Background:Sexual health is an essential element of overall health and well-being. Rheumatic diseases may affect sexual functioning in many ways related to pain, fatigue, stiffness, functional impairment, depression, anxiety, negative body image, reduced libido, hormonal imbalance and drug treatment. However, these issues are rarely addressed in clinical practice.Objectives:The aim of this study was to evaluate sexual function in a cohort of men with rheumatic disease compared to healthy controls.Methods:This was an observational, single-center, cohort study conducted between august 2019 and march 2020 in the Rheumatology department of “Saint Mary” Clinical Hospital in Bucharest which included 120 men with ages between 18 and 60 years - 60 patients with rheumatic diseases and 60 healthy controls. The study tools were the Sexual Health Inventory for Men (SHIM) questionnaire and one questionnaire referring to personal data, history of the rheumatic disease, comorbidities, treatment and sexual impairment. Also, the disease activity was assessed using specific scores for each condition.Results:In this cohort of 60 patients, the mean age was 45.26 (7.8) years and the diagnoses wereankylosing spondylitis (AS) - 37%,psoriatic arthritis (PsA) - 18%, rheumatoid arthritis (RA) - 17%, systemic sclerosis (SS) - 15% and gout - 13%. More than half of the patients (62%) had active disease based on specific scores (ASDAS for AS, DAS28-CRP for RA, EScSG disease activity indices for SS, DAPSA for PsA). Regarding sexual life, this study showed a significant decrease in sexual life quality after rheumatic disease diagnosis(before diagnosis: 71,67% - satisfying and 16,67% - not satisfyingversus after diagnosis: 21,67% - satisfying and 68,33% - not satisfying). Most patients (90%) reported impairment of their sexual life after diagnosis. In terms of sexual dysfunction (SD), a significantly higher proportion of patients (40%) mentioned reduced libido compared to the control group (18,33%) (p=0.043). Also, 21,66% of the patients reported erectile dysfunction (ED) in comparison with only 8,33% in the control group (p=0.009). Most patients with AS, RA, PsA and gout had mild ED while most patients with SS presented with mild to moderate ED. Also, the SHIM score mean value was significantly lower in the study group (17,65)compared to the control group (20,15) (p=0.009). The importance of SD in this cohort is emphasized by the fact that only one patient conceived after rheumatic disease diagnosis. Concerning treatment, more than half of the patients (55%) reported no effect of the therapy on their sexual life while 38.33% mentioned that medication improved their sexual life and very few (7%) reported a worsening.Conclusion:This study revealed a higher prevalence of sexual dysfunction in male patients with rheumatic disease in comparison with healthy controls. Considering the importance of sexual and reproductive health, rheumatologists should approach this topic with their patients and offer them guidance.References:[1]AG Tristano, “The impact of rheumatic diseases on sexual function”, Rheumatol Int 2009 Jun;29(8):853-60Disclosure of Interests:None declared

BackgroundOsteoarthritis (OA) is a prevalent condition for which treatments are based on analgesia and physical therapies. Despite that, most of the patients continue to have pain and limited function influencing there day by day life.ObjectivesOur objective was to evaluate pain perception in a cohort of participants, diagnosed with osteoarthritis.Methods75 patients with osteoarthritis were enrolled in this study, conducted in Sf. Maria Hospital between 1 June and 30 December 2015. All patients signed an informed consent approved by local ethic committee. Data about demographics, joint involvement and treatment were collected. All patients completed a HAQ evaluation and a Visual Analogue Scale (VAS) for pain (0–10). We developed a questionnaire in order to capture patient perception about osteoarthritis symptoms and how this disease impact there life. They were asked about how pain interfere with usual activity (work, preparing meal, house kipping), with social activity (family interaction, friends) or how they perceived pain or efficacy of the treatment in the last month. They were also asked about there expectations related to this disease. Statistical analysis was made with SPSS.ResultsMean age at evaluation was 63 with a female predominance (83%). 89.3% were taking NSAIDs and 73.3% acetaminophen. Functional status evaluated by HAQ showed that 24% patients had a score of 0, with 57% having a score of 1 and 19% a score of 2. VAS for pain was at least 5 for more than 80% of patients, despite treatment. Higher VAS was significant more frequent in female patients (p 0.001), in patients with family history of osteoarthritis (p 0.023) and in the one with sedentary life style (p 0.035). Most of the patients considered that pain interfere with daily activity, the impact being evaluated as moderate for 46.67% of patients and severe for 32%. Pain also had a negative impact on their social life, the percentage for moderate disturbance being of 38.67% and 18.67% for severe one. Only 11% of patients consider that the pain control is well managed. Despite these results, 40% of the patients do not expect that there quality of life will improve in the future.ConclusionsResidual pain after treatment is present in most of the patients with osteoarthritis and these interfere significantly with daily living and quality of life. These patients enter in a vicious cycle related to worsening pain – low physical activity. Although this findings, there is a resumption of these patients in front of the disease.ReferencesNeogi T, The epidemiology and impact of pain in osteoarthritis, Osteoarthritis and cartilage, 2013, 21: 1145–1153.Disclosure of InterestNone declared

The usefulness of capillaroscopy in the follow-up of scleroderma patients and the possible prognostic role for the appearance of visceral involvement is suggested by many authors but still under debate.The aim of this study was to assess the role of monitoring capillaroscopic abnormalities (qualitative and semiquantitative) in relation with parameters of interstitial lung involvement and pulmonary arterial hypertension(PAH). A strong correlation was identified between initial capillaroscopy scores and FVC (r=-.47, p=0.002), DLCO (r=-.51, p< 0.001) and sPAP (r=0.34, p<0.001). Active and late capillaroscopic pattern were correlated with diagnosis of lung fibrosis (χ2=14, p=0.007) and PAH at follow-up examinations (χ2=14,2, p=0.007). Progression of capillaroscopic pattern at follow-up evaluations was not correlated with significant worsening of lung volumes, DLCO, sPAP. Instead, progression of microangiopathy evolution score (>1) was asociated with worsening of FVC (r=0.32,p<0.001), DLCO(r=0.21,p=0.02) and new diagnosis of lung fibrosis on HRCT (r=0,19,p=0.035). Semiquantitative scoring, rather then qualitative capillaroscopic assessment can have a predictive role for new involvement or worsening of previous lung involvement (especially interstitial lung disease) in scleroderma patients, confirming the putative role of capillaroscopy as biomarker in SSc.

Background: No fully validated index is available for assessing overall disease activity in systemic sclerosis (SSc). Objectives: To estimate the effect of disease activity as measured by different disease activity indices on the risk of subsequent organ damage. Methods: The European Systemic sclerosis study group activity index (EScSG AI), the European Scleroderma Trials and Research Group Activity Index (r-EUSTAR AI), 12 point activity index proposed by Minier (12point AI) were calculated for 91 patients; the CRISS (The Composite Response Index for Systemic Sclerosis) for patients included after 2016. Data were analysed by parametric and non-parametric tests and logistic regression. Results: EscSG AI, r-EUSTAR AI and 12point AI correlated with lung involvement. EScSG AI and r-EUSTAR AI correlated with diffuse skin involvement. EscSG AI correlated with digital ulcers and diffuse cutaneous involvement and r-EUSTAR AI with renal crisis. Bivariate analysis showed an inverse correlation between the three disease activity scores and forced vital capacity (FVC) (p<0.001) and diffusing capacity for carbon monoxide (DLCO) (p<0.001) and positive correlation with pulmonary fibrosis (p<0.001), modified Rodnan skin score (mRSS) (p<0.001), health assessment questionnaire (HAQ) (p<0.001), systolic pulmonary pressure (sPAP) (p<0.001), C-reactive protein (CRP) (p<0.001) and capillaroscopy scoring (p<0.001) at both baseline visit and at the 3-year follow-up visit. Logistic regression revealed that baseline EScSG AI adjusted for gender and age and that baseline 12-point AI both adjusted and unadjusted predicted worse skin involvement at 3-year follow-up; while adjusted EScSG AI predicted decreasing of DLCO. Also, 12-point AI predicted decline of FVC and higher HAQ scores at 3-year follow up; while baseline r-EUSTAR AI was able to predict muscular deterioration, decline of FVC and the increase of HAQ score during 3 years of following. An active disease according to EScSG AI at first visit predicted progression of joint involvement while an active disease at baseline showed by r-EUSTAR AI predicted muscular deterioration, FVC and DLCO worsening, as well as an increasing in HAQ score during the follow-up period. r-EUSTAR AI was the only score to predict the decrease of FVC in a multiple regression prediction model [OR= 1.306 (1.025, 1.665), p=0.31] while baseline EScSG AI best predicted worsening of DLCO [OR=1.749 (1.104, 2.772), p=0.017]. Conclusion: Our study could not establish a gold standard to assess disease activity in SSc; especially EscSG AI and r-EUSTAR AI could quantify and predict major organ involvement in daily practice. CRISS can be useful as an outcome measure for patients with short disease duration included in clinical studies.

Background. Behçet’s disease is a rare type of vasculitis. Validated activity and damage scores were developed for vasculitis patients in order to allow a better way to evaluate disease activity and decide treatment plans. Objective. The main objective was to compare two vasculitis activity scores applied to a group of patients diagnosed with Behçet’s disease and establish correlations between them, damage and the need for immunosuppressive therapy. The secondary objective was to evaluate the connection between damage progression, classical immunosuppressant therapy and long-term cortisone use. Methods. A study was performed on a cohort of patients diagnosed with Behçet’s disease according The International Criteria for Behçet‘s Disease (ICBD) under surveillance in one Rheumatology Centre, from a non-endemic area. Vasculitis activity and damage scores were calculated for each patient. Results. 20 patients were included in the study, with a mean age of 35.7 years ± 10.5 years standard deviation(SD), 14 (70%) under the age of 40, with a male predominance 60% (12 patients). All patients presented active disease at the time of the diagnosis. Spearman’s rank correlation coefficient between BVAS v3 and BDCAF was strong r = 0.862 and statistically significant p < 0.001. The outcome analysis after remission was calculated and rank correlation coefficient between VDI, and both BVASv3 and BDCAF was moderate (VDI-BVASv3 r = 0.747, p < 0.001, VDI - BDCAF r = 0.795, p < 0.001). As for immunosuppression induction decision and activity scores, the correlation coefficient was moderate (r = 0.734 for BVASv3, r = 0.647 for BDCAF) with p < 0.001. There was a moderate correlation between immunosuppressive treatment and VDI (r = 0.700, p < 0.001). The cause of damage (i.e. vasculitis vs. treatment) is not taken into consideration when we calculate VDI. Data analysis showed the presence of mild correlation and no statistical impact between cyclophosphamide treatment duration and damage calculated as VDI (r = 0.474, p = 0.36). In contrast, when rank correlation coefficient between cortisone therapy and VDI was calculated, a moderate statistical impact was observed (r = 0.609, p < 0.001). Conclusions. An objective assessment of disease’s activity can be obtained using disease activity indexes. A moderate to strong correlation was obtained between activity indexes, immunosuppressive treatment initiation and damage progression. Comparing the two activity indexes, it resulted that: BVASv3 correlates stronger with the need for immunosuppressive treatment and both of them are equally able to anticipate damage. Damage progression was correlated stronger with long-term cortisone use, rather than immunosuppressive therapy.