measured at three different sites: whole body, lumbar spine and hip using the dual-energy X-ray absorptiometry (DXA) equipment. Data were entered and analyzed using SPSS version 11.5 software.
 Results: Twenty-six JIA patients including 20 females (74.1%) and six males (22.2%) were enrolled with a mean disease duration of 20.23 years [2-54 years]. The mean age was 28.2 years [7-58 years]. The distribution of JIA subtypes among patients was as follows: 6 with oligo articular JIA and 20 with polyarticular JIA. Sixteen patients (59%) practiced regular physical activity. In our series, the frequency of low bone mineral density was 41% in children with JIA and 68 % in adults with JIA. Only two patients presented a fragility fracture in adulthood represented by a hip fracture following low-energy trauma and treated surgically in both cases. No patient received an anti-osteoporotic treatment. In-group 1, there was a significant correlation between low bone mass and weight (p=0.020), BMI (p=0.028), disease duration (p=0.045), positivity of AAN (p=0.050), disease activity (p=0.019), oral corticosteroid (p=0.034) and biologic treatment (p=0.043). In-group 2, a statistically significant correlation was found between low bone mass and age at the time of JIA diagnosis (p=0.041), weight (p=0.03), physical activity (p=0.05), disease duration (p=0.021), functional impact of the disease assessed by the HAQ score (p=0.018), oral corticosteroid therapy (p=0.014) and biological therapy (p=0.012).
 Conclusion: our study showed that a combination of factors contributed to compromise bone health in patients with JIA. Fragility fractures were rare and occurring mainly in adulthood. An adequate control of disease activity, proper management of treatment, adequate calcium and vitamin D intake, as well as regular physical activity, may contribute to preserve bone health in those patients.

Thyroid function in pediatric patients with juvenile idiopathic arthritis.

Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease characterized by chronic synovitis, sometimes associated with fever, rash, pericarditis and uveitis. Limited data are available concerning autoimmune diseases associated with JIA in childhood. (a) evaluating the thyroid function in a group of Italian children affected by JIA; (b) identifying which Autoimmune Thyroid Diseases (ATDs) are related to JIA in this population. A population of 51 patients with JIA was investigated. Each patient enrolled was evaluated clinically (family history for Autoimmune Diseases (ADs), personal history and physical examination). In the sample were evaluated thyroid function, inflammation's index and anti-thyroid antibodies. The 68.6% (35) of our patients had the oligoarticular form, 27.5% (14) had the polyarticular one, 2% (1) had systemic onset and 2% (1) had undifferentiated arthritis. We focused our attention on the differences between the first two forms. We did not find any difference on the gender prevalence (p > 0.05). A higher presence of anti-TPO antibodies was found in the polyarticular form, with a significant difference with the oligoarticular one (p = 0.032). We researched the anti-hTG antibodies (p > 0.05) and ANA for each group (p > 0.05). We found a significant prevalence of family history for ADs in the polyarticular form (p < 0.05). Our findings show the necessity to focus on thyroid function in patients with JIA. Although the oligoarticular form is the most frequent, the polyarticular form shows a higher frequency of thyroid function's alteration. This suggests the need for specific attention in polyarticular form.

Monogenic variants in Laccase domain-containing1 (LACC1) as the cause of juvenile arthritis

Monogenic mutations in laccase domain-containing 1 (LACC1) are associated with clinical pictures that mimic severe courses of polyarticular or systemic juvenile idiopathic arthritis. The diseases are characterized by an early onset during the first year of life, afamilial clustering and ahigh inflammatory activity. The courses are mostly difficult to influence and often lead to sequelae. In this article four cases from two families are presented in which the homozygous mutation p.T276fs* in LACC1 was detected. The children initially suffered from polyarticular or systemic forms of juvenile arthritis. Of the patients two are currently being treated with tocilizumab and methotrexate and one female patient without a basis treatment is currently only receiving local repeated intra-articular steroids. A fourth female patient underwent an allogeneic bone marrow transplantation due to arelapse of an acute lymphatic leukemia. Since then, no further inflammatory symptoms have occurred. The cases presented are compared with the other 50courses published to date. In addition, recent studies investigating the influence of LACC1 mutations, particularly on macrophage function, are summarized.

E13 Cervical spine involvement in juvenile idiopathic arthritis: frequency and associated factors

Abstract Background Juvenile idiopathic arthritis (JIA) is a pediatric rheumatism including several subgroups. The cervical spine involvement is poorly studied in JIA compared with adult rheumatism. Objectives This study aimed to assess the frequency and associated factors with cervical spine involvement in JIA. Methods We conducted a retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a 28-year period (1994 – 2022). We retrieved radiographs of the cervical spine in anteroposterior, lateral, and lateral flexion views in search of an atlantoaxial dislocation (AAD). Demographic, clinical, biological, and radiological data were compared according to the presence or absence of AAD. Results A total of 29 Patients were enrolled (12 men and 17 women), the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. The mean body mass index (BMI) was 21.20 ± 4.88 [14.17–27.55] kg/m2. Most patients had a polyarticular form (55.2%, n = 16). Mean C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 42.74 ± 63.37 [2–218] mg/l and 69.67 ± 36.23 [36–108] mm/h. A biological inflammatory syndrome was present in 19 cases. Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively. At least one extra-articular involvement was noted in 16 cases. Bone erosions and hip involvement were noted in 18 and 14 cases, respectively. AAD was noted in 4 patients (13.8%). It was diagnosed on average 4.28 ± 10.07 [0–27] years after disease onset. AAD was only associated with extra-articular involvement in our study (75% vs 13.6%; P = 0.047). On the other hand, our study showed that age, gender, age at onset, diagnostic delay, duration of symptoms, BMI, JIA sub form, inflammation markers, rheumatoid factor, ACPA, antinuclear antibodies, bone erosions, and hip involvement were not associated with AAD. Conclusion The cervical spine involvement was not negligible in our study and was associated with extra-articular involvement. This condition is serious and can be life threatening. Therefore, it is important to perform more studies to better evaluate its frequency, clinical presentation, and imaging.

E18 What is the relationship between body mass index and juvenile idiopathic arthritis characteristics?

Abstract Introduction Juvenile idiopathic arthritis (JIA) is a group of pediatric chronic inflammatory joint diseases. The various forms of JIA may be associated with delayed growth or local growth disturbances. Objectives We conducted this study to evaluate the relationship between the different clinical and biological characteristics of JIA and the anthropometric parameters of patients. Methods Retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a period from 1994 to 2022. Clinical and biological parameters were collected. Body mass index (BMI) was interpreted according to World Health Organization cut-offs as follows: underweight &amp;lt;18.5, normal [18.5–24.9], overweight [25–29.9], and obese ≥30 kg/m2. Results Seventeen women and 12 men were included. The mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. The polyarticular form was the most frequent (55.2%). Rheumatoid factor, ACPA and antinuclear antibodies were present in 41.4%, 24.1% and 17.2% of cases respectively. At least one extra-articular manifestation was noted in 16 patients: ophthalmologic (n = 6), skin (n = 4), cardiac (n = 4), pulmonary (n = 3) and renal (n = 2) involvement. Osteoporosis was noted in 7 cases. Mean C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 42.74 ± 63.37 [2–218] mg/l and 69.67 ± 36.23 [36–108] mm. An elevation of inflammation markers was noted in 19 cases. The mean haemoglobin value was 11.31 ± 2.10 [6.5–15] g/dl Anaemia was noted in 20 cases. The mean body mass index was 21.20 ± 4.88 [14.17–27.55] kg/m2, 36.4% of patients were underweight, 27.2% had a normal BMI, and 36.4 were overweight. No patient was obese. Growth delay was noted in 3 cases. Our statistical study found a correlation of BMI with ESR (r = 0.998; P &amp;lt; 0.001), rheumatoid factor positivity (r = -1.000; P &amp;lt; 0.001), and osteoporosis (r = 0.803; P = 0.030). No other correlation of BMI with clinical and biological characteristics of the study population was identified. Conclusion BMI should be well considered in the JIA evaluation and treatment. BMI correlated with ESR, rheumatoid factor positivity, and osteoporosis in our study.

E17 Juvenile idiopathic arthritis: are girls less lucky?

Abstract Introduction Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. ∼3 million children and young adults worldwide have JIA, with higher prevalence rates in girls. Objectives Our objective was to assess the relationship between gender and disease characteristics. Methods A retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a 28-year period from 1994 to 2022. We collected clinical, biological, and radiological disease characteristics from medical records. These parameters were compared according to gender. Results We have included 29 patients (17 women and 12 men). The mean age was 35.69 ± 11.72 [18–61] years. Symptoms began at an average age of 11.10 ± 4.25 [2–16] years and have been evolving since 24.48 ± 12.76 [1–47] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The mean body mass index (BMI) was 21.20 ± 4.88 [14.17–27.55] kg/m2, 8 patients had a normal BMI. Growth delay was noted in 3 cases. Sixteen patients (55.2%) had a polyarticular form. The presence of rheumatoid factor (RF), ACPA and anti-nuclear antibodies was noted in 12, 7 and 5 cases, respectively. At least one extra-articular manifestation was noted in 16 patients: ophthalmologic (n = 6), skin (n = 4), cardiac (n = 4), pulmonary (n = 3) and renal (n = 2) involvement. Osteoporosis was noted in 7 cases. Mean C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and haemoglobin value level 42.74 ± 63.37 [2–218] mg/l, 69.67 ± 36.23 [36–108] mm, and 11.31 ± 2.10 [6.5–15] g/dl. An elevation of inflammation markers was noted in 19 cases. Anaemia was noted in 20 cases. Bone erosions were noted in 18 cases. Hip and cervical spine involvement were noted in 14 and 4 cases, respectively. Our comparative study showed that rheumatoid factor positivity was significantly associated with female gender (73.3% vs 16.7%; P = 0.018). No other significant gender differences were identified when comparing the rest of the clinical, biological, and radiological variables. The correlation study concluded the following correlations of gender with haemoglobin level (r = -0.574; P = 0.001), rheumatoid factor positivity (r = 0.517; P = 0.016) and JIA subform (r = -0.482; P = 0.008). Conclusion A relationship of gender to rheumatoid factor positivity, haemoglobin level, and JIA subform was identified in our study. Larger-scale longitudinal studies would better investigate the influence of gender on JIA.

E15 Immunopositive and immunonegative juvenile idiopathic arthritis: what makes the difference?

Abstract Background Juvenile idiopathic arthritis (JIA) is a complex pediatric rheumatic disease of polymorphic expression. The immunological assessment is commonly performed during this disease. Objectives The objective of this work was to evaluate the difference between immunopositive and immunonegative forms of JIA. Methods We conducted a retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a 28-year period (1994 – 2022). We retrieved the immunological results of all patients. The disease was considered immunopositive in case of rheumatoid factor (RF) and/or anti-citrullinated peptide antibody (ACPA) positivity. Results We included 29 patients (12 men and 17 women) with a mean age of 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. The mean body mass index (BMI) was 21.20 ± 4.88 [14.17–27.55] kg/m2, 8 patients had a normal BMI. Growth delay was noted in 3 cases. The polyarticular form was the most frequent, observed in 55.2% of cases. At least one extra-articular manifestation was noted in 16 patients: ophthalmologic, skin, cardiac, pulmonary, and renal involvement were found in 6,4,4,3 and 2 cases, respectively. Osteoporosis was noted in 7 cases. Mean C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 42.74 ± 63.37 [2–218] mg/l and 69.67 ± 36.23 [36–108] mm/h. Bone erosions, hip involvement and atlantoaxial dislocation were noted in 18, 14, and 4 cases, respectively. Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively. The disease was considered immunopositive in 13 cases. Our comparative study found that women had more immunopositive forms (84.6% vs 15.4%; P = 0.010). In addition, osteoporosis was less frequent in immunopositive JIA (11.1% vs 88.9%; P = 0.003). Growth delay was only observed in immunopositive JIA (P = 0.012). Furthermore, the age at disease onset was greater in the immunopositive group (12.85 ± 2.94 vs 9.69 ± 4.7 years; P = 0.045). However, no significant differences were identified when comparing the rest of the JIA characteristics. Conclusion Evaluation of the immunological profile is required in JIA. Our study found associations of RF and/or ACPA positivity with age at disease onset, female gender, osteoporosis, and growth delay in JIA.

E28 Juvenile idiopathic arthritis: a preliminary study of 29 cases

Abstract Introduction Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory rheumatic diseases in children. It is defined as arthritis that began before the age of 16 years, lasting at least 6 weeks and without an identifiable cause. Our objective is to describe the clinical and immunologic profile of JIA. Patients and methods Descriptive, retrospective study of 9 years [2013– 2022] of rheumatology services at the CHU Fattouma Bourguiba Monastir. We retrieved 29 files of children diagnosed with JIA according to International League of Associations for Rheumatology (ILAR) criteria. Results There were 16 girls (55.17%) and 13 boys (44.83%). The mean age of onset of the disease was 9.38 ± 3,1 years with a range of 3–16 years. Five (19%) patients had a family history of chronic rheumatic diseases. Polyarthritis was seen in 16 (55.2%), oligoarthritis in 7 (24.1%) and mono-arthritis in 6 (20.6%). The forms of JIA in descending order: polyarticular in 11(37.9%), oligoarticular in 6 (20.7%), seropositive polyarticular form in 5 (17.2%), enthesitis related arthritis in 3 (10.3%), systemic JIA in 3(10.3%) and psoriatic arthritis in 1(3.4%). The presence of biological inflammatory syndrome in 82.7%: an accelerated ESR (68.9%) and positive CRP (65.5%), anaemia (51.72%), hyperleukocytosis (10.7%) and thrombocytosis (3.44%), and 2 patients presented with bicytopenia (10.3%). The immunological workup was marked by presence of: RF (7 cases), Anti-CCP (3 cases), Antinuclear antibodies (ANA) (4 cases). The symptomatic treatment included analgesics (91%), corticosteroids (62%), salazopyrine in 13.7%, methotrexate in 62% of cases and 3 patients under biotherapy. The evolution was good in most cases. The prognosis was life-threatening in two patients with a systemic JIA complicated by macrophagic activation syndrome. Conclusion Immunology was not sufficiently contributive. A cohort study in a general population is necessary to better to better elucidate the characteristics of JIA in Tunisia.

Brain natriuretic peptide and catecholamines in adolescents with juvenile idiopathic arthritis

Juvenile idiopathic arthritis is a group of chronic diseases of uncertain etiology, in which an immuno­inflammatory process develops with systemic damage to the vascular endothelium, leading to the involvement of vital organs and systems against the background of persistence of the inflammatory process.&#x0D; Objective — to determine the level of excretion of catecholamines in the daily urine and natriuretic peptide in the blood of adolescents with juvenile idiopathic arthritis.&#x0D; Materials and methods. The study involved 56 patients with juvenile idiopathic arthritis, aged (13.28 ± 0.38) years, including 17 boys, 39 girls. The polyarticular form of the disease was diagnosed in 48 patients (86 %), the oligoarticular form was in 8 (14 % of patients). The duration of the disease was (68.96 ± 6.29) months (from 12 to 180 months). All patients received methotrexate for more than 12 months, the average dose of which was (11.73 ± 0.39) mg/m2 per week. The control group consisted of 46 (27 boys and 19 girls) practically healthy peers (14.72 ± 0.28) years. The content of catecholamines (adrenaline and norepinephrine) in daily urine was studied by iodine oxidation with the formation of fluorescent trihydroxyindoles (adrenolutin and norepinephrine) and subsequent fluorimetry, as well as the level of brain natriuretic peptide in the blood by competitive immunoassay.&#x0D; Results and discussions. In patients with juvenile idiopathic arthritis, the level of excretion of catecholamines in the daily urine remains within the age norms, but significantly lower than in healthy peers (p &lt; 0.01), the adrenaline/norepinephrine ratio also decreases (p &lt; 0.05). A significant increase in the level of brain natriuretic peptide in the blood was found in patients with juvenile idiopathic arthritis (p &lt; 0.01), especially in children aged 11—14 years and disease duration up to 5 years (p &lt; 0.05).&#x0D; Conclusions. The change in the ratio of catecholamine excretion and blood natriuretic peptide level determines the processes of formation of morphofunctional disorders of the cardiovascular system in children with juvenile idiopathic arthritis.

Pattern of gout and its association with chronic kidney disease in Maiduguri, northeastern Nigeria.

Gout is considered uncommon among Black Africans. It is commoner in men and associated with obesity, hypertension, and chronic kidney disease (CKD). This study aims to determine the pattern and frequency of gout and its associated factors in Maiduguri, north-eastern Nigeria. A retrospective study of gout patients managed at the rheumatology clinic of the University of Maiduguri Teaching Hospital (UMTH), Nigeria, from January 2014 to December 2021. Diagnosis of gout was made using the Netherlands 2010 criteria, and CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60ml/min/1.73m2 using the 2021 CKD-epidemiology collaboration (CKD-EPI) creatinine equation. A P-value of < 0.05 was considered statistically significant. Out of 1409 patients seen during the study period, 150 (10.7%) had gout. They comprised 57.0% males, mostly presented with mono-articular disease (47.7%) with the ankle predominantly involved (52.3%). First metatarsophalangeal and knee joint involvement were commoner among males than females (59% vs 39%, p = 0.052 and 55.7% vs 34.8%, p = 0.05 respectively). The mean serum uric acid (SUA) level was 557.6 ± 176.2mmol/l, and the levels did not differ between gender (p = 0.118, CI [- 126.6 to 14.5]). Ninety (84.1%) had CKD with 20.6% in end-stage renal disease (eGFR < 15ml/min/1.73m2). Polyarticular involvement and tophi were commoner among patients with CKD (21.1% versus 11.8% p = 0.652 and χ = 4.364, p = 0.022 respectively) Serum uric acid levels positively correlated with serum creatinine (p = 0.006) and negatively correlated with eGFR (p = 0.001). The best predictor of SUA level was the eGFR (B = - 2.598, p < 0.001). Gout in north-eastern Nigeria constitutes about 11% of all rheumatic diseases and is typically monoarticular; however, polyarticular form and tophi were commonly seen in patients with CKD. Further studies will be needed to evaluate the relationship between the pattern of gout and CKD in the region. Key Points • Gout in Maiduguri is commonly monoarticular; however, polyarticular presentations and tophi are commoner among gout patients with chronic kidney disease (CKD). • The increase in the burden of CKD might have resulted in the increase in the number of females with gout. • The use of the validated and simple Netherlands criteria for the diagnosis of gout is useful in developing countries to overcome the challenges associated with the use of polarized microscope and thereby allowing further research on gout. • There is a need for further research on the pattern and prevalence of gout and its relationship with CKD in Maiduguri, Nigeria.

Current characteristics of a population of psoriatic arthritis and gender disparities

Psoriatic arthritis (PsA) is a polymorphic disease associated with numerous comorbidities. The objective of this study was to describe the main clinicobiological and imaging characteristics of a population of PsA and to extract any disparities between men and women. A total of 132 patients in the rheumatology department of Amiens University Hospital with a confirmed diagnosis of PsA according to the CASPAR criteria were included over a period of 4 months. All data were collected retrospectively in this observational and single-center study. The sex ratio was 1 and the average age at inclusion was 54.9 years. Peripheral PsA was the predominant clinical form. Axial PsA represented 12.1% of cases. Enthesitis was noted in 52.3% of cases while dactylitis was identified in 29.5% of cases. Moreover, 12.1% had a joint symptomatology preceding the appearance of cutaneous signs. HLA-B*27 positivity was found in 33.3% of cases. Chronic hyperuricemia accounted for 10% of our population. Sacroiliitis was observed in 41% of cases. The disparities between men and women are multiple and consistent with the literature: Polyarticular form, enthesitis, obesity, more intensive prescription of s-DMARDs, and b-DMARDs are more associated with the female population. Oligoarticular form, psoriatic nail dystrophy, radiological axial involvement, and chronic hyperuricemia are more encountered in the male population. Our study found a very heterogeneous disease, with marked differences between men and women. Peripheral PsA remains predominant but the search for associated axial involvement, which is probably underestimated, seems essential. This work studied the main characteristics of patients with PsA followed in real life, in a regional university reference center. We have highlighted a very heterogeneous disease as well as some gender disparities, not well described in the literature, which should be taken into account in order to optimize therapeutic management.

16 Spectrum of infections during juvenile idiopathic arthritis

BackgroundThe incidence of infections in patients with chronic inflammatory rheumatic disease is increased. It is often due to the disease itself and to the immunosuppressive treatments used.ObjectivesTo assess the incidence of infections during JIA.MethodsWe conducted a repeated cross-sectional study including 29 patients followed for JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period from 1994 to 2022. Sociodemographic and anthropometric parameters, clinical data, biological assessments, and prescribed therapies were collected. We identified patients who had at least one infectious episode during their follow-up.ResultsThere were 17 women and 12 men. The mean age was 35.69 ± 11.72 [18–61] years. The polyarticular form was seen in 55.2% of cases. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average disease duration was 24.48 ± 12.76 [1–47] years.Diabetes and arterial hypertension were the main comorbidities associated with JIA, observed in 13.8% of cases each. At least one extra-articular manifestation was noted in 16 cases: pulmonary (3 cases), cardiac (4 cases), renal (2 cases), cutaneous (4 cases) and ocular (7 cases).The most prescribed DMARDs was Methotrexate in 79.3% (n = 23), biotherapy was used in 3 (10.3%), NSAIDs and corticosteroids were used in 62.1% (n = 18) and 69% (n = 20) respectively.All the infections observed in our population were of community origin. Urinary tract infection was the most common infection (n = 5). Bronchopulmonary infections were observed in 2 cases including a case of tuberculosis. Sub periosteal abscess of the femur was also seen in one of the patients.Regarding the SARS-CoV-2 infection, 6 patients were infected, 2 of whom required hospitalization, including one in the intensive care.ConclusionThe risk of infections is increased during JIA. This is due to the immunosuppression induced by the disease, the treatment, and comorbidities.

13 Juvenile idiopathic arthritis and cardiovascular risk factors

BackgroundJuvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease. Although, some patients achieve remission, some cases of JIA may persist into adulthood. Patients with JIA and other inflammatory joint diseases have increased cardiovascular disease risk compared with the general population.ObjectivesTo study the cardiovascular risk factors in JIA and their association with disease parameters.MethodsThis was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). We collected sociodemographic and anthropometric parameters, clinical data, results of biological assessments, and data on prescribed therapies.We studied the following cardiovascular risk factors: family history of cardiovascular event, physical inactivity, smoking, arterial hypertension, diabetes, dyslipidaemia and obesity.ResultsWe included 29 patients. The M/F sex ratio was 0.71, the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. The mean BMI was 21.20 ± 4.88 kg/m2 [14.17–27.55].The polyarticular form was the most frequent, noted in 55.2% of cases (n = 16). Extra-articular manifestations were observed in 55.2% of cases. Mean CRP was 42.74 ± 63.37 [2–218] mg/l and biological inflammatory syndrome was present in 19 cases. Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively.Corticosteroid therapy and NSAIDs were prescribed to 18 of the subjects.Cardiovascular risk factors were present in 41.4% (n = 12) of cases: family history of cardiovascular event (n = 2 cases), physical inactivity (n = 5 cases), smoking (n = 3 cases), arterial hypertension (n = 4 cases), diabetes (n = 4 cases), dyslipidaemia (n = 4), and BMI ≥ 25 kg/m² (n = 4).Following parameters were significantly higher in patients with cardiovascular risk factors: the presence of a biological inflammatory syndrome (81.8% vs 35.3%; p = 0.016), the frequency of prescription of corticosteroids (91.7% vs 52.9%; p = 0.026) and NSAIDs (83.3% vs 47.1%; p = 0.047).However, no significant difference was noted when comparing these parameters: gender, age, age of disease onset, disease duration and presence of extra-articular manifestations. Moreover, cardiovascular risk factors were not associated with the presence of rheumatoid factor, ACPA, and antinuclear antibodies.ConclusionInflammation, corticosteroid therapy and NSAIDs are associated with the presence of cardiovascular risk factors in JIA. The evaluation and control of this risk must be regular during patient follow-up. Control of inflammation and rationalization of treatment are necessary.

14 Juvenile idiopathic arthritis: osteoporosis and fractures

BackgroundJuvenile idiopathic arthritis (JIA) is the most common inflammatory arthritis in children. Chronic inflammation, as well as the various treatments used during JIA increase the risk of occurrence of osteoporosis (OP) and fractures.ObjectivesThe objective of this work was to determine the frequency of OP in JIA and to investigate the factors associated with its occurrence.MethodsThis was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). We collected sociodemographic and anthropometric parameters, clinical data, results of biological assessments, bone densitometry results and data on prescribed therapies. We compared these variables according to the bone densitometry profile to assess the factors associated with OP in JIA.ResultsThere were 29 patients (17 females and 12 males), the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. Three patients were smokers. The mean BMI was 21.20 ± 4.88 [14.17–27.55] kg/m2, and 4 patients had a BMI ≥ 25 kg/m².The polyarticular form was the most frequent, noted in 55.2% of cases (n = 16). NSAIDs, corticosteroids and methotrexate were prescribed in 62.1%, 69% and 79.3% of cases respectively.OP was found in 24.1% of cases (n = 7). Mean T-score values at the lumbar and femoral sites were −2.20 ± 1.22 SD and −2.31 ± 0.97 SD, respectively. Six patients suffered at least one fracture.Patients with OP had lower BMI than patients with normal bone density (17.02 ± 2.46 vs 23.91 ± 5.42; p = 0.046). Furthermore, absence of rheumatoid factor was associated with OP in our study (83.3% vs 16.7%; p = 0.008).On the other hand, the following parameters were not associated with the occurrence of OP in our study: age, gender, smoking, age at onset and duration of progression of JIA, BMI, extra-articular manifestations, CRP, antinuclear antibodies, ACPA and erosive character. Regarding the treatment received (NSAIDs, corticosteroids and methotrexate), no difference was found between patients.ConclusionOsteoporosis in JIA is common and has a prognostic impact. It must be systematically screened throughout the follow-up. In our study, OP was associated with the absence of rheumatoid factor and was more frequent in patients with low BMI.

12 Hip involvement in juvenile idiopathic arthritis: frequency and associated factors

BackgroundJuvenile idiopathic arthritis (JIA) is a pediatric rheumatic disease with several subgroups. The hip is frequently affected. The frequency of this involvement can reach 50% especially in the severe and destructive forms. Arthroplasty may be indicated in advanced cases.ObjectivesTo assess the frequency and associated factors with hip involvement in (JIA).MethodsWe conducted a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Demographic, clinical, biological, and radiographic data were collected. These parameters were compared according to the presence or absence of hip involvement.ResultsA total of 29 Patients were enrolled (12 men and 17 women), the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years.Sixteen patients had a polyarticular form. Mean CRP values were 42.74 ± 63.37 [2–218] mg/l, a biological inflammatory syndrome was present in 19 cases. Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively. At least one extra-articular manifestation was noted in 16 cases.Hip involvement was noted in 14 patients (48.3%). It was bilateral in 64.3% of cases (n = 9). Twenty-three hips were affected in total (56.9%). Hip involvement was diagnosed 14.5 ± 9.37 [1–28] years after disease onset. Arthroplasty was performed on 10 hips with a delay of 201.60 ± 104.75 [108–348] months between diagnosis of JIA and surgery.Hip involvement was associated with male gender in our study (75% vs 29.4%; p = 0.016). On the other hand, our study showed that age, age at onset, diagnostic delay, symptoms duration, smoking, BMI, extra-articular manifestations, CRP, rheumatoid factor, antinuclear antibodies, ACPA and erosive character were not associated with hip involvement.ConclusionOur study showed that hip involvement is common in JIA, mainly in male patients. It usually occurs late in the disease course. Since hip involvement is a cause of disability and functional impairment, it should be assessed regularly.

17 Anemia in juvenile idiopathic arthritis: analysis of associated factors

Abstract Background Anaemia is the most frequent hematological disorder in chronic inflammatory rheumatic disease. Few studies have focused on this impairment in juvenile idiopathic arthritis (JIA). Objectives To identify the factors associated with anaemia in JIA. Methods We conducted a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Demographic, clinical, biological, and radiographic data were collected. These parameters were compared according to the presence or absence of anaemia. Results Seventeen women and 12 men were enrolled. The mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. The polyarticular form was the most frequent (n = 16). Rheumatoid factor, ACPA and antinuclear antibodies were present in 41.4%, 24.1% and 17.2% of cases respectively. Mean CRP values were 42.74 ± 63.37 [2–218] mg/l, a biological inflammatory syndrome was present in 19 cases. NSAIDs, corticosteroids and methotrexate were used in 62.1% (n = 18), 69% (n = 20) and 79.3% (n = 23) respectively. Anaemia was noted in 69% (n = 20) of cases, it was hypochromic in 8 cases and microcytic in 11 cases. The mean haemoglobin value was 11.31 2.10 [6.5–15] g/dl. Anaemia was associated with the following parameters in our study: female sex (88.2% vs 41.7%; p = 0.008), absence of anti-nuclear antibodies (76.9% vs 20%; p = 0.026) and corticosteroid therapy (85% vs 33.3%; p = 0.005). However, the comparison of patients according to the presence of anaemia did not show any significant difference for these parameters: age, age at onset, diagnostic delay, duration of symptoms, extra-articular manifestations, CRP value, presence of biological inflammatory syndrome, rheumatoid factor, ACPA, erosive nature and treatment (NSAIDs and methotrexate). Conclusion Anaemia is common in JIA. Its treatment is part of the overall management of the disease.

Peripheral arthritis in psoriatic arthritis: from immunopathogenesis to therapy with Janus kinase inhibitors.

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease characterised by high phenotypic heterogeneity. Peripheral polyarticular, pauciarticular, axial, enthesitic, and dactylitic forms have been classically described, although it is not clear whether they all have the same pathophysiological mechanisms. Use of cytokine-targeted therapies in the last 20 years has significantly impacted the quality of life of patients with PsA even though a significant proportion of patients, regardless of the mechanism of action considered, remain non-responders, suggesting the need for better understanding of the pathophysiological basis of the disease to appropriately stratify patients and identify new therapeutic targets. The pre-clinical demonstration of the pathophysiological relevance of the JAK/STAT pathway in the pathogenesis of PsA and the emerging efficacy data from randomised controlled trials of JAK inhibitors in PsA patients have set the stage for a new pharmacological era in patients with PsA. In this review, we discuss the rationale for using approved JAK inhibitors for treatment of peripheral PsA and their positioning in the context of EULAR/GRAPPA guidelines.

The Presence of Antinuclear Antibodies (ANAs) in Children with Juvenile Idiopathic Arthritis and Arthritis Related to Infection: a Single Center Experience

Objective - to determine the presence of antinuclear antibodies (ANAs) in children with juvenile idiopathic arthritis (JIA) and arthritis related to infection (ARI). Methods - Retrospective-prospective study at the Clinic for Children’s Diseases Tuzla, from January 2014 to January 2020. Results - 81 children were included in the study: 26 boys and 16 girls with JIA (median age 9.9 years) and 22 boys and 17 girls with ARI (median age 9.6 years). The most common form of JIA was oligoarticular (64.2%), while reactive arthritis (ReA) was the most common form of ARI (64.1%). ANAs were positive in 7/42 (16.6%) children with JIA: 5/27 (18.5%) children with the oligoarticular and 2/10 (20%) children with polyarticular rheuma factor negatve form. Considering ARI, ANAs were positive in 12/39 (30.7%) children: 9 children with ReA (23.1%) and 3 children with postinfectious arthritis (7.6%). We did not find a significant difference in ANAs positivity between the examined groups of children (χ2=1.523; P=0.21). One child with JIA and 25.6% of children with ARI had a positive ANA profile; a statistically significant difference (P=0.002) was found. Conclusion - ANAs tests have little diagnostic utility in clarifying the diagnosis of JIA, and should not be used as a screening tool if JIA is the diagnosis under consideration. The persistence of ANAs was not associated with the type of arthritis, juvenile or ARI.