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 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

BackgroundThe COVID-19 pandemic is a major concern for the management of patients with rheumatic diseases (RD). Indeed, an increasing risk of coronavirus infection has been demonstrated in these patients, explained on the one hand by the chronic inflammation and on the other hand by the immuno-modulating treatments used [1]. In this context, vaccination represent an efficient mean to prevent infections and should be included in the management of these patients.ObjectivesThe objective of our study was to determine the peculiarity of vaccination against SARS-COV2 in patients with RD treated with biologic therapies.MethodsWe conducted a cross-sectional study during August 2021, including patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA). Sociodemographic data as well as disease characteristics were recorded. Patients were asked to answer a self-questionnaire about SARS-COV2 vaccination: modalities, time between doses, type of vaccine, adverse events, and time to biologic injection. We compared these results between the two groups: group 1 patients on biologics and patients on conventional disease-modifying antirheumatic drugs (DMARDs). A significance level was set for p<0.05.ResultsThe study included 102 patients with RD: RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 years [19-77]. There was a female predominance (71 women and 31 men) with a gender ratio of 0.4. The mean duration of disease progression was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7 mg [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. SARS-COV2 infection was found in 27.3% of cases, of which 19% had a severe form. Sixty percent of patients received the SARS-COV2 vaccine, and 25% of them received only the first dose. The mean time between the two injections was 27 ± 7.6 days [23-67 days]. The most common type of vaccine was Pfizer (54.4%), Moderna (5.5%), followed by AstraZeneca (20%), Sinovac (16.4%), Johnson (1.8%) and Sputnik (1.8%). Three patients deferred their biotherapy injection by one week. Only one patient discontinued methotrexate therapy for one month. Sixteen patients reported adverse events such as injection site pain (62.5%), disease flare (12.5%) and fatigue and fever (25%). Patients receiving biologics were not at greater risk of SARS-COV2 infection (p=0.076) or hospitalization (p=0.131) compared to patients receiving conventional therapy. Similarly, patients on conventional therapy did not report more adverse events (p=0.678). The vaccination rate was significantly higher in patients on biologics compared to patients on CsDMARD: 72% versus 43%, p=0.004.ConclusionOur work demonstrated that patients treated with biologics adhered to vaccination and did not have more SARS-COV2 infections or adverse events compared to patients on conventional treatment.References[1]Akiyama S, Hamdeh S, Micic D, Sakuraba A. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. 2020;80:384-391.Disclosure of InterestsNone declared

BackgroundWith the advent of the treat-to-target strategy (T2T), clinical remission has become the main objective to achieve in patients with rheumatic diseases. Contrary to rheumatoid arthritis, the T2T strategy is less codified in axial spondyloarthritis, even more in non-radiographic SpA (nr-axSpA) [1]. More importantly, T2T based on imaging remission and guidance for tapering medication has not been extensively studied.ObjectivesThe objective of this study was to investigate the prevalence of bone marrow edema in the sacroiliac joint of nr-axSpA patients in remission.MethodsWe undertook a cross-sectional study including nr-axSpA patients according to the ASAS criteria, treated with NSAIDs. Socio demographic data as well disease characteristics were recorded. Disease activity parameters were also collected including the duration of morning stiffness, the number night awakening, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). MRI-SIJ was performed for all the patients. All the images were screened for bone marrow edema with the corresponding sequence (short tau inversion). To define remission, we used in addition to BASDAI<4, more stringent criteria: BASDAI<4 and CRP<6 mg/l and ESR<20 mm/h and EGM<4 [2]. The level of significance was fixed for p<0.05.ResultsThe study included 43 nr-axSpA patients. There was a female predominance with a sex ratio of 0.43. The mean age of the patients was 42±12 years [20-71] and the mean disease duration was 17±9.7 years [4-38]. The mean ESR and CRP were 2.2 mg/L [2-65] and 6.4mm/h [1-47], respectively. A higher level of acute phase reactants was found in 40.5% of cases (ESR: 35.7%, CRP: 11.9%). Forty percent of the patients had high CRP or ESR despite BASDAI<4. According to BADSAI<4, of the 15 patients in remission, BME was displayed in 43.5% of the cases. According to the used criteria, 25.6% of the patients were in remission, of which 45.4% exhibited BME in the sacroiliac joint. There was no statistically significant association between disease activity according to the used definition and the presence of BME (p=0.473). Nr-axSpa patients in remission without BME had more durable morning stiffness and articular involvement without reaching a statistically significant difference (p=0.361, p=0.08 respectively). Similarly, we did not find an association between this subgroup and sex, age, night awakenings, the presence of HLAB27 (p>0.05).ConclusionOur study showed that even when using stringent criteria, subclinical remission evidenced by BME was not achieved in nr-ax SpA. Nevertheless, imaging remains one important parameter to consider in therapeutic decision making. More studies are needed to identify the best criteria for an optimal remission in this population.References[1]Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis?. Rheum Dis Clin North Am. 2020;46(2):311-25.[2]Navarro-Compán V, Plasencia-Rodríguez C, de Miguel E, et al. Anti-TNF discontinuation and tapering strategies in patients with axial spondyloarthritis: a systematic literature review. Rheumatology (Oxford). 2016;55(7):1188-94.Disclosure of InterestsNone declared

BackgroundThe concept of non-radiographic axial spondyloarthritis (nr-axSpA) has revolutionized the classical understanding of axSpA. Indeed, it facilitated the classification of patients with axSpA who did not present substantial structural damage as it was only detectable on magnetic resonance imaging of the sacroiliac joints (MRI-SIJ) [1]. Continuous non-steroidal anti-inflammatory (NSAIDs) intake has been reported as a potential factor reducing the sensitivity of MRI-SIJ to detect bone marrow edema (BME).ObjectivesThe aim of the study was to investigate the effect of continuous NSAIDs intake on BME in nr-axSpA.MethodsWe undertook a cross-sectional study including nr-SpA according to the ASAS criteria and treated with NSAIDs at baseline. Socio demographic data as well disease characteristics were recorded. Disease activity parameters were also collected including the duration of morning stiffness, night awakenings, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). MRI-SIJ was performed for all the patients. All the images were screened for bone marrow edema with the corresponding sequence (short tau inversion). Patients were grouped according to NSAIDs intake: G1: continuous versus G2 occasional. The level of significance was fixed for p<0.05.ResultsThe study included 43 nr-axSpA patients. There was a female predominance with a sex ratio of 0.43. The mean age of the patients was 42±12 years [20-71] and the mean disease duration was 17±9.7 years [4-38]. The mean morning stiffness duration was 47.3±45.6 [15-240] minutes. The mean spinal VAS was 5.9±2.6 [0-10]. Nearly 41% of the patients had an active disease with a mean BASDAI of 4.7± 2.1 [0-8.6]. The prescribed NSAIDs were as follows: Diclofenac (44 %), Indomethacin (8%), Ketoprofen (18%), Meloxicam (3%), Celecoxib (3%), Piroxicam (3%) and Naproxen (21%). Nearly half of the patients were continuously taking NSAIDs (52.6%) versus occasional intake (47.4%). Four patients failed two NSAIDs and were treated with a third one. Both groups were comparable for age (p=0.193), sex (p=0.386), and disease duration (p=0.4). Similarly, there were no statistically significant differences regarding disease activity parameters between both groups: numerical rating scale of pain (p=0.713), ESR (p=0.314), CRP (p=0.644), morning stiffness (p=0.428), night awakening (p=1), as well as BASDAI (p=0.514). Regarding MRI-SIJ findings, hyper signal in STIR sequence was comparable between both groups (G1: 35% vs G2:33%, p=0.914). Moreover, the increased signal with Gadolinium injection on T1-weighted images was similar between both groups (p=0.113).ConclusionOur study showed that continuous NSAIDs intake was not associated with significant changes in MRI-SIJ features. This study suggests that a NSAID-free period is not necessary before assessing bone marrow edema on MRI-SIJ.References[1]Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis?. Rheum Dis Clin North Am. 2020;46(2):311-25.Disclosure of InterestsNone declared