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Background:Ankylosing spondylitis (AS) is an inflammatory disease, with new bone formation and ossification of the ligamentous apparatus as the primary pathological changes. The osteoporosis is coexisting with new bone formation. It is well known a common complication of this chronic disease. Hip involvement is common in AS [1].Objectives:The objective of this work is to assess the impact of chronic inflammation of the hip (coxitis) on the bone density at this site.Methods:This is a cross-sectional study of patients who fulfil the modified New York criteria for AS. These patients had not medical history of osteoporosis or other condition that may affect bone metabolism. Hip involvement was appreciated by physical examination and pelvic x-ray. The functional hip gene was assessed by Lequesne Algofunctional Index (LFI). Bone mineral density at the femoral site was measured using Lunar Prodigy dual-energy X-ray absorptiometry. Osteoporosis is defined when T score is ≤ -2.5 DS (standards deviations). Osteopenia is defined when T score is ≤ -1 DS but more than -2.5 DS. A p value Results:Forty-seven AS patients were collected, 12 women and 35 men with a mean age of 43.8 ± 13.4 years. Smoking was noted in 25% of cases. AS clinical form was axial in 33 cases (70.2%) and mixed (axial and peripheral) in 14 cases (29.8%). The mean duration of AS was 15 ± 10.9 years. Nineteen patients (40.4%) were on DMARD at the time of the study. Coxitis was present in 31 patients (66%). It was bilateral in 13 cases (42.5%). The mean of the LFI was 7.1 ± 6.5 with extremes of 0 to 18. Coxitis form was early in 18 cases (40.9%), synostosis in 15 cases (34.1%) and destructive in 11 cases (25%). Twenty-nine patients (61.7%) had normal femoral bone densitometry, 13 patients (27.7%) had osteopenia and 4 patients (8.5%) had osteoporosis. The mean T-score value at femoral neck site was -0.5 SD ± 1.303 [-3– -2]. Patients with coxitis had a significantly lower T score at the femoral site compared to those without coxitis (-0.77 ± 1.31 DS versus 0.07 ± 1.11 DS respectively with p = 0.036).Conclusion:Our study confirms the role of chronic inflammation in the genesis of bone loss in AS. Given the risks of developing secondary complications as a result of low bone density, early management of AS should be recommended in order to control the inflammatory process and prevent the onset of osteoporosis.References:[1]Toussirot E, Wendling D. Bone mass in ankylosing spondylitis. Clin Exp Rheumatol 2000:16–20.Disclosure of Interests:None declared.

Background:The challenge posed by the COVID-19 pandemic may represent an overwhelmingly stressful event for ankylosing spondylitis (SpA) patients and impact their treatment adherence. In response to the COVID-19 pandemic, Tunisia,have adopted community containment to manage the spread of the virus. However, COVID-19 restrictions can alter psychological wellbeing and limit access to treatment for SpA patients.Objectives:This study aimed to evaluate the impact of COVID-19 pandemic on psychological health and treatment adherence on Tunisian SpA patients.Methods:This is a cross sectional study including patients with SpA (ASAS criteria). A survey comprising questions about adherence to stay home warnings; the obligation to go outside for work; satisfaction with the medical support or information received for COVID-19; showing up to medical check-ups, proper use of the medications; medications that the patient stopped taking.Anxious and depressive symptoms were assessed using the Arabic version of Hospital Anxiety and Depression Scale (HADS) questionnaire.Results:We included thirty patients. the average age was: 39,7 years-old and the sex ratio was: 13,3. 75 % of patients were married. The SpA was axial in 25%, peripheral in 20%, and both in 55 %. Most patients had a moderate activity and the mean activity scores were: BASDAI = 2.60, ASDAScrp:2.6538% of patients were on biologics, 36 % on sulfasalazine and NSAIDs and 26 % on NSAIDs only.It seemed that significant number of patients strictly adhered to stay home warnings (> 89%) only 11% were obliged to go out for work during general lockdown while only 24 % adhered to it after general lockdown.Most of the patient 78 % were not satisfied with the medical support or information about COVID 19. 88% of patients requested information from TV while 10 % requested it from social media and 2 % from relatives and friends working in health care field.After the outbreak, 23% of the patients who had a scheduled chek-up visit attended the appointment as it was before.The remaining either ‘did not want to come’ (43%), wanted to come but could not contact anyone in the hospital (11%), was advised to postpone their visits (10%), or couldn’t find means of transport (13%).A significant number of patients decreased or skipped their dose (69%), while only 13% continued their medications and 16%stopped taking NSAIDs.Biological DMARDs(anti-TNF agents) were the most frequent drugs which patients decreased their dose, skipped or stopped taking 33%. sulfasalazine and NSAIDs were least likely 17% to be skipped or stopped.43% of patients Had a HADS anxiety level more than or equal to 11: 87 % women and 13 % men. The highest anxiety scores were found among patients aged less than 45 years old (87%) married with children .32% of patients had a HADS depression level more than or equal to 11: 54 % women and 44 % men. the highest depression scores were found among patients aged less than 45 years old married with children.No significant relationship was found between anxiety and depression levels regarding biologic treatment.Conclusion:Our results suggest that patients with SpA were less likely to comply strictly to ‘stay home’ restrictions, most probably due to the male predominance and relatively younger age. Additionally, we noticed that SpA patients treated with anti-TNF agents were the patients that regular drug use had been considerably disrupted.COVID 19 pandemic has heightened the need to care for patients with SpA in an increasingly virtual environment.Additionally, we found that being female, having a lower level of education, having a child, living in a crowded family is correlated to higher levels of anxiety and depression.References:[1]Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II),Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9) Arthritis care.Acknowledgements:I would like to express my special thanks of gratitude to Rheumatology department of Hedi Chaker Hospital Sfax.Disclosure of Interests:None declared

Background:Spondylodiscitis is an infective process of the disc and the two adjacent vertebrae. It is quite a rare disease accounting for 2–7% of all cases of septic osteomyelitis. These spinal infections touch commonly a single level, the lumbar spine being the most affected. Non-contiguous spine level involvement is seldom reported in the literature. This last group is for the most part imputable to granulomatous organisms [1,2].Objectives:Study the clinical, microbiological, radiological, therapeutic and evolutional characteristics of non-contiguous multi-levels spondylodiscitis.Methods:We conducted a retrospective descriptive study over twenty-one years in the Department of Rheumatology. The diagnosis of spondylodiscitis was based on combination of clinical, biological and radiological arguments.Results:Eight patients had non-contiguous multi-levels infectious spondylodiscitis. There were 6 men and 2 women. The mean age was 53.3±26.2 years. The mean delay from onset of symptoms to diagnosis was 134.6±77.6 days. Back pain was the most common symptom. All patients had spinal syndrome. The Signs of spinal cord compression were observed in 3 patients. C-reactive protein levels were elevated in 6 patients (mean: 56 ± 30.8 mg/L). Plain radiography, performed in all cases, showed pathological pictures in 7 patients. Magnetic resonance imaging was performed in 6 patients. Vertebral levels affected were thoracic / lumbar in 6 cases, cervical/thoracic in 1 case and cervical/lumbar in 1 case. The paravertebral abscess was associated to the disc involvement in 3 cases. Epiduritis was associated in 3 cases. Pathogens were isolated in all cases. Tuberculosis was the most common cause. The leading causative agents in non-tuberculosis spondylodiscitis were staphylococcus aureus, brucella and streptococcus B. Two microorganisms combined were found in two cases (mycobacterium tuberculosis associated to Escherichia coli in one case and mycobacterium tuberculosis associated to Brucella in another). Medical treatment was adapted to the microbial culture and the sensitivity profile of the etiological agent. After therapy, 7 patients had regression of symptoms and 1 patient had a permanent neurological impairment.Conclusion:Multilevel spondylodiscitis involving non-contiguous spine segments is rare. Although atypical organisms are generally held to be responsible, the common bacteria such as Streptococcus B or Staphylococcus aureus should not be overlooked.References:[1]Zimmerli W. Clinical practice.Vertebral osteomyelitis. N Engl J Med 2010 Mar;362(11):1022–9.[2]Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008; 56(June (6)):401–12.Disclosure of Interests:None declared

Background:Due to their serious consequences affecting quality of life, prevention of osteoporosis is considered a priority. Thus, identifying the level of knowledge is useful in developing effective interventions and in guiding public health programs to prevent osteoporosis.Objectives:The aim of this study is to describe beliefs and practices of menopaused Tunisian women related to health and osteoporosis in order to develop effective and targeted interventions for the prevention of this disease.Methods:A descriptive cross-sectional study was conducted among menopaused Tunisian women who consult the basic health center in the area of Sfax region in Tunisia. Data collection include socio-demographic characteristics, the “osteoporosis health belief scale” developed by Kim and his colleagues and the daily calcium intake which was calculated by a questionnaire developed by Patrice Fardellone.Results:We have included 170 women. The mean age was 58.92 ± 9.07 years. Seventy-seven percent of women were housewives, 14.7% were active and 8.3% were retired. Seventy-five percent were married. Forty-two women (24.7%) were illiterate, sixty-three (37.1%) were at primary level and 33.5% were at secondary level. One hundred twelve women (65.3%) live in an urban environment, against 34.7% who belong to a rural environment.The level of perception of osteoporosis was very altered in 22.9%, altered in 32.4% and moderately altered in 31.8% of women. Women’s perceptions of the benefits of physical exercise and calcium intake were moderately altered in 42.4% and 51.2%, respectively. For obstacles to the practice of physical exercise, the level of perception was altered in 43.5% of women. Regarding the obstacles to calcium intake, the perceptions of our population were altered in 32.9% of cases.The daily intakes of calcium vary from 215 to 1444 mg per day with an average of 620.20 ± 204.523 mg / day. Only eight women (4.7%) had sufficient daily intake.Conclusion:Our study showed that all subscale of the “osteoporosis health belief scale” were altered. Promotion programs should aim at creating a supportive physical and social environment for the adoption of safer behaviors and especially education must be targeted.References:[1]Belgacem, A. Nouira, et S. Soussi, « Les perceptions des femmes tunisiennes selon le modèle des croyances liées à la santé et leurs pratiques relativement à l’ostéoporose », Pan Afr Med J, vol. 23, 2016.[2]H. Ahmadieh, A. Basho, A. Chehade, A. Al Mallah, et A. Dakour, « Perception of peri-menopausal and postmenopausal Lebanese women on osteoporosis: A cross-sectional study », Journal of Clinical & Translational Endocrinology, vol. 14, p. 19-24, déc. 2018.Disclosure of Interests:None declared.

Background:Infertility is a disease of the reproductive system defined by the failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Although rheumatoid arthritis (RA) tends to have a late onset, the disease also occurs during child-bearing years and may interfere with procreation.Objectives:The aim of this study was to compare fertility rates in women with RA with birth-year-matched references from the general population.Methods:This is a case-control study. Menopausal married women who were diagnosed in the department of Rheumatology at Hedi Chaker Hospital before the age of forty were recruited into this study as cases and apparently healthy age matched married women were recruited as controls. Demographic, clinical, immunological, radiological and therapeutic data were collected from each case using the medical record of patient. Data obtained included age, age of RA onset, duration of RA, extra-articular manifestations, Rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (ACPA), the presence of erosions on radiographs of hands and feet and the therapy.Rheumatoid arthritis and controls women were asked to state their menstrual regularity, age at menarche, age at menopause, gestity, parity, number of living children, time to first pregnancy, presence of primary or secondary infertility, the interpregnancy interval, presence of miscarriage or in utero foetal death (IUFD) or preterm delivery and their number.Results:The mean ages of the cases and controls was 54 ± 8,11 years [39, 69]. The median duration since onset of RA in the patients was 22,5 ± 10,53 years [1, 47]. The mean age of onset of the disease was 31,4 ± 6,3 [18, 39] years. Forty-nine percent (49%) of patient had extra-articular manifestations: ocular sicca syndrome in 43,8% of cases, pulmonary fibrosis in 5,3% of cases and rheumatoid nodules in 1,8 % of cases. Rheumatoid factor (RF) was present in 61,4% of cases while anti-CCP anti-body was present in 59,6% of cases.Erosive polyarthritis was found in 80,7% of patients. The mean rate of RF was 319,7 ± 462,4 UI/ml and the mean rate of anti-CCP was 185,8 ± 264.Women with RA had a statistically significant mean time to pregnancy longer than the control group. Primary infertility was seen in 15 (26,3%) patients and 2 (3,5%) controls, whereas secondary infertility was seen in 31 (54,5%) patients and 2 (3,5 %) controls. The patients were significantly more likely to have primary and secondary infertility. There were no significant differences in the age at menarche, the number of children, the gestity and the parity between the two groups. The age at menopause was statistically significant lower in the group patients than controls.Conclusion:Our study showed that RA women are more likely to have reduced fertility than general population. Although this study cannot definitively address the issue of impaired fertility among women with RA, the results are suggestive enough to warrant further research into the link between RA and fertility that takes women’s childbearing choices into account.References:[1]Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 2012; 64: 668-74.[2]Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2015; 74: 1836-41.[3]Pope JE, Bellamy N, Stevens A. The lack of associations between rheumatoid arthritis and both nulliparity and infertility. Semin Arthritis Rheum 1999; 28:34250.[4]Akintayo RO, Aworinde O, Ojo O, Akintayo FC, Akinlade OM, Awodun RO, Isa SO. Is rheumatoid arthritis an innocent bystander in female reproductive problems? A comparative study of fertility in Nigerian women with and without rheumatoid arthritis. Eur J Rheumatol 2018; 5(3): 179-83.Disclosure of Interests:None declared

Background:Bone metastases (BM) are tumor cells that originate in a primary malignant tumor and are localized remotely in bone tissue. They more or less faithfully reproduce the morphological and biological characteristics of the primary tumor. Histological analysisis essential to confirm the diagnosis of BM and to identify the primary tumor if possible and sometimes to help in the selection of treatment.Objectives:The aim of this work is to study the contribution of bone biopsy during revealing BM in diagnostic strategy and therapeutic decision.Methods:We retrospectively studied the files of 105 patients hospitalized in a Rheumatology department of for BM revealing from January 2000 until December 2015. For each patient we collected epidemioclinical and anatomopathological data to arrive at the diagnosis of primary neoplasm and histological type.Results:The patients were divided into 86 men (81.9%) and 19 women (18.1%) with a sex ratio (M / F) of 4.52. The average age of our patients was 64.91 ± 13.29 years. Pain was the most frequent reason for consultation found in 97.1%. This pain was either of bone site (61.9%) or of radicular topography (41.9%). Bone swelling or a pathological fracture revealed BM in 4.8% and 8.6% of the cases, respectively. The onset of neurological damage was noted in 13.3% of the cases.Histologically, the bone biopsy performed in 64 patients made it possible to specify the histological type (carcinoma, adenocarcinoma) in 64% of the cases and to lead to primary cancer in 57.8%. A non-radio-guided percutaneous bone biopsy was performed in 44 patients (68.75%) including 41 osteo-medullary biopsy in iliac crest (BOM) and 3 in the sternum, a bone biopsy directed under scanner in 16 cases (25%) and a surgical bone biopsy in 4 cases.The BOM was positive in 21 cases (51.2%) showing a poorly or moderately differentiated adenocarcinoma or carcinoma. It allowed referral to a primitive in 20 cases: a prostatic origin in 11 cases, a pulmonary origin in 5 cases, a digestive origin in 2 cases, a mammary origin in one case and a neuroblastoma in one case.Conclusion:Thanks to improved sampling and immunohistochemistry techniques, the precise histological type and location of the primary tumor could be identified, there by improving the quality of care for patients with increased life expectancy.Disclosure of Interests:None declared

Background Both vitamin D deficiency and hypertension are increasingly prevalent public health concerns in developing countries. Objectives This study aims to assess 25-hydroxyvitamin D (25(OH)D) status in postmenopausal women and to analyze its relationships with arterial hypertension. Methods A total of 200 tunisian postmenopausal women aged from 50 to 89 years were recruited from the rheumatology departement in CHU Hedi Chaker, Sfax, Tunisia. Clinical characteristics and patient medical history were collected using a validated questionnaire. Blood samples were taken for measurements of vitamin D, intact parathyroid hormone (PTH), and routine chemical analysis. Serum 25(OH)D and PTH were measured by electrochemiluminescence. SPSS 20 was used for the statistical analysis. Results The mean age was 63,74 ± 7,8 years. Mean PTH was 61,80 ± 25,6 ng/L. Serum 25(OH)D levels were below 10, 20, and 30 ng/ml in 55, 30.5 and 14.5% of participants, respectively. Systolic blood pressure (SBP) was above 140mmHg in 60,5% of the patients while 26.5% had a diastolic blood pressure (DBP) higher than 90mmHg. PTH was highly correlated to 25(OH)D (r=-0,305, p After multivariate adjustment for a range of potential covariates (Age, Body mass index, waist size and glomerular filtration rate) in a binary logistic regression model, a significant inverse association was found between serum 25(OH)D concentration and systolic hypertension risk: In fact Risk of systolic hypertension seems to be lowered in the group with high 25(OH)D levels (≥15 ng/mL) compared with those with low levels ( Conclusions This study is timely, because a discrepancy exists between findings from observational studies and results of randomized intervention trials. Reverse causation, inherent weakness of observational studies, is a possible explanation as individuals with hypertension might have more chronic diseases and therefore spend less time outdoors with sun exposure, important for endogenous vitamin D production. In fact, randomized intervention trials will be needed to determine whether vitamin D supplementation can be used to prevent or treat hypertension. References Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol 2014; 2: 76–89. Tamez H, Thadhani RI. Vitamin D and hypertension: an update and review. Curr Opin Nephrol Hypertens 2012; 21: 492–99. Disclosure of Interest None declared

Introduction A monofœtal death is described in 0.5 to 7% of twin pregnancies. The neurological complications risk in the surviving twin is estimated at 18% in monochorionic pregnancies and it is based on vascular anastomoses between the fetal circulations. Purpose To insist in twin pregnancy monitoring in case of one foetal death to avoid cerebral damage in the surviving twin. Materials and Methods We report observations of 5 hospitalised newborns in Sfax Neonatology Department from August 2003 to October 2007 who presented neurological complications following foetal death of their twins. Results The pregnancy was dichorionic in one case, monochorionic in the others. A twin transfusion syndrome was diagnosed in one case. The average term was 36 weeks and twin fetal death occurred at an average term of 33 weeks. The delivery was vaginal in two cases and caesarean in three. One child was clinically asymptomatic and the others showed neurological distress : convulsions or hypotonia. Transfontanellar ultrasound was done in one case, tomography in two cases, MRI in one case and Angio MRI in one case. Brain lesions were ischaemic in four cases and haemorrhagic in one. Death occurred in one case at the age of 10 days. There was a psychomotor retardation in the others with epilepsy in two cases. Conclusion Cerebral damage in the surviving twin is based on different pathophysiological mechanisms. Strict monitoring should guide our choice of the appropriate moment of delivery.