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Background:literature suggests that smoking is one of the crucial triggering factors of rheumatological diseases.(1) In axial Spondyloarthritis (axSpA), classified into radiographic SpA (AS) and non-radiographic SpA (nrSpA), smoking associated with disease activity and extra-articular manifestation. (2) The relationship between smoking and HLAB-27 as well as MRI inflammation in axSpA patients and the difference between nrSpA and AS regarding smoking have not been studied to date in details.Objectives: to investigate the influence of smoking on disease activity and MRI inflammation in axSpA patients (AS and nrSpA).Methods:sixty Egyptian patients (42 males and 18 females) with the mean age (31.33 ± 7.02), with early active axial spondyloarthritis (49 AS and 11 non-radiographic SpA) within two years disease duration, diagnosed based on ASAS classification criteria. All clinical indices (BASDI, BASFI, BASMI, ASDAS-CRP) were applied to all patients. HLA-B27 and the inflammatory markers (ESR, CRP) was done. MRI of sacroiliac joints was performed in a standard protocol using short tau inversion recovery and T1 sequences (slice thickness 3-4mm, both semi-coronal and semi-axial orientations), and scored by the Berlin method. Smoking use assessed by smoking pack-year index.Results:of all 60 patients, 38 smokers and 22 non-smokers. No significant difference regarding smoking packs index between nrSpA and AS. (p=0.822) There was a robust correlation between smoking packing index and the Berlin score of MRI in all axSpA patients (rs=0.631) (p=<0.001). Moreover, there was a significant correlation between smoking and C-reactive protein (rs=0.952) as well as HLA-B27. (rs=0.340) (p<0.001) Furthermore, a significant relationship between smoking and activity indices (BASDI (rs=0.961) and ASDAS-CRP (rs=0.938)). Otherwise, no significant correlation among smoking, BASMI, and BASFI as well as ESR.Table (1): Correlation between smoking pack index and different parameters Disease activity Smoking pack index Non radiographic SpA (n = 11) Radiographic SpA (n = 49) Total (n = 60) rs p rs p rs p BASDI 0.986* <0.001* 0.224<0.001* 0.204<0.001* ASDAS-CRP 0.981* <0.001* 0.969* <0.001* 0.938* <0.001* rs: Spearman coefficient*: Statistically significant at p ≤ 0.05Table (2): Correlation between smoking pack index and HLAB27, inflammatory marker (CRP) and Berlin score of MRISmoking pack index Non radiographic SPA (n = 11) Radiographic SPA (n = 49) Total (n = 60) rs P rs p rs p HLAB27 0.602* 0.049* 0.293* 0.041* 0.340* 0.008* Berlin score of MRI 0.687* 0.020* 0.742* <0.001* 0.631* <0.001* CRP 0.991* <0.001* 0.970* <0.001* 0.952* <0.001* rs: Spearman coefficient*: Statistically significant at p ≤ 0.05Conclusion:Smoking has no significant difference between AS and nrSpA. Smoking has a significant association with HLA-B27, the inflammatory lesions of MRI, and clinical indices (BASDI, ASDAS-CRP) as well as C reactive protein in AS and non-radiographic SpA patients while it has no association with the other clinical in...

Background:Reactive arthritis (ReA) is an emerging arthritis after viral infection especially respiratory and gastrointestinal related viruses. In 2020, SARS-COV2 virus is sweeping worldwide with diverse symptoms and prolonged post-Covid manifestations in which are arthralgia and myalgia are frequently present for days and even months. Interestedly, arthritis in covid era is a part of ReA or a flare of autoimmune disease, it is challenging.(1)Objectives:Our objective was to determine the frequency of musculoskeletal symptoms with SARS-COV2 virus and after recovery as well as its relation to autoimmune diseases flares.Methods:A Prospective study was done on 241 patients who admitted to the Rheumatology clinic from March 2020 to January 2021, complaining from new onset of musculoskeletal symptoms. Detailed history, Examination of systems including Musculoskeletal, laboratory investigation, past history of existing rheumatic disease, and history of infection with covid 19.Results:Among 241 patients with median age 34.4, 36.92% had an existing Rheumatic disease while 63.08% are not. Moreover, 39% of patients had a post history with covid 19 within weeks. The most frequent Musculoskeletal symptoms are myalgia (74.56%), arthralgia (69.36%), and arthritis (10.78%). Furthermore, ReA (Post covid arthritis) accounted (2.07%) especially monoarthritis of Ankle (68.75%) while rheumatic diseases flares (24.48%) as well as new onset rheumatic diseases (39.68%). (p ≤0.001) patients of ReA improved on NSAID and intrarticular injection of glucocorticosteroid.Conclusion:Covid 19 is one of environmental triggers for development of rheumatic disease as well as reactive arthritis post viral infections. ReA is commonly affected the Ankle joint mainly monoarthritis and had improved on oral NSAID and intrarticular injection of Glucocorticosteroid.References:[1]Schett, G., Manger, B., Simon, D. et al. COVID-19 revisiting inflammatory pathways of arthritis. Nat Rev Rheumatol16, 465–470 (2020).Disclosure of Interests:None declared.

Background:Systemic lupus erythematosus (SLE) is known to affect the reproductive health of female patients in various ways. Identifying the unmet information and needs of women with SLE about the impact of the disease on maternal health, pregnancy, family planning and contraception is of paramount importance.Objectives:Our aim was to understand the information needs of women with SLE and capture the gaps in the knowledge of reproductive issues.Methods:We interviewed 284 female patients with SLE in three centers all affiliated to Alexandria Faculty of Medicine, using a 41 multiple-choice based questionnaire about pregnancy counselling, contraception and the use of drugs during pregnancy. The disease knowledge index (DKI) created by Andreoli et el.,(1) was applied to assess the global knowledge and information of patients on the impact of SLE on reproductive health.Results:Forty percent of patients declared to have performed the last gynecological visit since 3 years, versus (49.3 %) patients who have done their last visit within a year. 255 patients reported to have received counselling about contraception; 141 of which provided by gynecologists and not rheumatologists. 114 (40.1%) patients have never been asked about the desire to have children. Regarding the methods of contraception used, 104 (36.6%) patients stated that they don’t know there are different forms of pills and have never heard of the progestin-only pills. As for the DKI, patients showed proper knowledge about the possibility for SLE women to fall pregnant, have healthy children and the fact that lupus flares up during pregnancy. 118 (41.5%)of the patients didn’t know whether children of women with SLE carry a higher risk of having general health problems or not. Also, a great proportion of patients chose “do not know” for the possibility that children could inherit the mother’s disease (49.6%). Concerning the drugs used during pregnancy, surprisingly, (34.2%) patients stated that Hydroquinone shouldn’t be used during pregnancy, and (28.9%) didn’t know if it is compatible with pregnancy or not. Nearly half the patients who were interviewed didn’t know that Methotrexate, Cyclophosphamide and Mycophenolate mofetil are contraindicated in pregnancy. About 80% of the patients stated that SLE influenced the number of the family size they desired in various ways and 134 (47.2%) patients blamed the disease for not being able to take care of their children. Expectedly, SLE impacted patients’ marriages in different forms; 27 (9.5%) of the patients claimed that the disease led to their divorce, 52 (18.3%) explained that their spouses constantly complained about their illnesses, and 19 (6.7%) refused to answer this question. A total of 181 (63.7%) patients had spontaneous abortions, among which 181 (63.7%) patients before being diagnosed with SLE, and 134 (74%) of these abortions occurred in the first trimester.Conclusion:There is a crucial unmet need for women with SLE, identified as a wide gap in communication about reproductive issues. This is influenced by the quality of physician-patient communication, as well as rheumatologist-obstetrician communication.References:[1]Andreoli L, Lazzaroni MG, Carini C, Dall’Ara F, Nalli C, Reggia R, et al. “Disease knowledge index” and perspectives on reproductive issues: A nationwide study on 398 women with autoimmune rheumatic diseases. Joint, bone, spine: revue du rhumatisme. 2019;86(4):475-81.Acknowledgments:I wish to express my deepest gratitude to Dr.Laura Andreoli and her colleagues for allowing us to use their questionnaire in our study.Disclosure of Interests:None declared

years (0-13). The median SLEDAI of the patients was 2 points (0-19). As a result of psychiatric screening, separation anxiety disorder, generalized anxiety disorder and specific phobia were significantly more common in SLE patients than in healthy controls (respectively p=0,054, p=0,052, p=0,018). The Wechsler Intelligence Scale for Children-IV (WISC-IV) was applied to children and adolescents. In the test results, Perceptual Reasoning Converted Index (PRCI) and Perceptual Reasoning Standard Index (PRSI) were significantly lower in SLE patients compared to the healthy control group (respectively p=0,039, p=0,046). The 'comprehension' subtest, 'symbol search' subtest and Verbal Comprehension Standard Index (VCSI) were found significantly lower in SLE patients compared to the healthy control group (respectively p=0,046, p=0,017, p=0,036). Conclusion This study is the first in the literature about this field. It is important to show early neuropsychiatric involvement with neurocognitive and neuropsychological tests in pediatric SLE patients. We also examined the incidence of psychiatric diagnosis in SLE patients. SLE patients should be evaluated with neurocognitive and neuropsychological tests regardless of disease activity, even though they do not have neurological signs and symptoms. Patients should be closely monitored for neuropsychiatric involvement and tests should be repeated if necessary.