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BackgroundThe hip disease develops in 30% to 50% of children with juvenile idiopathic arthritis (JIA) and is associated with poor outcomes and functional impairment. The coxitis in enthesitis-related arthritis (ERA or juvenile-onset spondyloarthritis) patients was frequent but weakly studied.ObjectivesTo assess the occurrence of coxitis in patients with ERA and compare it to that of older patients with spondyloarthritis (SpA).MethodsWe conducted a retrospective comparative study including patients with ERA and adult spondyloarthritis patients.The first group included patients under 16 years old fulfilling the International League of Associations for Rheumatology (ILAR). The second group of patients fulfilled the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria.We studied the socio-demographic characteristics of both groups, the hip involvement occurrence, and the treatment modalities.Quality of life was appraised by the Study 36-item Short-Form Health Survey (SF-36) and the Ankylosing spondylitis quality of life test (ASQOL).ResultsForty ERA (mean age= 25,3 ± 10,15) patients and 134 SpA (mean age=37,96±11,77) patients were enrolled. Seventeen ERA patients (42,5%) had coxitis at recruitment compared to 28 SpA patients (20,9%), p=0,06. More than half of the ERA patients were positive to HLAb27, compared to the SpA group (44,7%) without reaching a significant threshold, p=0,07. The mean delay of coxitis onset in ERA patients was 4,66 ± 8,46 years, and was 5,65 ± 6,85 years in SpA patients, with no significant difference between the two groups (p=0,527). There was no difference between the two groups for the coxitis being unilateral or bilateral (p=0,272 and 0,169 respectively). Regarding the treatment approach, local therapy was proposed to 11 patients in the ERA group and 13 patients in the SpA group (p=0,07), with synoviorthesis being the most common therapy. Total hip replacement was done in 8 ERA patients (of which seven were bilateral) and in 17 SpA patients (of which ten were bilateral), without reaching the significant threshold (p=0,858). There was no significant difference between the two groups on the period when the total hip replacement was done (p=0,925). Quality of life assessed by the ASQOL and the SF-36 was comparable between the two groups (p=0,666 and 0,326; respectively).ConclusionOur study shows the high prevalence of hip involvement in the juvenile group of SpA. This complication occurs within the five years of disease outcomes and constitutes a turning point in their lives.Disclosure of InterestsNone declared

BackgroundThe advent of COVID-19 has allowed a rapid expansion of telemedicine (TM) and its implementation in various specialties. Despite this extensive use of TM, its role in rheumatology is conflicting and much remains unknown about TM’s acceptability and efficiency in rheumatology [1].ObjectivesOur study aimed to evaluate rheumatologists’ and patients’ willingness for TM and factors helping to adopt this alternative.MethodsWe conducted a cross-sectional study including patients attending our rheumatology department as well as rheumatologists. Patients were contacted by phone and rheumatologists were invited to answer a questionnaire via Google Form. We evaluated their points of view and suitability for TM by inquiring about their experience with tele-rheumatology, information technology supports, personal barriers to telemedicine, and reasons for adopting this alternative. Moreover, additional questions probed the clinician’s perception of the appropriate clinical context for TM application as well as the corresponding legislation.ResultsOverall, 135 responses were collected including 60 rheumatologists and 75 patients. The distribution of diagnosis was as follows: rheumatoid arthritis (RA) (n=15), spondyloarthritis (SpA) (n=20), juvenile idiopathic arthritis (n=23), and osteoarthritis (n=17). Of the rheumatologists, 76.2 % were aged between 30 and 50 years old, 79.3% reported working at an academic center, and the majority were physician-level practitioners (71.2%), working for more than 5 years (61%). Afforded electronic devices were as follows: laptop (87.9%), smartphone (70.7%), afforded headset microphone (24.1%), camera (29.3%) for doctors. Forty-six percent of the rheumatologists estimate that they have a good internet connexion, 62.7% had an appropriate place for teleconsultation. Nearly, 40.7% of the rheumatologists were familiar with the concept of TM but only 39% reported experience with TM. Willingness to accept this model of care for rheumatologists and patients was found in 78% and 37.3% respectively. According to the doctors, the benefits of TM encompassed tele-training (61.7%), remote medical monitoring (61.7%) especially during the COVID-19 (70.2%), benefits for patients (74.5%), reduced inequalities in access to healthcare (46.8%), and improved quality of care (29.8%). The main barriers to TM were the lack of clear legislation (47.8%) and financial compensation (17.4%). Clinicians and patients identified common barriers to effective tele-rheumatology as the inability to perform a physical exam (91.3% vs 33.3%), the fear of trivializing the disease (34.8% vs 36%), and the lack of resources and infrastructures (43.5% vs 29.3%). The majority of the doctors (86.2%) expressed their willingness to attend training workshops. Reported areas to apply TM according to the doctors were mainly osteoarthritis (76.3%) and rheumatic diseases (64.4%), but also pediatric rheumatology (28.8%) and undiagnosed new patients (3.4%). Regarding legislation, most of practitioners estimated that it should be selective with specific authorizations (42.4%) or relaxed with the possibility of derogation (32.2%). Twenty-two percent of them reported that legislation should be strict with the possibility of sanctions, whereas a minority (3.4%) opted for a free practice without regulation at all. Factors associated with adherence to TM were age<40 years (p=0.036) for doctors and familiarity with the concept (p=0.006) and electronic devices afforded (p=0.000) for the patients.ConclusionFindings from this study showed the reluctance of the patients to adhere to TM compared to doctors. Concerns and risks may lessen for both sides, once remote consultations are applied. Nevertheless, patient education is required for the success of TM application.References[1]Sloan M, Lever E, Harwood R, et al. Telemedicine in rheumatology: A mixed methods study exploring acceptability, preferences and experiences among patients and clinicians [published online ahead of print, 2021 Oct 26]. Rheumatology (Oxford). 2021;keab796.Disclosure of InterestsNone declared

BackgroundThe Juvenile Arthritis Disease Activity Score (JADAS) is a feasible tool which consists of four items: tender (TJC) or swollen joint count (SJC), the physician and the patient’s/parent’s global assessment and the erythrocyte sedimentation rate (ESR). C-reactive protein (CRP) has also been suggested as an alternative inflammatory marker.ObjectivesTo compare the performance of JADAS-ESR and JADAS-CRP in the evaluation of JIA activity.MethodsTwenty nine patients who met the International League of Associations for Rheumatology (ILAR) criteria for JIA were enrolled in the study. Disease activity was assessed by the JADAS-ESR and JADAS-CRP scores at 54 consultations, 29 at baseline and 25 during the last follow-up consultation. Data of JIA subtypes, disease duration and treatment were retrospectively collected from medical records. All data were checked for normality by the Kolmogorov-Smirnov test. The Spearman correlation was used for data analysis and p values less than 0.05 were considered statistically significant.ResultsThe mean age of our population was 13.1±4.2 years [4-21] and the sex ratio of males to females was 1.07. The mean disease duration was 4.69±3.26 years [0.3-13]. JIA subtypes were: enthesis-related arthritis (n=12), polyarthritis (n=7), oligoarthritis (n=6), undifferentiated (n=3) and psoriatic arthritis (n=1). At baseline most of our patients (51,73%) were not under treatment, 34.49% were under non-steroidal anti-inflammatory drugs (NSAIDs) and 13.8% under methotrexate (MTX). At the last follow-up consultation 41.38% of the patients were under MTX, 34.49% under NSAIDS and 10.35% under TNF inhibitor (Etanercept). At baseline JADAS-ESR1 was correlated to JADAS-CRP1 (p<0.001, r=0.808) in all AIJ subtypes. JADAS-ESR1 and JADAS-CRP1 were not correlated to ESR1 (p=0.416, p=0.661) nor to CRP1 (p=0.376, p=0.058). Both JADAS-ESR1 and JADAS-CRP1 were correlated to TJC1 (p<0.0001, r=0.643; p=0.015, r=0.502) and only JADAS-ESR1 was correlated to SJC1 (p=0.012, r=0.461). At the last follow-up consultation, correlations were observed between JADAS-ESR2 and JADAS-CRP2 (p<0.001, r=0.992) in all AIJ subtypes. JADAS-ESR2 and JADAS-CRP2 were both correlated to CRP2 (p=0.015, p=0.003) but not to SJC (p=0.175, p=.119), nor to ESR2 (p=0.535, p=0.426).ConclusionOur study suggests that both JADAS-ESR and JADAS-CRP correlate closely during the follow-up of JIA. JADAS-CRP could be recommended for assessing disease activity in JIA.Disclosure of InterestsNone declared

BackgroundThe Covid-19 pandemic has been raging for more than a year in a pandemic mode. Since then, many questions have been raised regarding the management of patients with rheumatic diseases (RD). In this context, the maintenance therapy of conventional, biologic and targeted synthetic disease-modifying antirheumatic drugs (Cs DMARDs, bDMARDs and tsDMARDs respectively) during the Covid-19 infection remains a subject of debate given their immunosuppressive effects as well as their potential generation of lung fibrosis. While the EULAR 2020 guidelines emphasize that discontinuation or maintenance should be discussed on a case-by-case basis, the ACR guidelines advocate discontinuation of all therapies except for the anti-interleukin-6 [1,2].ObjectivesThe objective of our work was to report our real-life experience of therapeutic maintenance during the covid-19 pandemic.MethodsWe conducted a cross-sectional study of patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA) recruited from the rheumatology department of the Kassab Institute of Orthopedics. All the patients were asked to complete a questionnaire about their disease management in the era of the Covid-19. The questionnaire included sociodemographic data, treatment modalities, as well as data related to the infection with the Covid-19 (severe forms defined by the need for oxygen therapy or hospitalization), and changes in treatment during the infection.ResultsThe study included 102 patients with RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 [19-77] years. There was a female predominance with a sex ratio of 0.4. The mean duration of the disease was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7±4.5 mg/L [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. A Covid-19 infection was occurred at least once in 25.5% of cases, of which 19.2% had a severe form (hospitalization (15.4%), oxygen therapy (19.2%)). No deaths were observed. The treatments received during the covid-19 infection were: corticosteroids (n=5), heparin therapy (n=6) and antibiotic therapy (n=10). No patient tapered treatment dosage of DMARDs but discontinuation was reported by 4 patients with a mean time between discontinuation and resumption of 2.1 ± 2 months [0.5-5 months]. The cessation of the treatment was dictated by the treating physician in 2 cases and involved csDMARD in 3 cases (Methotrexate (n=2), Leflunomide (n=1)) and biologics in only one patient. There were no cases of clinical pulmonary worsening upon resumption of the treatments. We found no statistically significant association between severe forms of the infection and the type of RD (p=0.925), as well as the presence of comorbidities (p=0.825). Similarly, the presence of severe forms was not associated with the use of long-term NSAIDs (p=0.29), corticosteroids (p=0.85), or biological treatment (p=0.7). However, maintenance therapy was significantly associated with a lower risk of severe forms (p=0.013).ConclusionOur work showed that the maintenance of conventional treatment during Covid-19 infection was associated with a lower risk of severe forms. Our results, along with those of other studies in the literature, support the maintenance of antirheumatic treatments.References[1]Landewé RB, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;79(7):851-8.[2]Roongta R, Ghosh A. Managing rheumatoid arthritis during COVID-19. Clin Rheumatol. 2020 Nov;39(11):3237-44.Disclosure of InterestsNone declared