Background Knee osteoarthritis is a common disease which mainly concerns aged population and impairs the quality of life in all aspects. Apart from causing pain or other related biomechanical comorbidities, osteoarthritis might affect phychological and social aspects of life. Objectives The purpose of the study was to investigate the impact of knee osteoarthritis on the quality of life and whether certain factors are related to this impact. Methods In a cross-sectional study, performed in our Hospital from January 2016 to December 2016, 150 patients (127 females and 23 males) with a mean age of 61.8 ± 8.07 years were examined. The sample included outpatients of the Rheumatology Department diagnosed with osteoarthritis and patients displaying knee pain. Individuals who had undergone previous knee surgery, and those with other osteometabolic, rheumatic diseases or chronic degenerative disorders that could interfere with the quality of life, were excluded from the study. All participants, who gave their informed consent, answered the identification questionnaire and were interviewed with the Western Ontario and McMaster Universities Arthritis Index (WOMAC), The World Health Organization Quality of life (WHO QoL) questionnaire, the IPQ and the PHQ-9. All instruments used, were standardized in the Greek context. Results The effect of certain variables including patient associated characteristics, demographics, medical history, drug intake and symptomatology related to osteoarthritis, were evaluated with each of the WHO QoL measurements, the IPQ total score and the WOMAC scale. The regression analysis results demonstrated common significant correlations regarding the presence of injuries, the depression, the increased body mass index (BMI) and occasional crepitus. However, no significant difference was observed between patients with osteoarthritis and patients without osteoarthritis, concerning any of the examined parameters. Conclusion It was demonstrated that quality of life indices were related to agents that are not exclusively met in patients with osteoarthritis which implies that patients` quality of life does not depend on the specific diagnosis but on patient`s psychological aspect (depression), presence of pain (injury) and overall health status (BMI). References [1]Kiadaliri AA, Lamm CJ, de Verdier MG, Engström G, Turkiewicz A, Lohmander LS, Englund M. Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life: a population based cohort study in southern Sweden. Health Qual Life Outcomes. 2016;14(1):121. [2]Neogi T, Nevitt MC, Yang M, Curtis JR, Torner J, Felson DT. Consistency of knee pain: correlates and association with function. Osteoarthritis Cartilage. 2010;18(10):1250–5. Disclosure of Interests None declared

A 56-year-old non-diabetic woman with no evidence of prior SARS-CoV-2 infection presented with profound left upper arm pain, soreness and curtailed movement. Because of disabling pain she could hardly carry her handbag. The patient reported no unaccustomed or vigorous exercise or heavy manual labor prior to the onset of symptoms. Pain had developed 8 days after a second dose of COVID-19 vaccine into her deltoid muscle and produced decreased range of motion and progressive weakness. She had no systemic symptoms as malaise and fever. Upon physical examination, there were no signs of skin erythema or swelling. There was tenderness over the deltoid muscle, guarding and decreased abduction of the shoulder and arm. Serologic testing yielded increased serum creatine kinase concentration suggesting skeletal muscle damage. Urine analysis excluded myoglobinuria. At MRI for investigation of muscle pain and dysfunction, middle head of the deltoid muscle appeared severely edematous, with no apparent tearing or abscess (Figure 1a). Deltoid muscle architecture was preserved and edema appeared to track along the muscle fascicles. On contrast-enhanced MR images, affected muscle exhibited prominent enhancement indicating inflammation (myositis) (Figure 1b). Management consisted of rest, cryotherapy, compression and NSAIDs to decrease subjective pain. Symptoms resolved over the course of 6 weeks with no residual loss of function. Interestingly, MR findings persisted almost 2 months past resolution of symptoms. With intramuscular vaccination, muscle is exposed to modified contaminant agents through direct inoculation, which elicit an immune response to the injected antigen. When present, induced muscle toxicity may relate to the inciting agent, its components and the host’s immune or inflammatory response. Although in our attempt to eliminate needle myopathy in our patient, we performed no muscle biopsy, the temporal link between symptoms and vaccination procedure, coupled with reversible toxicity suggests diagnosis of COVID-19 vaccine-associated myopathy as the cause of symptoms. We presume that in addition to minor muscle injury at the site of injection, toxic myopathy may indeed comprise the underlying cause for reported pain of a variable severity at the vaccination site. Although similar to the COVID-19 infection itself the exact mechanism causing damage to the injected muscle is not known, it is worth reporting our observation of myositis suggesting a causal relationship to the novel, modified mRNA COVID-19 vaccine-adverse event, myalgia.

Abstract Background/Introduction: Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting 15-30% of patients with psoriasis. Patients with PsA present 43% higher risk of cardiovascular disease compared to non-psoriatic patients. However, the probable existence of subclinical myocardial dysfunction in these patients has not been fully elucidated. Purpose Purpose of this study is to evaluate systolic and diastolic myocardial function in asymptomatic patients with PsA and no cardiac comorbidities and to reveal the value of speckle tracking echocardiography in this object. Methods Sixty patients (29 males, mean age 52.55) and 34 healthy controls (18 males, mean age 50.79) participated the study. They were subjected to TTE to evaluate left ventricular systolic function with conventional indexes such as ejection fraction (EF) and with novel indexes such as global longitudinal strain (GLS); diastolic dysfunction was also assessed in both groups. Blood exams were conducted including crp, esr. Severity scales of the disease such as PASI and DAS 28 scores, and the duration of the disease were also recorded. Results Linear regression analysis showed significantly impaired global longitudinal peak systolic strain (GLS) in PsA patients (mean =-19.79, s.d. =4.54) compared to the controls (mean =-23.67, s.d. =3.27). Ejection fraction, on the contrary, did not show any significant difference between the two groups. Left ventricular diastolic function did not present significant difference between the two groups. Comparison of GLS with PASI and DAS 28 scores, disease duration, esr and crp showed no association. Conclusions PsA patients present a higher risk of left ventricular systolic dysfunction. GLS is a useful tool in revealing myocardial impairment. Moreover, this high risk for systolic dysfunction did not appear to correlate with disease severity markers. Systolic and diastolic function indexes GroupStatistics group N Mean Std. Deviation Std. ErrorMean p-value E/A Cases 60 1,1510 ,49319 ,06367 0,971 Controls 34 1,1471 ,53555 ,09185 E/E" (average) Cases 60 8,21 3,016 ,389 0,703 Controls 32 7,95 3,096 ,547 GLS (%) Cases 52 -19,795 4,5495 ,6309 <0,001 Controls 34 -23,671 3,2668 ,5602 EF(%) Cases 59 59,24 3,919 ,510 0,986 Controls 34 59,26 10,880 1,866 Differences between PsA patients and control group Abstract P1767 Figure. GLS in PsA patients and control group

BACKGROUND AND PURPOSE:Histopathologic studies have demonstrated WM damage in primary Sjögren syndrome. The purpose of this study was to evaluate WM microstructural changes by use of DTI-derived parameters in patients with primary Sjögren syndrome.MATERIALS AND METHODS:DTI was performed in 19 patients with primary Sjögren syndrome (age, 64.73 ± 9.1 years; disease duration, 11.5 ± 7.56 years) and 16 age-matched control subjects. Exclusion criteria were a history of major metabolic, neurologic, or psychiatric disorder and high risk for cardiovascular disease. Data were analyzed by use of tract-based spatial statistics, for which the WM skeleton was created, and a permutation-based inference with 5000 permutations was used with a threshold of P < .01, corrected for multiple comparisons to enable identification of abnormalities in fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity.RESULTS:Tract-based spatial statistics showed decreased fractional anisotropy in multiple areas in patients with primary Sjögren syndrome compared with control subjects, located mainly in the corticospinal tract, superior longitudinal fasciculus, anterior thalamic radiation, inferior fronto-occipital fasciculus, uncinate fasciculus, and inferior longitudinal fasciculus. Increased mean diffusivity and radial diffusivity and decreased axial diffusivity were observed in most of the fiber tracts of the brain in patients with primary Sjögren syndrome, compared with control subjects.CONCLUSIONS:Patients with primary Sjögren syndrome show loss of WM microstructural integrity, probably related to both Wallerian degeneration and demyelination.

Background Illness perceptions and psychological distress are important in determining outcomes in rheumatic diseases. Objectives We aimed to assess illness perceptions and psychological distress and their associations with Physical health-related quality of life (HRQoL) in primary Sjogren9s Syndrome (pSS), Systemic Lupus Erythematosus (SLE) and Rheumatoid arthritis (RA). Methods In 57 pSS, 75 SLE and 199 RA patients we administered the Patient Health Questionnaire (PHQ-9), the Symptom Distress Check-List (SCL-90-R) and the Brief-Illness Perception Questionnaire (B-IPQ) to assess psychological variables and the World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) to assess HRQoL. Hierarchical regression models were used adjusting for demographic and clinical variables. Results The prevalence of clinically significant depressive symptoms (PHQ-9≥10) was 24.6% in pSS, 29.3% in SLE and 25.1% in RA. Patients with pSS showed little understanding of their disease (comprehensibility) and attributed more symptoms to their illness (identity) compared to SLE and RA. Depressive symptoms and concerns about the consequences of the disease were associated with Physical HRQoL independently of pain, disease duration and disease severity in all three diseases. In pSS, however, the patients9 worries about the consequences of their illness totally mediated the relationship of pain with Physical HRQoL. Moreover, SLE patients9 concerns about numerous bodily symptoms attributed to the illness (illness identity) were also important independent correlates of Physical HRQoL. Conclusions These findings indicate that patients9 illness perceptions are important correlates of HRQoL in these disease groups and encourage the design of psychotherapeutic trials targeting disease-related cognitions in an attempt to improve patients9 HRQoL. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3177

Background The pathophysiological hallmarks of systemic sclerosis (SSc), i.e. functional and morphological vascular alterations, systemic inflammation and aberrant collagen deposition may affect the cardiovascular system and produce an array of clinical manifestations, e.g. pulmonary arterial hypertension, restrictive cardiomyopathy, conduction heart disturbances or premature atherosclerosis. Objectives To investigate cardiac structural and functional parameters in SSc patients without clinically evident heart disease. Methods SSc patients and age- and sex-matched healthy controls underwent transthoracic echocardiography for the evaluation of left ventricular (LV) morphology and function, of cardiac valves and for the estimation of pulmonary systolic arterial pressure (PASP). Additionally, patients underwent stress-rest myocardial perfusion imaging (MPI) scintigraphy by single-photon emission computed tomography (SPECT) for the detection of reversible myocardial perfusion defects. Results Thirty-three female and 4 male SSc patients with a mean age of 54.4 years and 37 matched controls were studied. Nineteen patients had diffuse and 18 limited SSc, with a mean disease duration of 18.6 years. Echocardiography revealed LV hypertrophy in 9 patients (24.3%), but in none of the controls (p=0.001) and LV diastolic dysfunction in 17 (45.9%) patients and 15 (40.5%) controls (p=0.639). After exclusion of patients with arterial hypertension, LV hypertrophy was still found in 23.1% (p=0.002 vs controls) and LV diastolic dysfunction in 38.5% (p=0.868 vs controls). Median LV ejection fraction (EF) was 67% (range 50-80) and 66% (range 54-78) in patients and controls respectively (p=0.436). SSc patients had median PASP 30 (range 20-51) mmHg, while controls had median PASP 20 (14-28) mmHg (p<0.001). Of the 35 SSc patients who underwent scintigraphic MPI, 21 patients (60%) exhibited reversible LV perfusion defects. Their mean age was 51.8 years. In all cases ischemia was graded as mild or moderate and in only one case as significant. There were no statistically significant differences regarding demographics, echocardiography or autoantibody profile between patients with and without ischemia. Conclusions Left ventricular hypertrophy and raised PASP were more common in SSc patients than healthy controls. Moreover diastolic dysfunction and reversible ischemia were found in a significant proportion in this group of mostly female middle-aged SSc patients. A high level of awareness for subclinical heart involvement is warranted when treating patients with SSc. Disclosure of Interest: None Declared

OBJECTIVESThe aim of this study was to examine the distribution of lectin-like oxidised LDL receptor-1 (LOX-1) levels in patients with active BD, possible association of LOX-1 with the oxidised LDL (oxLDL), endothelial nitric oxide synthase (eNOS), nitric oxide (NO), endothelin-1 (ET-1) levels, and to characterise the differences between patients with active BD and those with systemic lupus erythematosus( SLE) in terms of these parameters compared with healthy controls.METHODSA total of 30 patients with active BD, 22 patients with SLE as patients controls, and 30 healthy subjects were enrolled in this study.RESULTSSignificantly lower eNOS ve NO levels were observed in patients with BD and SLE compared with healthy controls. oxLDL, LOX-1 ve ET-1 levels were significantly increased in active periods of patients with BD and SLE compared with healthy control. There was no significant difference in oxLDL levels between subjects with BD and SLE. LOX-1 levels were significantly higher in active periods of patients with BD than in SLE , ET-1 levels were significantly lower.CONCLUSIONSEndothelial dysfunction parameters are elevated in patients with BD having active disease. The necessary measures should be considered in terms of risk of atherosclerosis in BD, especially for the early identification of endothelial damage by looking at LOX-1 levels.

OBJECTIVES:We aimed to assess the defensive profile of primary Sjögren's syndrome (SS) patients and to investigate the independent associations of psychological distress and personality variables with health-related quality of life (HRQOL).METHODS:In 40 primary SS patients we assessed psychological distress (SCL-90-R), ego defense mechanisms (Defense Style Questionnaire), hostility features (HDHQ) and HRQOL (WHOQOL-BREF). Fifty-six patients with Systemic Lupus Erythematosous (SLE) and 80 healthy participants matched for age and sex served as controls.RESULTS:Primary SS patients presented higher rates of general psychological distress compared to SLE and healthy participants. Symptoms of somatisation were more prominent in SS than SLE or healthy controls. SS patients presented less use of humour defense and more help-rejecting complains and delusional guilt hostility, compared to controls. Primary SS patients' HRQOL was more impaired than healthy participants and comparable to SLE. Psychological distress was a constant independent correlate of SS patients' HRQOL, while less use of humour (p<0.001) and higher rates of delusional guilt (p=0.032) were also significantly associated with Physical HRQOL independently of psychological distress; more use of schizoid fantasy was also independently associated with impaired Environment HRQOL (p=0.005).CONCLUSIONS:Primary SS patients exhibit several specific psychological difficulties in adaptation to life stressors, and clinicians and consultation-liaison psychiatrists, apart from the early assessment and treatment of psychological distress and somatisation symptoms, should consider the patients' underlying defensive profile and coping capacities, since such personality traits, although usually underestimated, are also independently associated with the disease outcome.

The coexistence of breast cancer and scleroderma is a rare entity. A close temporal relationship between both diseases onset implies a possible etiopathogenetic correlation. We present the case of a 60-yearold woman with breast cancer that occurred three months after diagnosis of scleroderma. A review of the literature is also reported.

This study aimed to assess the association of coping with health-stressors and defence styles with health-related quality of life (HRQOL) in systemic lupus erythematosus (SLE). In 56 SLE patients we assessed disease activity (SLEDAI), functional limitations (HAQ), psychological distress (SCL-90-R), defence styles (Defence Style Questionnaire), hostility (HDHQ), coping with health-stressors (Sense of Coherence scale) and HRQOL (WHOQOL-BREF). Two hundred and eight rheumatologic patients (168 with rheumatoid arthritis [RA] and 40 with primary Sjogren's syndrome [SS]) served as disease controls. SLE patients' HRQOL was similar to that of patients with RA and primary SS after adjusting for demographic and disease variables. Psychological distress was significantly associated with most aspects of HRQOL, but sense of coherence mediated the relationship of psychological distress with Physical HRQOL; this mediation effect was unique to SLE, as mediation analyses showed. Maladaptive action defence style was also significantly associated with Environment HRQOL independently of psychological distress (p < 0.024). These findings indicate that, apart from the early assessment and treatment of psychological distress, clinicians and consultation liaison psychiatrists should bear in mind the SLE patients' psychological resources and coping capacities to deal with the stress of the disease, since such traits, although usually underestimated, are strongly independently associated with HRQOL. Lupus (2011) 20, 893-903.

Objective: To investigate subclinical atherosclerosis in patients with systemic sclerosis (SSc).Methods: Sixty-six patients with SSc who met the American College of Rheumatology criteria for the disease were included. The serum levels of total cholesterol (TC), triglycerides, high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were determined in all patients. Carotid artery intima-media thickness (IMT) and carotid plaques were measured. Patients with a history of atherosclerosis, hypertension, smokers, or patients suffering from conditions that affect the lipid profile, such as diabetes mellitus, hypothyroidism, liver or kidney diseases, Cushing's syndrome, obesity, and a history of familial dyslipidaemia, were excluded. Patients receiving medication affecting lipid metabolism were also excluded from the study. Fifty-one age-and sex-matched nonsmoking volunteers were used as controls.Results: Sixty patients were investigated. Six were excluded. Of these, two were smokers, two had diabetes mellitus, one hypothyroidism, and one had hypertension treated with diuretics. Patients with SSc exhibited mild dyslipidaemia expressed mainly by low serum levels of HDL-C and high TC (p < 0.001 and p < 0.021, respectively) compared to controls. In addition, the atherogenic ratio LDL-C/HDL-C was significantly higher among SSc patients (p < 0.0001). Common carotid artery IMTs were higher in SSc compared to controls (0.77 +/- 0.2 vs. 0.59 +/- 0.14, p < 0.0001). No correlation between IMTs and any SSc features were found. Logistic regression analysis showed an independent association of scleroderma with IMTs and TC.Conclusion: The scleroderma patients exhibited an atherogenic lipid profile and subclinical atherosclerosis and have an increased risk for cardiovascular events.