Seronegative Spondyloarthropathies Research Articles

OA15 A case series of idiopathic granulomatous mastitis patients and their immunosuppressive management

Abstract Background/Aims Rheumatologists are experts in managing immunosuppression and are asked to supervise immunosuppression for non-rheumatic conditions. Thus, it is important to be aware of these conditions and the regimes required. Idiopathic granulomatosis mastitis (IGM) is a rare inflammatory breast condition which can have systemic manifestations including arthritis. Methods Our index case presented with peripheral ankle synovitis/tenosynovitis, struggling to weight bear, whilst being investigated for a breast mass. Breast US, mammogram and biopsy (acute and chronic inflammatory cells including multi-nucleated giant cells) were completed and there was little response to 3 courses of antibiotics. No mycobacteria were seen on microscopy, ZN stain negative, CXR normal, T spot negative and serum ACE normal. There was no rash and no conditions associated with a seronegative spondyloarthropathy. RF, anti-CCP and ANA were negative. A moderate course of prednisolone immediately resolved the peripheral arthritis, but high-dose steroids were required to reduce the breast mass. The mass recurred upon weaning prednisolone requiring the addition of azathioprine as a steroid-sparing agent. Results Our case series includes the immunosuppressive management of 3 other IGM patients: 1) 43-year-old referred after an 8 year history of alternating breast ‘abscesses’ and sinuses treated with courses of antibiotics to little avail. High dose prednisolone and methotrexate resolved the breast mass within a month. 2) 37-year-old referred with a 14 year history of breast masses and fistulae previously treated with surgery and antibiotics. Currently asymptomatic so commenced on methotrexate. 3) 39-year-old referred with a 3 year history of recurrent sterile breast abscesses previously managed with antibiotics, incision and drainage. Recent small masses had settled with NSAIDs. Conclusion IGM is a rare benign inflammatory breast disease of unknown aetiology, commonest in Middle Eastern populations, median age 30s. The most common presentation is a unilateral painful mass, which can ulcerate, fistulate and form abscesses. Management of IGM varies from expectant/topical steroids/NSAIDs to high dose steroids and DMARDs. A literature review shows that the usual starting dose of prednisolone is 40-60mg; the addition of methotrexate and azathioprine increases likelihood of successful treatment and allows for faster steroid tapering. Surgery for specific types of IGM can also be useful; for example, where there is duct granuloma, surgical excision can be curative. IGM can associate with arthritis, erythema nodosum, and episcleritis. One case series found that 14% of patients with IGM had concomitant arthritis. Key points: In our local experience we have had four patients with IGM, all previously treated with antibiotics or surgical methods but subsequently diagnosed with IGM and referred for immunosuppressive therapy. Being a rare condition, we feel it’s important for clinicians to be aware of IGM and its link with inflammatory arthritis. Disclosure S. Islam: None. P. Stonelake: None. H. John: None.

P004 Empowering the reproductive choices of patients with rheumatic disease: using the BSR 2022 pregnancy guidelines audit tool to evaluate pre-conception medication advice

Abstract Background/Aims For ideal pregnancy outcomes, patients with inflammatory rheumatic disease require targeted disease control with pregnancy compatible medications. A proactive approach is required given that people often won’t disclose plans for a pregnancy with healthcare professionals unless directly asked, and 45% of UK pregnancies are unplanned. The BSR 2022 guidelines on prescribing drugs in pregnancy and breastfeeding makes various recommendations on pre-pregnancy counselling for people with rheumatic disease with referral to specialists with relevant expertise as appropriate. Therefore, we used the linked BSR audit tool to evaluate documentation of pre-pregnancy counselling in rheumatology clinics lacking obstetric input at our hospital. Methods Inclusion criteria were all females, aged 15-45 years, attending a doctor-led Rheumatology clinic without obstetric input between 24/4/23 - 30/4/23 at University College London Hospital. Exclusion criteria were infertility and those seen as one-off clinic appointments and not commenced on medications. Clinic notes from all Rheumatology reviews over the preceding one year were assessed using the audit tool in the 2022 BSR pregnancy guidelines. People currently pregnant were audited for the year prior to the date of conception of their pregnancy. Results Among 50 clinics reviewed, 42 female subjects were eligible across 19 clinics, 64% of whom were aged 36-45 years and 36% were aged 21-35 years. Six subjects were pregnant. Diagnoses included: 24% systemic lupus erythematosus; 19.5% rheumatoid arthritis; 17% seronegative axial spondyloarthropathy; and the remaining 39% consisted of fibromyalgia, hypermobility, and other inflammatory arthritidies. 70% of people were screened for antibodies that could adversely impact pregnancy (i.e. anti-Ro or anti-phospholipid). Only 26% of subjects had documentation of being asked if they wished to conceive. In subjects who did not express a wish to conceive, only 21% were asked if they were using contraception. A total of 17% of the 42 subjects were referred to a specialist Obstetric-Rheumatology clinic for pre-pregnancy counselling during the study period. Of 35 subjects taking medications, only 22.8% had documentation of appropriate pre-pregnancy drug counselling within the last year. Of patients without documented pre-pregnancy advice, 46% were taking medications considered unsafe in pregnancy. Furthermore, no patients were signposted to sources of further information on drug therapy and/or rheumatic disease in pregnancy. Conclusion This audit highlights a lack of regular documented discussions around family planning and medication counselling in female subjects of childbearing age attending rheumatology clinics lacking obstetric input. Regular discussions are important for those who do and don’t wish to conceive, to appropriately counsel regarding pre-pregnancy measures or contraception. This audit using the BSR audit tool will be used as the baseline for a quality improvement project to support colleagues in providing regular, accurate reproductive health advice, supported by trusted online resources and referral to a specialist obstetric-rheumatology service as required. Disclosure A. Shirazi: None. B. Goulden: Grants/research support; Undertaking a PhD supported by Versus Arthritis (ref. 22975). I. Giles: Grants/research support; IG has received an unrestricted research grant, travel and speaker fees from UCB Pharma.

Role of endoplasmic reticulum aminopeptidase-1 gene polymorphism (rs13167972) in occurrence susceptibility of ankylosing spondylitis in a sample of Iraqi male patients.

Ankylosing spondylitis (AS) is a chronic and systemic seronegative inflammatory spondyloarthropathy, an autoimmune disease that has been associated with impaired Endoplasmic Reticulum Aminopeptidase (ERAP)-1 activity, which is involved in priming antigenic peptides. The purpose of this study is to investigate the association of 3-UTR of ERAP1 gene polymorphism (rs13167972) with the AS occurrence susceptibility in a sample of Iraqi male patients. The AS patients were diagnosed clinically and by magnetic resonance imaging (MRI) and other clinical and laboratory criteria like symptoms, increased C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The blood grouping and Body Mass Index (BMI) were also investigated to be associated with AS occurrence. The genotyping of the 3-UTR region of the ERAP1 gene (rs13167972) was done by Sanger sequencing. The results revealed that the AS occurred significantly in the age group of 20-35years (p = 0.013). The BMI shows that the AS patients were overweighted males (p = 0.013) and the most predominant blood group in AS patients was O- (p = 0.002). The ESR and serum level of CRP were significantly raised in AS patient sera (< 0.001). The results of the receiver-operating characteristics curve analysis (ROC) revealed that the CRP (AUC: 0.995, cut-off: 2.48mg/L, had 95% %sensitivity, 100% specificity, p < 0.001) is more discriminative than BMI (AUC: 0.300, cut-off: 46.91kg, had 0% sensitivity, 100% specificity, p = 0.001), and ESR (AUC: 0.808, cut-off: 7.50mm/hr, had 60% sensitivity, 88% specificity, p < 0.001) in distinguishing between AS patients and control group. The genotyping of the 3-UTR region of ERAP1 gene (rs13167972) result shows that the AG and GG genotypes are significantly occurring in AS patients (70%, OR: 2.33, 95%CI: 1.02-5.36, p = 0.04). The G allele is significantly occurring in AS patients (47%, OR: 2.07, 95CI%: 1.15-3.71, p = 0.01). The AS occurred in young overweight males with blood group O-. The AG and GG genotypes are risk factors for AS development while the G allele is a risk factor that increases the chances for disease incidence.

The impact of anti-tumor necrosis factor alpha drugs on lipid profile of patients with rheumatoid arthritis or seronegative spondyloarthropathy

Background: Inflammatory arthritis is associated with abnormal levels of lipoprotein. The cause is considered to be inflammation. Recently, the use of biologic drugs in the treatment of inflammatory arthritis, especially rheumatoid arthritis (RA) and seronegative spondyloarthropathy, has increased. There are different results of the effect of these drugs on fat profile. Evaluate the impact of anti-tumor necrosis factor (TNF) alpha drugs on lipid profile of patients with RA or seronegative spondyloarthritis. Methods: In this cross-sectional descriptive study, 50 patients with rheumatoid arthritis or seronegative spondyloarthritis, who were candidates for TNF alpha treatment, were included in the study. After obtaining written consent, a checklist was completed for all patients including demographic information such as age, sex, height, weight, place of residence, level of education, type of disease, and lipid profile test results including total cholesterol, triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were recorded. Then the patients were treated and evaluated for fat profile after 3, 6, 9 months after receiving the relevant treatment regimen. The test results were recorded in checklists. After completing the study, the data were entered into the statistical package for the social sciences (SPSS) 24 software and analyzed. Results: The mean age of patients was 46.38±14.33 years. 54% of patients were female. 54% of patients had rheumatoid arthritis. 62% of patients were treated with Sinora. The results of this study showed that serum triglyceride levels increased during the study period and this increase was statistically significant but the trend of changes in serum cholesterol, HDL and LDL levels was not statistically significant. However, serum LDL levels measured in the ninth month increased significantly compared to the initial measurement. Conclusions: Results showed that there was a significant relationship between lipid profile changes and anti-TNF alpha consumption. Although decreased inflammation appears but other mechanisms may be involved in dyslipidemia.

Dynamic thiol-disulfide homeostasis as an oxidative stress marker in ankylosing spondylitis and undifferentiated spondyloarthropathy.

Seronegative spondyloarthropathies (SpA) are a group of chronic diseases characterized by axial inflammation, oligoarthritis, and enthesitis. Oxidative stress may contribute to a wide range of rheumatologic diseases, including SpA. This prospective case-control study was designed to compare thiol-disulfide levels as a marker of oxidative stress between SpA patients and healthy controls. A total of 144 patients diagnosed with undifferentiated spondyloarthropathy (USpA, n = 97) or ankylosing spondylitis (AS, n = 47) were included along with 80 healthy controls. Serum native thiol (NT), total thiol (TT), and disulfide (D) levels were measured using the fully automated Erel method. The ratios NT/TT, D/TT, and D/NT were calculated. Thiol-disulfide levels were compared between the SpA groups and the healthy controls. The NT and NT/TT ratios were found to be significantly lower in the SpA group (p < 0.001). The disulfide, D/NT, and D/TT ratios were found to be significantly higher in the SpA group (p < 0.001). In pairwise comparisons between the SpA subgroups, the NT and TT levels were lower in the USpA group than in the AS group (p = 0.021), but serum disulfide levels were higher in the USpA group than in the AS group (p = 0.004). Among the patients with SpA, the group taking antitumor necrosis factor (anti-TNF) had lower TT measurements compared to the group taking conventional disease modifying antirheumatic drugs (DMARD) (p = 0.039). The thiol-disulfide balance is disturbed in favor of disulfide in SpA patients compared to healthy volunteers. Native and total thiol measurements correlate with acute phase reactants and might be used to monitor disease activity. Anti-TNF therapy might control the oxidative degenerative process better than the conventional DMARD in SpA patients.

The adult with low back pain: causes, diagnosis, imaging features and management.

Low back pain is the leading cause of disability worldwide. This article highlights the importance of succinct history taking and a thorough clinical examination when managing a patient with lower back pain in hospital. Furthermore, it encourages the clinician to consider the pertinent causes of low back pain such as age-related degeneration, malignancy, trauma, infection and seronegative inflammatory spondyloarthropathies, and looks at the diagnosis, imaging features and key management options which are available in secondary care.

Multidisciplinary non-pharmacological treatments with effects on pain modulation and functioning in spondyloarthropathies – a systematic review

Abstract: Treatment for chronic rheumatic diseases, included various modalities for pain management and for functioning modulation, has the main gole to increase the quality of life and to improve also the activities of daily living. Seronegative spondyloarthropathies (SpA) are a group of rheumatologic disorders that include ankylosing spondylitis, psoriatic arthritis, entheropatic SpA, reactive arthritis and undifferentiated SpA. Treatment methods include clasically pharmacological modalities. Physical therapy should also be highlighted as being part of the treatment. Balneotherapy and spa therapy are increasingly taken into account in evidence-based treatment guidelines for multiple rheumatic diseases, for specific effects on functional parameters and also for the involvement in cartilage regeneration. Balneotherapy is universally defined as the treatment method which uses bathing in thermal and mineral waters. Other balneological treatments include peloidotherapy, balneological gases and therapeutic waters in various forms of bathing, inhalation or drinking. Spa therapy comprises complementary and alternative treatment modalities including balneotherapy, hydrotherapy, exercises, and massage therapy. This systematic literature review aims to highlight the effects of balneotherapy in spondylarthropathies. The review is based on the internationally accepted method, the “PRISMA” methodology- “Preferred Reporting Items for Systematic Reviews and Meta-Analysis”.

Pattern of Uveitis in a Tertiary Hospital in North Jordan and the Impact of Behcet's Disease.

The purpose of this study is to assess the prevalence of autoimmune-mediated uveitis in relation to other diseases and to describe the clinical patterns of uveitis in a single tertiary hospital in north Jordan. A cross-sectional retrospective review was performed. We included all patients diagnosed with uveitis in King Abdullah University Hospital (KAUH) ophthalmology clinic and/or patients referred to KAUH rheumatology clinics for evaluation of suspected autoimmune mediated uveitis or for difficult to treat uveitis. This included patients from January 2015 to January 2019. Data collected about patients' age, sex, anatomical location of the disease, etiology, treatment, complications, and outcomes on vision loss were analyzed. A total of 221 patients were included in our study. The mean (±SD) age was 36 (±16) years. A total of 111 patients were female and 110 were male with a ratio of 1 : 1. Noninfectious uveitis was found to be more common than infectious uveitis (95% vs. 5% respectively). Autoimmune-mediated uveitis accounted for 40% of the total cases. The most common causes of autoimmune-mediated uveitis included Behcet's disease (n = 41, 19%) and seronegative spondyloarthropathy (n = 29, 13%). The majority of patients (n = 207, 94%) were treated with ophthalmic eye drops, cDMARDs (n = 101, 46%), biologics (n = 33, 15%), and colchicine (n = 30, 14%). Autoimmune-mediated uveitis, most commonly associated with Behcet's disease and seronegative spondyloarthropathy, represents a high percentage of uveitis in our area. This implies the need for a high index of suspicion at the time of evaluation.

The “Dagger Sign”: A classic sign in abdominal radiology

Ankylosing Spondylitis (AS) is one of the seronegative spondyloarthropathies, a group of inflammatory spine conditions that are characterized

Seronegative spondyloarthropathy-associated inflammatory bowel disease.

Seronegative spondyloarthropathy (SpA) usually starts in the third decade of life with negative rheumatoid factor, human leukocyte antigen-B27 genetic marker and clinical features of spinal and peripheral arthritis, dactylitis, enthesitis and extra-articular manifestations (EAMs). Cases can be classified as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, or juvenile-onset spondyloarthritis. Joint and gut inflammation is intricately linked in SpA and inflammatory bowel disease (IBD), with shared genetic and immunopathogenic mechanisms. IBD is a common EAM in SpA patients, while extraintestinal manifestations in IBD patients mostly affect the joints. Although individual protocols are available for the management of each disease, the standard therapeutic guidelines of SpA-associated IBD patients remain to be established. Nonsteroidal anti-inflammatory drugs are recommended as initial therapy of peripheral and axial SpA, whereas their use is controversial in IBD due to associated disease flares. Conventional disease-modifying anti-rheumatic drugs are beneficial for peripheral arthritis but ineffective for axial SpA or IBD therapy. Anti-tumor necrosis factor monoclonal antibodies are effective medications with indicated use in SpA and IBD, and a drug of choice for treating SpA-associated IBD. Janus kinase inhibitors, approved for treating SpA and ulcerative colitis, are promising therapeutics in SpA coexistent with ulcerative colitis. A tight collaboration between gastroenterologists and rheumatologists with mutual referral from early accurate diagnosis to appropriately prompt therapy is required in this complex clinical scenario.

Spondyloarthropathies That Mimic Ankylosing Spondylitis: A Narrative Review.

Ankylosing spondylitis is the most common type of seronegative inflammatory spondyloarthropathy often presenting with low back or neck pain, stiffness, kyphosis and fractures that are initially missed on presentation; however, there are other spondyloarthropathies that may present similarly making it a challenge to establish the correct diagnosis. Here, we will highlight the similarities and unique features of the epidemiology, pathophysiology, presentation, radiographic findings, and management of seronegative inflammatory and metabolic spondyloarthropathies as they affect the axial skeleton and mimic ankylosing spondylitis. Seronegative inflammatory spondyloarthropathies such as psoriatic arthritis, reactive arthritis, noninflammatory spondyloarthropathies such as diffuse idiopathic skeletal hyperostosis, and ochronotic arthritis resulting from alkaptonuria can affect the axial skeleton and present with symptoms similar those of ankylosing spondylitis. These similarities can create a challenge for providers as they attempt to identify a patient's condition. However, there are characteristic radiographic findings and laboratory tests that may help in the differential diagnosis. Axial presentations of seronegative inflammatory, non-inflammatory, and metabolic spondyloarthropathies occur more often than previously thought. Identification of their associated symptoms and radiographic findings are imperative to effectively diagnose and properly manage patients with these diseases.

Внекишечные проявления воспалительных заболеваний кишечника у детей: фокус на опорно-двигательный аппарат

The duration of inflammatory bowel disease (IBD) in children has an important effect on the condition of children's musculoskeletal system. The manifestations are different: from peripheral and axial spondiarthropathies to musculoskeletal deficiency in form of osteopenia and sarcopenia, nutritional deficiency and growth retardation. The article describes the modern foundations of the pathogenesis, duration, diagnosis and therapy of seronegative spondyloarthropathies in IBD in children. The ASAS, Garmisch-Partenkirchen criteria, ACR pedi or JADAS criteria used to verify spondyloarthritis and help specialist to assess the joint syndrome in children with IBD and monitoring the effect of therapy. Multidisciplinary management of children with IBD and joint syndrome by gastroenterologist and rheumatologist allows to choose the most successful individual treatment line for patients, many drugs (sulfasalazine, methothotrexate, biological therapy (a-TNF-α, a-IL 12/23, Janus kinase inhibitors) have common pathogenetic effects in IBD and joint syndrome. Therapy of peripheral arthropathies associated with IBD activity is aimed to controlling the main disease. We initiate early the treatment with вiological therapy (TNF-a) in children with axial spondyloarthritis and persistent peripheral duration. Musculoskeletal deficiency, nutritional insufficiency and growth retardation also largely determine the condition of children with IBD, correlating with the activity of disease at the manifestation of illness. However, in many patients, researchers have founded a persistent deficiency in bone and muscle health, even with good control of IBD. Therefore, today the priority of studies are aimed to the prevention of disorders and early correction of nutritional status, a quick return to a healthy lifestyle for children with IBD, which promises to significantly improve the prognosis of the condition of musculoskeletal system. Key words: Crohn's disease, extraintestinal manifestations, inflammatory bowel disease, children, musculoskeletal deficiencyt, spondyloarthropathy, ulcerative colitis

Uveitis in spondyloarthropathies

Background: Uveitis is associated with several systemic disorders. It may be the initial presentation or manifestation of a systemic disease. It is the most common ocular complication and is sometimes the earliest manifestation of spondyloarthropathies. This study aimed to review the current literature on spondyloarthropathies and associated uveitis.&#x0D; Methods: A narrative review was performed using various combinations of the keywords spondyloarthropathies, seronegative spondylarthritis-related uveitis, and human leukocyte antigen-associated uveitis using PubMed/MEDLINE and Google Scholar from January 1, 2000, to September 30, 2022. We describe the disease mechanisms, genetics, and classification of spondyloarthropathies, the clinical patterns of their related ocular diseases, and the current modalities for the management of their ocular or systemic manifestations.&#x0D; Results: Seronegative spondyloarthropathies are a group of rheumatic disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease-related spondyloarthropathy, juvenile-onset spondyloarthritis, and undifferentiated spondyloarthritis. These are characterized by enthesitis in the absence of serum rheumatoid factor and have a strong association with human leukocyte antigen B27. The clinical courses and features of spondyloarthropathies are remarkably diverse. Ocular inflammation is common in spondyloarthropathies, often precedes the onset or diagnosis of systemic disease, and responds well to topical therapy. Timely diagnosis of systemic diseases may improve quality of life and help avoid ocular and skeletal complications. Recurrence of ocular inflammation is frequent; on occasion, it may be associated with etanercept administration.&#x0D; Conclusions: Eye care professionals should be able to recognize spondyloarthropathies, manage ocular disease, and collaborate with related specialties for modification of systemic treatment if associated with ocular complications. Timely referral and early management could attenuate or prevent ocular or systemic morbidities associated with spondyloarthropathies.

T1w MRI vs STIR MRI vs Conventional Radiography in Evaluation of Seronegative Spondyloarthropathies

Ankylosing spondylitis and other seronegative arthropathies are conventionally diagnosed using clinical criteria and xrays of SI joints and spine. The introduction of MRI particularly the STIR sequence has revolutionised the diagnosis and assessment of activity of the diseease. But as inferred from this study MRI is not infallible and xrays maybe superior to MRI to identify the structural changes and low dose CT maybe a good alternative to even MRI to establish the Diagnosis.

Frequency and Predictors of Opioid Use in Rheumatoid Arthritis and Seronegative Spondyloarthropathy Patients.

Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate the state of opioid use in RA and SpA patients. This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05. About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval. Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related to opioid abuse.

Systemic Lupus in males – clinical-laboratory, immunological and histological characteristics.

Systemic lupus erythematosus is a chronic, systemic, non-organ-specific autoimmune disease that affects all organs and systems of the human body and is characterized by the production of autoantibodies against nuclear antigens. Its prevalence in Europe reaches 1:2500. It affects mostly women (female : male ratio=9 : 1) in fertile age group (15-45 years). The clinical course of lupus in males is characterized by more aggressive clinical course and the development of serious complications, such as vasculitis, central nervous system involvement, antiphospholipid syndrome, etc. For the period of 7 years (2012-2019) we observed overall 18 male patients with systemic lupus, 11 with biopsy-proven renal involvement and 7 without clinically significant renal disease (proteinuria &lt; 0.5 g/24 h., no erythrocyturia/cylindruria, normal renal function), mean age at the diagnosis 39.6 +/- 12.3 years. All patients received pathogenetic treatment (corticosteroids + cytotoxic agents). Three had secondary antiphospholipid syndrome, 1 – inflammatory bowel disease, 1 – seronegative spondyloarthropathy. Three had type 2 diabetes. The authors discuss the clinical, immunological and histological characteristics and the therapeutic approach in males with systemic lupus.

Total Hip Replacement in a Case of Ankylosing Spondylitis: Anesthetist’s Preparedness

Ankylosing Spondylitis is an autoimmune seronegative spondyloarthropathy which manifests as a relapsing remitting disease. Since the disease involves the spine, it becomes significant for anesthesiologists as ensuring airway control in general anesthesia, and regional neuraxial blockade becomes difficult. Hence the anesthesiologist should be prepared beforehand with the anesthesia plan and the backup plan if the primary plan fails. In this report, we highlight the anesthetic management of a 66 year-old male who was a known case of ankylosing spondylitis and was planned for a total hip replacement.

Evaluation of subclinical myocardial dysfunction using speckle tracking echocardiography in patients with ankylosing spondylitis

Objective: Ankylosing spondylitis is a part of diseases called “seronegative spondyloarthropathy”. Affects the vertebral column, sacroiliac joint and peripheral joints. This chronic rheumatic disorder involved extra -articular parts like Heart, lungs, central nervous system and eyes. Ankylosing spondylitis lead to multiple cardiac complication such as systolic and diastolic dysfunction of left ventricle, valvular involvement , inflammation of aorta and pericardium with enlargement of the heart. Aim of the study: To evaluate of systolic and diastolic left ventricle dysfunction by echocardiography with speckle tracking in ankylosing spondylitis patients. Method: Fifty adult patients with Ankylosing Spondylitis fulfilling the inclusion criteria coming to outpatients of Merjan Medical City were recruited, diagnosed according to the criteria of the American College of Rheumatology criteria; 2D Echocardiography, Tissue Doppler Imaging and Speckle Tracking Echocardiography was done. Statistical analysis of correlation was done with Chi‑square test and t-test, the statistical significance was taken P &lt; 0.05. Results :There was a significant lowering in the mean of global longitudinal strain in ankylosing spondylitis patients than in control ( p = 0.047*).

PATTERNS OF UVEITIS AT A TERTIARY REFERRAL CENTER IN YEMEN: ONE CENTRAL RETROSPECTIVE STUDY

Background: Uveitis is described as a disorder of the eye so as to leads to the iris, ciliary body, choroid, and adjacent parts of the eye inflammation. The disturbances may produce impermanent or continuing visual impairment or sightlessness. Purpose: The main purpose of the study was to reveal the causes of uveitis in a referral center in Sana'a city, Yemen. Sequentially the study was conducted to assist in the development and design of preventive policies and diagnostic methods for uveitis in Yemen. Methods: This cross-sectional, retrospective analysis integrated 65 uveitis patients who were referred to the Eye Consulting Center clinic, from January 2021 to the end of December 2021. Data concerning patient gender, age and anatomical location of disease, clinical and pathological manifestations were collected then evaluated. Results: The mean patient age at onset of uveitis was 36.3 ± 13.4 (range: 9-75) years. The female to male ratio was 2.6: 1. Sixty-seven percent participated uveitis patients suffered from bilateral involvement. The predominant type was Pan-uveitis (46.2%), anterior acute uveitis (36.9%), intermediate acute uveitis (12.3%) while posterior acute uveitis was less common (4.6%). Considering medical conditions, 53.8% of patients had acute uveitis and 46.2% had chronic uveitis. Laterality, 38.5% had unilateral uveitis while most patients had bilateral uveitis. Also, 53.8% of patients developed complications. Given the possible causes, the most common diagnoses were 'idiopathic' (32.3%), HLA-B27-positive (21.5%), Behçet‘s syndrome (13.8%), and granulomatous uveitis (TB) (9.2%)., seronegative spondyloarthropathy (6.2%), Fuch’s uveitis (6.2%), followed by less common Vogt Koyanagi Harada (4.6%), herpetic uveitis (3.1%), and toxoplasmosis (3.1%). Conclusion: On the contrary to most uveitis epidemiologic studies the uveitis etiologic and clinical patterns were diverse in a tertiary referral center in Sana’a city, Yemen. Pan-uveitis and anterior acute uveitis were the most frequent clinical pattern in this study, and the most common related causes were HLA-B27 positive and Behçet's syndrome. Peer Review History: Received: 12 March 2022; Revised: 17 April; Accepted: 30 April, Available online: 15 May 2022 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Jucimary Vieira dos Santos, Hemonorte Dalton Barbosa Cunha, Brazil, jucimaryvieira@yahoo.com.br Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Similar Articles: PREVALENCE OF CNS TUMORS AND HISTOLOGICAL RECOGNITION IN THE OPERATED PATIENTS: 10 YEARS EXPERIENCE IN YEMEN

P061 Polymyalgia rheumatica following COVID-19 vaccination: presentation of four patients

Background/AimsVaccination against coronavirus is a cornerstone in the fight against the COVID-19 pandemic. Although the safety and efficacy of vaccines was established prior to roll out, long-term data and reports of rare adverse reactions remain inadequate. Literature reviews revealed two cases of PMR-like syndrome, left elbow arthritis and a case of rheumatoid arthritis (RA) flare following COVID-19 vaccination. Additionally, a case of new onset RA and case of reactive arthritis was reported with COVID infection.MethodsWe present four patients with polymyalgia rheumatica (PMR) following COVID-19 vaccination. The clinical details of the four patients are outlined in the table: P061 Table 1Patient 1Patient 2Patient 3Patient 4Demographic data76-year-old Caucasian male68-year-old Caucasian male73-year-old African male65-year-old Caucasian maleType of COVID-19 vaccineAstraZenecaPfizerAstraZenecaAstraZenecaOnset of symptoms after the second dose of COVID-19 vaccinationWithin 1 weekWithin 2 weeksWithin 1 weekWithin 1 weekClinical symptoms-Inflammatory joint pain mainly in shoulders and hand with two hours morning stiffness -Bilateral knee and ankle swelling. -Significant restriction of self-care activities in daily living (ADL)-Severe shoulder pain and morning stiffness -Hand pain affecting ADL-Widespread painful joints affecting the neck, pelvic girdle, and hands -Significant restriction of self-care activities-Sudden onset of pain and stiffness of both shoulders and pelvic girdle -Requiring a walking stick. -Significant morning stiffnessClinical signs- Limited shoulder abduction -Tenderness over PIP and MCP without synovitis- Limitation of shoulder movement-Limitation of shoulder movement-Limitation of both shoulder movementAutoimmune profile (RF, CCP, ANA, ANCA and protein electrophoresis)NegativeNegativeNegativeNegativeFull blood countHaemoglobin (Hb) 125 g/l and white blood cells (WBCs) 17 10 × 9/1Hb 147 g/l and WBCs 11.5 10× 9/1Hb 160 g/l WBCs 14 10× 9/1Hb 124 g/l and WBCs 9.8 10× 9/1CRP at the onset of symptoms96 mg/l61 mg/l105 mg/l161 mg/lPrednisolone dose30 mg per day as there was no response to 15 mg and tapered as per PMR regime15 mg per day tapered as per PMR regime40 mg per day by A & E; and tapered as per PMR regime15 mg per day tapered as per PMR regimeUltrasound (US) revealed typical finding of bilateral sub deltoid bursitis and biceps tendonitis in the first patient and there was severe right sub deltoid bursitis with biceps tendonitis in the second patient. None of the patients had features to suggest malignancy, giant cell arteritis, seronegative spondyloarthropathies or connective tissue disease.ResultsAfter exclusion of other inflammatory causes of shoulder pain, they were diagnosed with PMR based on clinical judgement and high inflammatory marker at time of presentations, ultrasound findings and significant improvement with prednisolone.ConclusionPMR following COVID-19 vaccination is exceptional and cannot be proven. In these patients post vaccination chronology of events favours this diagnosis. It is known that immunological illness may start after viral infection or vaccination (hapten or immune stimulation). The patients have responded well to the prednisolone similar to typical PMR cases. We need further studies to look at possible link between COVID-19 vaccination and PMR.Disclosure M. Mohareb: None. A. Bharadwaj: None. A. Nandagudi: None.