Soft Tissue Rheumatism Research Articles

P102 Should Fibromyalgia be Diagnosed in Primary or Secondary Care?

Abstract Background/Aims Both the Rheumatology Getting It Right First Time (GIRFT) report, published in February 2021, and the British Society for Rheumatology (BSR) referral guidelines from October 2021 recommend not referring patients with suspected Fibromyalgia to Rheumatology services. In contrast the Royal College of Physicians (RCP) guidelines on Fibromyalgia from 2022 recommend that for unequivocal cases, referral is not necessary, but that referral is appropriate if there is diagnostic uncertainty. We undertook an evaluation of our Rheumatology service to assess whether following either of these guidelines would be appropriate. Methods A prospective analysis of all patients referred to one general Rheumatologist over 18 months to assess the accuracy of suspected fibromyalgia diagnoses from primary care. The included cases were all patients referred with possible fibromyalgia on the referral letter, along with patients with an end diagnosis of fibromyalgia. Results Seventy-two patients were referred to one consultant with possible fibromyalgia on the referral letter. Of these, only 44 (61%) were confirmed as having fibromyalgia. Common other problems felt by the GP to be fibromyalgia included 2+ areas of localised soft tissue rheumatism (seven patients), localised chronic back pain (six patients) and biomechanical lower limb pains due to flat feet (three patients). Another 39 patients were diagnosed as fibromyalgia when not considered by primary care; nine of these patients were referred on the early arthritis pathway and two patients to the axial spondyloarthritis clinic. Overall this workload only constituted approximately 9% of new patients to the service, with patients with an end diagnosis of fibromyalgia making up approximately 7% of the overall new referrals. Conclusion The problems with diagnosing fibromyalgia in primary care are likely multifactorial - general practitioners (GP’s) are very busy and there is an increasing use of allied health professionals (AHP) in primary care, who do not always have the experience or training to diagnose fibromyalgia or other common musculoskeletal conditions. Some GP’s do not feel comfortable diagnosing fibromyalgia and some patients are just not happy with a primary care opinion. Overall, we do not feel that the diagnosis of fibromyalgia can be left solely in the hands of primary care; if the patients in this review had not been referred, then a significant number would have been incorrectly labelled as fibromyalgia, with all the problems that may bring. In view of this, the RCP guidelines would appear more appropriate than the BSR referral guidelines, but even then some of the patients in this review may still have ended up with an incorrect diagnosis, so overall Rheumatology departments should be very cautious about declining referrals for possible fibromyalgia and we continue to see these referrals in our department. Disclosure M.P. Sykes: None.

COMPARISON OF ROPIVACAINE ALONE VS ROPIVACAINE WITH METHYLPREDNISOLONE INJECTION AS A TREATMENT OF TRIGGER POINTS FOR MYOFASCIAL PAIN: A SUPERIORITY RANDOMIZED CLINICAL TRIAL

Soft tissue rheumatism, known as myofascial pain syndrome (MPS), is typified by taut bands, transferred pain that is distinct, sensory alterations that occur, and a local twitch response. It is also connected with trigger points in one or more muscles. The purpose of the research is to evaluate the effects of injections of Ropivacaine alone vs. Ropivacaine with methylprednisolone in decreasing pain in people in our community who have myofascial pain caused by trigger points. The design of this study was a randomized controlled trial. This study was carried out from July 2022 to August 2023. The research comprised 50 individuals (27 females and 23 males) diagnosed with MPS who came to our clinic. Using online randomization software, the patients were randomly divided into two groups. Group B got a mixture of 0.25% Ropivacaine & 10mg methylprednisolone in 3ml normal saline at each trigger point, whereas Group A received 3ml of 0.25% Ropivacaine. Dry needling of trigger sites was done in both groups. Patients were assessed at two, four, and eight weeks of intervention. The patients' pre-treatment assessment measures showed no statistically significant differences. After 4 and 8 weeks of assessment, Group B NRS pain and BDI scores showed statistically significant improvements compared to pre-treatment results (p<0.05). NRS and BDI scores were reduced in group A compared to their pretreatment values, but that was not clinically significant. Results of our study showed that there was a statistically significant difference between both groups in terms of pain, stress, and anxiety after the intervention. Ropivacaine with methylprednisolone gave better results than Ropivacaine alone in reducing pain and anxiety among the study population.

The Epidemiology of Rheumatic Diseases in India

Epidemiological studies, referred to as the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) studies, have been conducted under the aegis of the International League against Rheumatism and the World Health Organization to evaluate the epidemiology of rheumatic and musculoskeletal (RMSK) diseases in India. These COPCORD studies conducted in rural Bhigwan and urban Pune in Maharashtra, rural Calicut and rural Trivandrum in Kerala and rural and urban Lucknow in Uttar Pradesh, along with data from the Global Burden of Diseases study have helped to understand the burden of rheumatic diseases in the community. Based on these studies, RMSK diseases, which are amongst the top 25 causes of disability in the Indian population, are prevalent in nearly 25%–30% of the Indian population. The common rheumatic diseases in the community are soft tissue rheumatism, neck and back pain, fibromyalgia and unspecified pains and osteoarthritis (most commonly affecting the knee). These diseases most commonly affect young persons between the third to the fifth decade of life, more often affect females, are prevalent in both rural and urban populations, and account for considerable disability in up to one-fifth of individuals leading to loss of livelihood and dependence on others for self-care. Community-based national healthcare programs to manage RMSK diseases at the community level are urgently needed. There also remains an unmet need to train more doctors to diagnose and manage rheumatic diseases at the primary, secondary and tertiary levels of care.

Investigation of Early Growth Response Protein (EGR) Levels in Patients with Fibromyalgia Syndrome: A Cross-Sectional Study.

Fibromyalgia is a soft tissue rheumatism characterized by chronic and widespread musculoskeletal pain at specific points in the body. In this study, we aimed to investigate the relationship between Early Growth Response (EGR1, EGR2, and EGR3) protein levels in patients with Fibromyalgia Syndrome (FMS) and healthy controls. In our studies, 76 FMS patient group and 78 healthy control group who were newly diagnosed with primary FMS according to the 2010 American College of Rheumatology criteria for fibromyalgia in Sivas Cumhuriyet University Hospital, Physical Therapy, and Rehabilitation were used. Venous blood samples were taken from both groups for the measurement of EGR1, EGR2, and EGR3 protein plasma levels, and protein levels were determined using ELISA methods. Statistical parametric test assumptions were compared using the Independent Student's t-test. In addition, specificity, sensitivity, and AUC values were calculated with the ROC curve. The relationship between plasma EGR1 protein levels of FMS patients and control groups was statistically significant (p=0.001). EGR1 protein levels were found to be lower in the patient group diagnosed with FMS compared to the control group. It has been suggested that EGR1 protein levels can be important in the diagnosis of FMS disease.

Symptoms of rheumatoid arthritis and fibromyalgia and their relationship with anxiety

Rheumatoid arthritis (RA) is an autoimmune disease that affects synovial attachments and negatively affects many organs and tissues. Non-inflammatory soft tissue rheumatism of the disorder and the disease. Pain is the most common and regular symptom in both diseases. The purpose of the study is to reveal the crises of pain with FMS and RA and psychiatric diseases such as anxiety or their association. The study included RA and FMS patients according to the 2010 ARA criteria. 50 patients with FMS and 50 patients with RA were included. If anxiety was present for both groups, the Hamilton Anxiety Scale (HAQ) was used for measurements, the Beck Depression Scale and Zung's vulnerability were used to determine the psychological dimensions of the copies, and the Visual Analogue Scale (VAS) was used to determine the pain intensity. The general care of the patients on a daily basis was examined. The patient and control group were compared to see if there was a significant difference in terms of these measurements.

Automated characterization and detection of fibromyalgia using slow wave sleep EEG signals with glucose pattern and D'hondt pooling technique.

Fibromyalgia is a soft tissue rheumatism with significant qualitative and quantitative impact on sleep macro and micro architecture. The primary objective of this study is to analyze and identify automatically healthy individuals and those with fibromyalgia using sleep electroencephalography (EEG) signals. The study focused on the automatic detection and interpretation of EEG signals obtained from fibromyalgia patients. In this work, the sleep EEG signals are divided into 15-s and a total of 5358 (3411 healthy control and 1947 fibromyalgia) EEG segments are obtained from 16 fibromyalgia and 16 normal subjects. Our developed model has advanced multilevel feature extraction architecture and hence, we used a new feature extractor called GluPat, inspired by the glucose chemical, with a new pooling approach inspired by the D'hondt selection system. Furthermore, our proposed method incorporated feature selection techniques using iterative neighborhood component analysis and iterative Chi2 methods. These selection mechanisms enabled the identification of discriminative features for accurate classification. In the classification phase, we employed a support vector machine and k-nearest neighbor algorithms to classify the EEG signals with leave-one-record-out (LORO) and tenfold cross-validation (CV) techniques. All results are calculated channel-wise and iterative majority voting is used to obtain generalized results. The best results were determined using the greedy algorithm. The developed model achieved a detection accuracy of 100% and 91.83% with a tenfold and LORO CV strategies, respectively using sleep stage (2 + 3) EEG signals. Our generated model is simple and has linear time complexity.

Spectrum of Rheumatic Disease in Physical Medicine and Rehabilitation Department in a Tertiary Level Hospital in Bangladesh

Background: An umbrella term encompassing diseases that damage the joints and/or connective tissue and cause chronic, frequently intermittent discomfort is rheumatism. Rheumatism is a general term that refers to at least 100 distinct diseases and disorders. Given the dearth of research on this subject, the study's goal was to investigate the range of rheumatic disease among patients presenting as outpatients in the Physical Medicine & Rehabilitation department of a tertiary level hospital. Objective: To evaluate the spectrum of rheumatic disease in a tertiary level hospital in Bangladesh. Materials and Methods: This cross-sectional study was carried out at the Physical Medicine and Rehabilitation department of the DMCH for six months. The study sought to enroll patients who had musculoskeletal problems or systemic symptoms that would indicate rheumatic illness. After meeting the requirements, patients were accepted. Each respondent provided written informed consent, and those who refused to engage in the study or undertake additional research were not included. By conducting a face-to-face interview with the respondents and utilizing a pre-tested semi-structured questionnaire, information about the respondents' socio-demographic characteristics, disease duration, clinical symptoms and signs, and investigations report was gathered. Data analysis was done in SPSS-16. Results: Mean age of respondents was 46.36±12.25 years (male= 50±11.68 years and female= 44.19±12.03 years [age range 21-70 years] with 35.7% male and 64.3% female. Around 54.17% of the cases presented with articular symptoms, 43.23% of the patients had degenerative and 10.94% had inflammatory joint diseases. Among the inflammatory arthritis, (38.09%) rheumatoid arthritis and (30.95%) Ankylosing spondylitis was most common whereas (28.92%) lumbar spondylosis and peripheral (28.31%) osteoarthrosis were predominating among non-inflammatory arthritis. Nonspecific back pain was the commonest (60.12%) of specific disorders included in soft tissue rheumatism, followed by (25.77%) adhesive capsulitis of shoulder. Conclusion: Articular disorders both non-inflammatory & Inflammatory, soft tissue rheumatism, disorder of bone and multi-system disorders; these four types of disorder were encountered in this tertiary care hospital.

A Review of Community-Oriented Program for Control of Rheumatic Diseases Studies from India

Abstract Background: Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) is a global community-based program, emphasizing prevalence data. In India, it has been headed by the World Health Organization (WHO), the International League of Associations for Rheumatology (ILAR), and the Bone and Joint Decade (BJD), India. The Indian Council of Medical Research (ICMR) also utilized the COPCORD methodology. This study aimed to review Indian COPCORD data. Methods: PubMed, COPCORD website, conference proceedings, and citations were searched from inception to 2022. Search terms included WHO-ILAR, COPCORD, and India. Studies conducted in India and available in English were included. Abstracts from journal supplements or conference proceedings were included if they studied the Indian population. Results: Bhigwan, Pune, Bikaner, Lucknow, Calicut, and Trivandrum studies were published as full-length articles. Soft-tissue rheumatism showed a higher prevalence than most diseases everywhere. The appraisal checklist found a few lacunae in the description of the study setting and statistical analysis clarity. Bhigwan had a high prevalence of “ill-defined diagnosis” (6.25%). Osteoarthritis (OA) knee had a prevalence of 10.6% in Lucknow urban. RA prevalence was 2.54% in Bikaner. Pune exhibited the highest OA prevalence (6.25%). Age and gender were important risk factors in the Calicut study. Trivandrum found that functional impairment impacted workability and finances. Malappuram reported higher rheumatic musculoskeletal disease (RMSD) in women (70%). Conclusion: COPCORD studies were the first to highlight the burden of RMSD in India. Nonclinical aspects such as architecture and living conditions have been described. Further research regarding functional ability, work disability, and psychosocial factors is recommended. Future scope to look at economic aspects and environmental risk factors remains.

E036 Arthritis in East Africa: an observational study

Abstract Background/Aims The burden of musculoskeletal (MSK) disease in East Africa remains largely unknown. Early evidence from Tanzania suggests that it may have a substantial adverse impact on health care outcomes, with both social and economic consequences. Limited data on prevalence and case mix of MSK disorders is presently available in East Africa. Data is urgently required to facilitate the planning, provision and funding of the services needed to meet population requirements here. The need is likely to be greatest among the poorer and most isolated members of the community. We describe the case mix of MSK disorders we encountered among people across five regions who had no previous access to clinical care in East Africa. Methods Over a four-week period in 2022, we undertook a series of clinics in five separate locations across impoverished areas of Zambia and Kenya. These ranged from city slums to isolated rural communities. We recorded demographic features for every consultation, along with our diagnosis and intervention. We calculated the percentage of people consulting with MSK issues and describe the case mix of MSK disorders, along with interventions provided. Results We completed a total of 1089 community consultations in Zambia and Kenya. Of these, a total of 271 people (24.9%) reported primary MSK issues. This population was mainly female (66%) and had a median (range) age of 58 (13-90) years. The percentage of patients who consulted with MSK issues were significantly influenced by geographic location, rising from 8% in urban areas to 52% in the most rural sites. The commonest MSK diagnoses we made at first consultation were osteoarthritis (49.8%), mechanical low back pain (27.7%) and soft tissue rheumatism (10.0%), with 3.0% having evidence of inflammatory joint disease (IJD). Therapeutic intervention was provided in 62.3% and procedures were performed in 11.4%. Conclusion MSK disease appears to be a common reason for seeking medical intervention in East Africa, especially among older females who have accumulated a significant mechanical burden from physical exertion and childbearing. Therapeutic intervention was frequently required, although smaller numbers had evidence of IJD. Increased awareness of the burden of MSK disease on poorer populations is necessary. Training programs in rheumatology are urgently required to ensure that care pathways are established with adequate funding and regular rapid access to ensure the provision of appropriate support and intervention. Disclosure C. Kuo: None. L. Black: None. C. Kelly: None.

Epidemiology of rheumatic and musculoskeletal diseases in a Nigerian peri-urban community: results of a cross-sectional survey using the COPCORD stage 1 model.

There is relative neglect of rheumatic and musculoskeletal diseases (RMDs) in sub-Saharan Africa (SSA). While hospital-based reports on RMDs abound, there is a paucity of population-based reports on these conditions which are otherwise recognized to cause functional disability and reduced quality of life in the affected individuals. Thus, the objective of this study is to determine the prevalence, diagnostic types, and predictors of musculoskeletal (MSK) pain in Agbowa, a peri-urban community in Lagos, South-West Nigeria. This community-based survey utilized the World Health Organisation/International League of Association of Rheumatology Community Oriented Programme for the Control of Rheumatic Diseases (WHO/ILAR COPCORD) stage 1 model. All respondents had their profiles documented via modified COPCORD questionnaires. Pain intensity and functional disability were assessed by the Numerical Rating Scale (NRS) and Health Assessment Questionnaires Disability Index (HAQ-DI) respectively. The rheumatic and musculoskeletal diseases were classified using relevant validated criteria. Data obtained were analysed using SPSS Version 21. There were 3056 respondents who were predominantly female (59.2%). The period prevalence of MSK pain among the 3056 respondents was 58% (n = 1,773). There were significantly more females with MSK pain than males (62.8% vs. 37.2%, p = 0.001). Overall, 380 (12.4%) subjects had clinically diagnosed RMDs. The common RMDs in decreasing order were osteoarthritis (n = 185, 6.1%), chronic low back pain (n = 95, 3.1%) and soft tissue rheumatism (n = 52, 1.7%). The bivariate analysis showed that female sex, family history of MSK conditions, history of previous trauma, and some comorbidities were significantly associated with MSK pain. The median HAQ-DI was 0.6 (IQR 0.1-1.8) with significant disability (HAQ-DI ≥ 1) in 39.5% of the subjects. The burden and impacts of these conditions are considerable. Thus, the government needs to devise programmes and policies to limit the effects of RMDs in such communities.

Prescription Claims for Immunomodulator and Antiinflammatory Drugs Among Persons With Ehlers-Danlos Syndromes.

Joint hypermobility in Ehlers-Danlos Syndromes (EDS) predisposes persons with EDS to frequent subluxations and dislocations, chronic arthralgia, and soft-tissue rheumatism. Epidemiologic trends of rheumatologic conditions among persons with EDS are lacking. Prescription claims databases can reflect underlying disease burdens by using medication claims as disease proxies. We examined the prevalence of prescription claims for commonly prescribed immunomodulator and antiinflammatory (IMD) drugs among persons with EDS compared with their matched control person, and hypothesized peripubertal increases among female persons with EDS. We compared the percentages of IMD drug prescription claims among 3,484 persons with EDS (ages 5-62 years) against their age-, sex-, state of residence-, and earliest claim date-matched control persons using 10 years (2005-2014) of private prescription claims data and a minimum 2-year enrollment inclusion criterion. Our cohort comprised 70% adults and 74% female persons. At least 1 IMD medication was prescribed to 65.4% of persons with EDS compared with 47.4% of control persons. We observed 1.3 to 4.2 times higher odds (P < 0.0001) for 5 out of 6 IMD drug classes among persons with EDS compared with matched control persons, except for biologic agents (conditional odds ratio 1.3, 95% confidence interval 0.8-2.0). Peripubertal increases were observed for nonsteroidal antiinflammatory drugs, oral, and injectable steroids. To our knowledge, our study is the first to examine the full range of IMD drug prescription claim trends among persons with EDS. We believe our research findings can have notable diagnostic and management implications for EDS patients who present with multiple comorbidities and generally require a more granular assessment of their medical conditions.

Prevalence and pattern of soft‐tissue rheumatism in a rural community in South‐South Nigeria: A cross‐sectional survey

AbstractBackgroundSoft tissue rheumatism arises from the pathology of periarticular structures. They are marked by pain and disability. Epidemiological studies in sub‐Saharan Africa are sparse. This study aimed to determine the epidemiology of soft‐tissue rheumatism in a rural community in South‐South Nigeria.MethodsThis was a community‐based, cross‐sectional study conducted from February to July 2017 in South‐South Nigeria among 319 participants using the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology. Participants aged 18 years and older were included in the study. Subjects reporting positive musculoskeletal pain were examined for specific soft tissue rheumatism. The diagnosis was based on established criteria.ResultsThe mean age of the study population was 48.87 ± 19.58 years. The prevalence of soft‐tissue rheumatism was 11.0% (35/319). Soft tissue rheumatism was more prevalent in females (24, 68.6%) than in males (11, 31.4%). The most common form of soft‐tissue rheumatism diagnosed was adhesive capsulitis (20.0%), closely followed by rotator cuff tendinitis (14.3%), carpal tunnel syndrome (14.3%), and plantar fasciitis (14.3%). Age (p = 0.06), body mass index (p = 0.034), and dyslipidemia (p = 0.028) were significantly associated with the prevalence of soft‐tissue rheumatism. A significant disability index (HAQ‐DI ≥ 1) was recorded in 40.0% of participants with soft tissue rheumatism. Twelve (34.3%) participants with soft‐tissue rheumatism attributed the disorder to their work, and 74.3% used hospital‐prescribed medications for treatment.ConclusionSoft‐tissue rheumatism is associated with a significant disability affecting activities of daily living. Factors associated with its prevalence include increasing age and obesity.

Disease Pattern of Musculoskeletal Disorders of the Patients Attending Outdoor of the Department of Physical Medicine and Rehabilitation, Sir Salimullah Medical College, Dhaka

Background: Physical medicine and rehabilitation (PM&amp;R) is a medical speciality focused on prevention, diagnosis, rehabilitation, and therapy for patients who experience functional limitations resulting from injury, disease, or malformation. Department of Physical Medicine and Rehabilitation (PMR) at Sir Salimullah Medical College and Mitford Hospital provides outdoor services for different musculoskeletal and neurological disorders which include counseling, drug management, physical therapy, speech therapy, ADL training etc. In this study, we enrolled only the patients of musculoskeletal disorders. Objectives: To understand the disease pattern and demographic characteristics of the patients of Musculoskeletal disorders presenting to the department of PMR. This will increase the awareness regarding PMR services among doctors and other health care providers and also to facilitate rehabilitation plan of a musculoskeletal disorder. Methods: This cross-sectional observational study was done on outdoor patients attending the Department of PMR at Sir Salimullah Medical College from 1st January, 2021 to 31st December, 2021. We have enrolled only the patients of musculoskeletal disorders. Results: Total number of patients was 13644, most of them were female. Maximum number of patients belong to 20-50 years of range and they mainly come from surrounding urban areas. Regarding the musculoskeletal disease pattern, 34.2% patients presented with mechanical low back pain (LBP) and related diseases, 11.4% patients with neck pain, 13.7% with knee pain, 9.4% with shoulder pain, soft tissue rheumatism (STR) comprises of 8.7%, 4.6% with heel pain and related disorders, 14.3% with rheumatological diseases, other musculoskeletal diseases contribute to 3.7%. Patients with LBP and related diseases were diagnosed as non-specific mechanical LBP (74%), Herniated disc disease(5%), Lumbar spondylosis, Spondylolisthesis (2%), etc. Conclusion: LBP and related diseases affect most of the people attending outdoor with musculoskeletal diseases. Sir Salimullah Med Coll J 2022; 30: 186-189

Prevalence of rheumatic diseases in Baix Empordà

BackgroundIn Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. Materials and methodsObservational, descriptive and cross-sectional study carried out on the population attended from 2016 to 2017 in SIBBE (Serveis de Salut Integrats del Baix Empordà), an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: "with rheumatic disease", "possible rheumatic disease" and "without rheumatic disease". ResultsIn total, 71,785 patients were distributed as: 36.2% “with rheumatic disease (n = 25,990); 6.1% with “possible rheumatic disease” (n = 4406) and 57.7% “without rheumatic disease” (n = 41,389). The group "with rheumatic disease" showed a predominance of women (59.7% vs. 44.9%) and older age (59.1 ± 17.7 vs. 45.1 ± 16.2; p < .001) compared to the group "without rheumatic disease". The presence of rheumatic disease increased progressively with age, being maximum in the group between 55–75 years. Conclusions36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Empordà population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age.

Musculoskeletal Disorders due to Chikungunya Virus: A Real Experience in a Rheumatology Department in Neiva, Huila.

Chikungunya (CHIKV), is an endemic RNA virus in some regions of Asia and Africa. In Colombia in 2014, its spread starts explosively and quickly. The presentation of CHIKV is a febrile condition, with musculoskeletal symptoms, which can progress to erosive arthropathy and polyarticular deformity. The purpose of this study is to evaluate in patients suffering from CHIKV infection in Neiva, Huila who attend the Rheumatology clinic, the symptomatic and serological behavior, and to describe comorbidities associated to the chronic phase of the disease. An observational, longitudinal and retrospective analysis of data collected in 410 patients afflicted with the CHIKV virus, with symptoms lasting more than 3 months, who persisted with musculoskeletal and joint symptoms. The patients were classified according to their commitment in post-viral arthralgias, polyarthritis post viral, Rheumatoid Arthritis (RA) post CHIKV, Spondyloarthritis postCHIKV, and soft tissue rheumatism. The statistical analysis was performed using SPSS software (version 24). A descriptive analysis was carried out to evaluate quantitative variables such as the mean (standard deviation), and categorical variables such as frequency (%). The categorical variables were compared using the Chi-square equation. As a statistical significance, a p less than .05 was considered. Of the 410 patients, 89.23% were women, with polyarticular involvement in 92.26% of the cases. Of the patients, 49.83% had osteoarthritis. At the time of the evaluation in the Rheumatology clinic, 46.3% of the cases presented persistent non-inflammatory arthralgias, and 53.7% of the patients underwent arthritis on physical examination, of which, remarkably, 20.3% met the criteria for rheumatoid arthritis postCHIKV. The development of musculoskeletal symptoms after CHIKV infection is a very serious public health problem, with persistent complications and long-term morbidity risk in real life. The presence of net postviral arthritis is noteworthy, however the development of postCHIKV rheumatoid arthritis usually requires more advanced pharmacological measures, including, in some cases, transition to biological therapy. The presence of symptoms of venous insufficiency in the lower limbs that developed with CHIKV infection was an incidental finding that requires a more precise study.

Usefulness of rheumatology consultancy in situ: Analysis of a long-term experience

ObjectiveTo report the long-term experience of a rheumatologist consultant “in situ” (RCI) in a primary care centre (PCC). Material and methodsObservational retrospective study analysing the complete cohort of the patients seen by the RCI between 2013 and 2019. Rheumatology patients’ clinical characteristics and course of care were collected to estimate the diagnoses that were most likely to be monitored by a primary care physician (PCP). ResultsA total of 876 consultations were attended; 205 were men (23.4%) and 671 women (76.6%).Most of the consultations (280, 33.2%) were diagnostic. On 167 occasions (19.8%) therapeutic issues were analysed; in 47 (5.6%) therapeutic infiltrations were performed. Chronic patient control was applied in 163 subjects (19.3%). A request for tests not available to the PCP was the reason for the consultation in 154 situations (18.3%). The profile most likely to continue being monitored in the PCC is the patient with osteoarthritis (OR = .13, CI 95%: .02–.67), soft tissue rheumatism (OR = .006, 95% CI: .01–.45) or cervical disc herniation (OR = .13, 95% CI: .02–.66). Less likely to be monitored by PCP after being seen by the RCI were subjects with rheumatoid arthritis (OR = .03, 95% CI: .00–.24), other inflammatory arthropathies (OR = .36, 95% CI: .16–.80) or with polymyalgia rheumatica (OR = .19, 95% CI: .06-.64 ), and those in need of chronic disease monitoring (OR = .16, 95% CI: .07–.34). ConclusionsThe RCI makes it easier for the PCP to monitor patients with osteoarthritis, soft tissue rheumatism and cervical disc pathology.

Poster Presentations

Background: The workload at rheumatology clinics have been growing relentlessly and an audit on new referrals helps to identify referral behavior of primary care doctors and improvement can be done by providing further training. Objective: To audit on new referral cases to rheumatology clinic during Covid-19 pandemic 2020 and to identify new cases with misdiagnosis for future training purpose. Methods: This was a retrospective study. The electronic medical records of all new referral to rheumatology clinic Hospital Sultan Ismail from 1 st January 2020 to 28 th February 2021 were reviewed. The variety of new cases, reason of referral and final diagnoses were identified and analyzed. Results: There were total of 462 new cases referred throughout the 14 months during Covid-19 pandemic. Majority of them are diagnosed to have rheumatoid arthritis (RA, 115/462) followed by systemic lupus erythematosus (SLE, 93/462), psoriatic arthritis (PSA,82/462), gout (26/462), osteoarthritis (23/462), soft tissue rheumatism (14/462), systemic sclerosis (SSc, 11/462), fibromyalgia (8/462), ankylosing spondylitis (AS, 8/462), sjogren syndrome (8/462), vasculitis (7/462), mixed connective tissue disease (MCTD, 7/462) and miscellaneous (23/462). 17 out of the new cases were diagnosed as unlikely rheumatic diseases. There were 20 pending cases awaiting final diagnosis. 96 of the referrals were identified as misdiagnosis with the highest as nodal osteoarthritis (18/96) followed by unlikely rheumatic disease (17/96), soft tissue rheumatism (14/96), RA (12/96), PSA (9/96), gout (4/96), sjogren syndrome (4/96), fibromyalgia (3/96), SLE (3/96), polymyositis (2/96), AS (2/96) and others (8/96 : DISH, hypermobility syndrome, RS3PE syndrome, degenerative disc disease, idiopathic uveitis, graft versus host disease, JIA, MCTD and traumatic arthritis). Conclusion: Nodal osteoarthritis and soft tissue rheumatism can be great mimicker for inflammatory arthritis and if wrongly diagnosed will induce unnessary anxiety or wrong treatment. More training are needed to improve clinical skills amongst primary care doctors.

Rheumatology education in India: a survey-based cross sectional study.

This study aimed at understanding the perception and perspectives of rheumatology trainees about specialist training in India. Rheumatology trainees (Doctorate of Medicine, Diplomate of National Board) in Indian universities (2010 onwards) were contacted to complete a validated e-survey consisting of 41 questions to evaluate the current rheumatology training in India. Of 53 respondents (M:F 3.4:1, mean age 37 years ± 12.7), 81.1% trained at government hospitals, and 15.1% trained at private hospitals. During training period, 37.5% respondents were exposed to 6–7 h of didactics/week. They treated nearly 175 patients (175 ± 35.4) per week and reported a reasonable level of independence in management of patients with common rheumatic diseases (RDs) during their training (7.5 ± 0.7 SD). However, nearly one-third of the trainees were not exposed to basic immunology and laboratory techniques. Similarly, placement in the radiology department was not a part of the curriculum for nearly half of the trainees, 80% were not confident to manage paediatric RDs and soft tissue rheumatism. Almost 60% did not feel comfortable in addressing ancillary care including patient counselling as they had not received formal training. Among the participants, 59% were not satisfied by the current system of assessment, 86.8% suggested for multiple time point-based assessment systems and 45.3% preferred objective and subjective assessment in final examinations. Rheumatology training in India offers notable exposure to patients and independence in managing cases. However, there is an unmet need for improvement in training in the field of laboratory, radiology and ancillary care, and to overhaul assessment system by including objective evaluation. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00296-021-04962-9.

Does the fibromyalgia affect the quality of life in the patients with inflammatory bowel disease

Background and aims: Data on the soft tissue rheumatism, especially fibromyalgia syndrome is limited in inflammatory bowel disease. Our aim in our study is to determine the prevalence of fibromyalgia syndrome and to evaluate the impact of it on quality of life in inflammatory bowel disease.&#x0D; Methods: 60 ulcerative colitis and 34 Crohn's disease patients were included. 2010/2011 and 2016 American College of Rheumatology criteria were used for fibromyalgia syndrome diagnosis. Fibromyalgia impact survey was applied to the all patients.&#x0D; Results: According to the American Colloge of Rheumatology-2010/2011 criteria, fibromyalgia syndrome frequencies were determined as 29.8% in inflammatory bowel disease, 23.4% in Crohn’s disease and 33.3% in ulcerative colitis (P ˃ 0.05). The frequency of fibromyalgia syndrome was significantly higher in inflammatory bowel disease and especially more in female. There was no significant difference between ulcerative colitis and Crohn’s disease in terms of widespread-pain-index, somatic-symptom-severity and fibromyalgia syndrome scores. Fibromyalgia impact scores were found significantly higher in those with fibromyalgia syndrome in inflammatory bowel disease, ulcerative colitis and Crohn’s disease.&#x0D; Conclusions: This is the first study to show the frequency of fibromyalgia syndrome in patients with inflammatory bowel disease in Turkish population. Fibromyalgia syndrome has been shown to be increased in inflammatory bowel disease patients and more in ulcerative colitis and female. The quality of life is more affected in inflammatory bowel disease patients with fibromyalgia syndrome.

Pattern of Musculoskeletal Disorders among Diabetic Patients Attending The Department of Physical Medicine and Rehabilitation in a Tertiary Care Hospital

Background: Disorders of musculo-skeletal (MSK) system are very common scenario watched in diabetic patients and is a major cause of morbidity, mortality and hospitalization.&#x0D; Objective: The present study to see the pattern of MSK disorders among the Bangladeshi diabetic patients.&#x0D; Materials &amp; Methods: This is a cross-sectional study carried out at the department of Physical Medicine and Rehabilitation in Thengamara Mohila Sabuj Sangha (TMSS) Medical College Hospital, Bogura for the period of one year from February 2019 to January 2020. A total of 450 diabetic patients with MSK disorders were included in this study.&#x0D; Results: A total of 450 patients with MSK disorders were studied. Out of them 208 (46%) were males and 242(54%) were females.31.5% were between the age group of 41-50 years and 28.9% was between 51-60years.Majority were housewives (51.2%) followed by cultivator(16.2%).Degenerative joint diseases were more common (31.4%) than inflammatory arthropathies (19.3%).Lumbar and cervical spondylosis constituted about 31.4% of all disorders&amp; 22.7% presented with OA knee whereas 15.6% presented with rheumatoid arthritis.&#x0D; Conclusion: Degenerative disorders of the MSK system are more common than the inflammatory ones amongst the diabetics.Maximum patients were having OA of knee, lumbar spondylosisand soft tissue rheumatism.&#x0D; KYAMC Journal.2021;12(1): 41-43