BACKGROUND:Acute Pancreatitis (AP) is an uncommon complication that rarely occurs during Rheumatoid Arthritis (RA). Among the varied etiologies of AP, Drug-induced Pancreatitis (DIP) remains a rare entity and a rather challenging condition. A large panel of drugs have been reported to cause pancreatitis; however, there are no cases of tofacitinib-induced pancreatitis reported in the literature. CASE PRESENTATION:We have, herein, reported the case of a Tunisian 58-year-old woman with a four-year history of RA who experienced two episodes of AP; the first one occurred on the second day of a 3-day series of methylprednisolone intravenous injections, and the second episode occurred on the sixth-day of tofacitinib administration. Each time, she presented acute abdominal pain with characteristic radiation to the back. Symptoms resolved spontaneously once the suspected drug was discontinued. In the event of a negative investigation, including abdominal ultrasonography and magnetic resonance imaging, and assessment of albumin, calcemia, triglyceridemia, serum ferritin, and IgG4 levels, DIP was the most likely diagnosis. CONCLUSION:Although DIP is still a rare condition, it remains serious with an increased risk of mortality. We intended to alert clinicians that in addition to the known side effects of tofacitinib, pancreatitis may be induced by this drug, especially in predisposed patients.

Infectious spondylodiscitis (ISD) is a rare infection of the spine. ISD caused by Acinetobacter baumannii and Citrobacter koseri is even rarer. Moreover, the association between ISD and malignancy is uncommon. In these case series, we report the remarkable case of a patient diagnosed with ISD associated with bone metastatic lesions of an unknown cancer and multiple myeloma accidentally discovered due to COVID-19 infection. We also reported two cases of ISD caused by rare organisms: the first case is a man with ISD caused by a multidrug resistant A. baumannii, and the second is a man with C. koseri bacteraemia complicated by paraspinal abscess and ISD.

Background Janus Kinase inhibitors (JAKi) have been shown to be effective in the therapeutic strategy of rheumatoid arthritis (RA). However, an increased risk of developing malignancy has been reported in previous literature [1]. Objectives This review aimed to investigate the risk of lung carcinoma and subsequent myeloproliferative neoplasm (MPN) in RA patients treated with JAKi. Methods We conducted a literature review in order to identify cases of lung carcinoma and MPN associated to JAKi in RA patients. A comprehensive search was conducted using PubMed and Scopus. The databases were searched from 2015 until date December 2022. No restrictions were applied in terms of study design, setting, country, or time frame. For PubMed, the search was carried out using a strategy employing the combination of synonyms of “pulmonary neoplasm”, terms related to “JAK inhibitors”, and terms related to “rheumatoid arthritis”. For Scopus, the previous terms were searched in the article title, abstract, or key-words. We also did manual research on reference lists of retrieved relevant articles. Articles were eliminated if they had duplicate titles, did not contain the key-words, or included the words “review”, “expert's opinion”, or “qualitative”. In this review, we included prospective or retrospective case reports and case series conducted on JAKi and lung carcinoma or MPN. Results The initial search yielded 153 papers. Following duplicate elimination, we screened for 119 papers. Only eight papers were finally selected for analysis and met inclusion criteria. The mean number of RA patients included was 2422 [486-6194]. Standardized incidence ratio of lung carcinoma and MPN ranged from 0.17 to 0.19 and 0.01 to 0.1, respectively. Most papers raised the possibility that RA patients treated with JAKi may have a markedly higher rate of development of lung carcinoma (95% CI [1.51 - 1.79]) or MPN (95% CI [2.05 - 2.96]) compared to patients who did not receive the treatment. The Table 1 exposes the main characteristics of the nine studies retained in this review. Conclusion Our study showed that JAKi was associated with an increased risk of development of lung malignancy and lymphoma. Although the risk of malignancy is increased compared with the general population, it is still similar to that seen in the overall RA patients. Reference [1] Curtis JR, Lee EB, Kaplan IV, et al. Tofacitinib, an oral Janus kinase inhibitor: analysis of malignancies across the rheumatoid arthritis clinical development programme. Ann Rheum Dis 2016;75(5):831–41 Acknowledgements: NIL. Disclosure of Interests None Declared.Table 1Studies assessing malignancy associated to JAKi therapy in RA patientsAuthorsYearArticle typeNeoplasmNumber of cases/ SIR*(95% CI**)Curtis JR et al.2015Retrospective case seriesLung carcinoma24 out of 5761/ 0.19(1.39-3.29)Hisashi Y et al.2016Prospective case seriesLung cancer Lymphoma2 out of 486/ –2 out of 486/ ––Masayoshi H.2019Prospective case seriesLung cancerLymphoma24 out of 5677/ –10 out of 5677/ ––Taylor CT et al.2021Retrospective case seriesLung cancerLymphoma26 out of 3770/ 0.176 out of 3770/ 0.01(0.11-0.25)(0.01-0.09)Eun BL et al.2014Prospective studylymphoma5 out of 958/ ––Curtis JR et al.2015Retrospective case serieslymphoma10 out of 5761/ 0.08(0.04-0.14)Mariette X et al.2018Prospective studyLymphoma19 out of 6194/ 0.1(0.06-0.15)Josef S et al.2019Retrospective case serieslymphoma6 out of 3492/ 0.09(0.03-0.19)*SIR: Standardized incidence ratio, **CI: confidence interval

Background: Synovial chondromatosis is an uncommon benign condition characterized by synovial membrane proliferation and metaplasia. Synovial chondromatosis cases in patients with rheumatoid arthritis have been reported. However, involvement of the glenohumeral joint is rare. Case Presentation: We herein report a case of a rare association of synovial chondromatosis involving the shoulder in a rheumatoid arthritis patient. The symptoms have improved with anti-tumor necrosis factor drugs. Consequently, there was no need for invasive therapy to treat synovial chondromatosis. Conclusion: Synovial chondromatosis can be aggressive and destructive. More trials are needed to establish a better clinical diagnostic strategy and pharmacological management.

Background Spondylarthritis (SpA) affects men more frequently than women. Few studies have analysed gender differences in clinical and biological characteristics of SpA, hence the purpose of this study. Objectives We aimed to analyse gender differences in SpA manifestations and disease activity. Methods We conducted a cross-sectional study including 30 men and 30 women with SpA meeting the 2009 ASAS criteria. The comparison between men and women included the following data: age at onset, disease duration, clinical and biological characteristics, activity scores (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS)), and functional impact (Bath Ankylosing Spondylitis Functional Index (BASFI)). Results Compared to women, male patients had a younger age at disease onset (male (M)= 24.7 ±7.7 vs female (F)= 28.9 ±5.8, p= 0.00), a longer disease duration (M= 14.3 ±6.1 vs F= 11.9 ±4.2, p= 0.05), a longer morning stiffness (p=0.01) and a greater number of nocturnal awakenings (p=0.01). Similarly, SpA was more active in male patients compared to female patients: CRP (M= 22 ±3.5 vs F= 14 ±2, p=0.00) and ASDAS (M= 3.7 ±0.7 vs F= 2.9 ±0.2, p= 0.01). Coxitis was more common among male patients: M= 28.3% vs F= 13.3%, p= 0.00. However, no gender differences were observed for VS, BASDAI, BASFI and therapeutic strategy. Comorbidities were predominant in male patients: cardiovascular disease (M= 18.3% vs F= 8.3%, p=0.00), osteoporosis (M= 16% vs F= 13.3, p=0.05), hypertension (M= 15% vs F= 6.6%, p=0.01) and dyslipidemia (M= 11.6% vs F= 6.6%, p=0.00). However, depression was more common among female patients (p= 0.01). Conclusion Our study showed that SpA was more active in male patients. Comorbidities were more common among men compared to women. Further studies should be conducted to better illuminate gender differences in SpA. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.

Background Pain is a cardinal symptom of several rheumatic conditions such as rheumatoid arthritis (RA) and fibromyalgia. Catastrophizing incorporates an amplification of symptoms associated with pain, and therefore contributes to its sustainability. Objectives We aimed to assess the impact of RA-associated fibromyalgia on catastrophizing. Methods We conducted a cross-sectional study including RA patients meeting the 2010 ACR/EULAR criteria. Patients were divided into two groups: group 1 (G1) including patients with fibromyalgia associated to RA, and group 2 (G2) including patients with RA. Fibromyalgia screening was based on the Fibromyalgia Rapid Screening Tool (FIRST). RA activity was assessed using the Disease Activity Score (DAS28 ESR). Quality of life was assessed using the Health Assessment Questionnaire (HAQ). Catastrophizing was assessed using the Pain Catastrophizing Scale (PCS), which is composed of 13 items. The PCS total score varies between 0 (absence of catastrophizing) to 52 (significant tendency to catastrophizing). The cognitive and emotional representation of pain was assessed by the Brief Perception Illness Score (BPIS). It consists of 9 items: 8 quantitative questions on a numerical scale ranging from 0 to 10, and one last item in the form of a qualitative question. The total score varies from 0 to 90, without predefined thresholds. The higher the score, the more threatening the patient’s perception of the disease is. The significance threshold was set at a p value of 0.05. Results Our study included 80 patients (G1: N= 40 and G2: N=40), 76 women and 4 men, with an average age of 59±9 years [42-77] in G1 and 53±10 years in G2 [37-74]. The mean disease duration was 11.29±6.24 years. RA was erosive in 90% of cases. Rheumatoid factor and/or ACPA were positive in 85% of cases. The mean delay between fibromyalgia and RA diagnosis was 49±7 months. Seventy five percent of patients were on corticosteroids with an average dose of 10 mg per day of Prednisone equivalent. All patients were receiving a DMARD: methotrexate 85%, leflunomide 11.2%, and biologics 37.5%. The mean VAS pain was 6.3±1.8 cm in G1, and 5±1.1 cm in G2. The mean VAS fatigue was 6±2.3 cm in G1, and 4 ±0.9 cm in G2. The mean global patient assessment was 5.9±2 in G1, and 3±0.5 in G2. The mean morning stiffness duration was 30 minutes in G1, and 55 minutes in G2. The mean DAS28 ESR was 5±0.7 in G1, and 3.97±0.5 in G2. The mean HAQ was 1±0.3 in G1, and 0.7±0.1 in G2. Catastrophizing was greater in patients with RA-associated fibromyalgia with a mean PCS of 41± 8.2 in G1 vs 32±4.4 in G2 (p=0.01). Cognitive and emotional impact was also greater in G1 compared to G2: the mean BPIS was 71±9 in G1 vs 55±7.5 in G2 (p=0.05). Conclusion Our study showed that fibromyalgia aggravates catastrophizing and illness perception in patients with RA. It is important to remind the place of cognitive therapy in the management of these chronic conditions. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.

BackgroundMethotrexate (MTX) remains the first line disease modifying antirheumatic drug (DMARD) in the course of treatment for rheumatoid arthritis (RA). There are wide variations in prescribing pattern among rheumatologists.ObjectivesWe aimed to determine the prescribing practices of MTX by Tunisian rheumatologists.MethodsWe conducted a cross-sectional study including Tunisian rheumatologists. An online survey composed of 18 questions via Google Drive Forms was designed to analyse the prescription trends of MTX in RA patients.ResultsThe online questionnaire was sent to 184 rheumatologists, 66 of whom (35.8%) responded. The majority of rheumatologists initiated MTX at therapeutic doses: 10 mg/week (34.8%) and 15 mg/week (36.3%). Ninety-eight percent of rheumatologists preferred the oral route during the initiation of MTX. Fifty-nine percent of rheumatologists advised their patients to take MTX on an empty stomach. Doctors preferred injectable MTX in case of digestive intolerance (96.9%) or in case of lack of efficacy (48.4%). Regarding the MTX escalation strategy, the majority of rheumatologists followed a conventional strategy with an increase in doses in steps of 2.5 mg (65%) and 5 mg (35%) every 02 (16.6%) to 04 (42.4%) weeks. The optimal dosage of MTX was reached after 08 and 12 weeks in 27.2% and 59% of cases, respectively. Sixty-eight percent of rheumatologists split doses of MTX, 60% of whom from a dose of 15 mg/week. The time interval between the two doses was 06 (27.2%) to 12 hours (27.2%). All rheumatologists systematically associated folic acid with MTX. The average dose of folic acid prescribed was 10 mg/week (72.7%). The doctors questioned advised patients to take acid folic 48 hours after MTX 51.5%. The maximum dose of MTX prescribed by rheumatologists before switching to biological (b) DMARDs was 20 mg/week (60.6%). In case of use of bDMARDs, 63.6% of doctors decreased the dose of MTX to 10 mg/week. Once remission is reached, 34.8% of doctors continued MTX at the same dose while 62% of them gradually reduced the dose (decrease of 2.5mg every 02 weeks in 27.2% of cases and 5 mg every 08 weeks in 34.8% of cases).ConclusionOur study showed that the majority of Tunisian rheumatologists prescribe MTX according to international recommendations. Indeed, the current therapeutic strategy for RA encourages powerful and effective treatment early in the course of the disease.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundGout is a common metabolic disease affecting at least 1% of the population. Its therapeutic management was recently redefined by the recommendations of the French society of rheumatology (SFR) 2020 [1,2].ObjectivesWe aimed to determine the level of adherence of Tunisian rheumatology interns to these recommendations.MethodsWe conducted a 26-item online questionnaire via Google Drive Forms destined to rheumatology interns. The questionnaire intended to assess the degree of application of the French recommendations for the treatment of gout.ResultsThe online questionnaire was sent to 50 rheumatology interns, 19 of whom (38%) responded. Thirty-one percent of participants were in first year, 15.7% in second year, 16% in third year and 31.5% in fourth year. The mean age was 28.3 ±8.7 years [26-33]. All participants were female. The average number of rheumatology internships performed was 3.9 ±0,2 [1-6]. All of the participants declared informing their patients of their pathology. The information given concerned the disease (94.7%), the aim of treatment (78.9%), the need for long-term adherence to treatment (94.7%), the risk of onset of gout symptoms at initiation of treatment (84.7%) and necessary adaptations to lifestyle (94.7%). Eighteen interns (94.7%) advised their patients to avoid certain foods: soda (84.2%), beer (89.4%), wine (36.8%), red meat (84.2%), fish (63.1%), chicken (26.3%) and seafood (73.6%). Almost all physicians screened for comorbidities (94.7%): hypertension (73.6%), dyslipidemia (78.9%), obesity (63.1%) and renal failure (78.9%). The therapeutic means that can be used in gout flares according to the doctors questioned were the following: non-steroidal anti-inflammatory drugs (NSAIDs) (94.7%), colchicine (100%), corticosteroid therapy (94.7%) and anti-interleukin1 (36.8%). Faced with a gout flare, 17 interns (89.4%) prescribed colchicine within 12 hours after the symptoms’ onset. Eleven interns (57.8%) followed the therapeutic regimen recommended by the SFR for flare treatment with colchicine. In the event of the onset of diarrhoea under colchicine, 8 interns (42.1%) stopped the treatment. Regarding corticosteroid therapy, the recommended dose of 30 to 35 mg/day was prescribed in 42.1% of cases. In case of kidney failure, doctors avoided prescribing NSAIDs in 89.4% of cases and colchicine in 63.1% of cases. Eighteen physicians (94.7%) prescribed allopurinol from the first gout flare. Colchicine was prescribed simultaneously with allopurinol in 47.3% of cases. Sixteen interns prescribed colchicine for six months in combination with urate-lowering treatment. Interns were aiming for a therapeutic uricemia target of 50mg/L in 15.7% of cases and 60mg/L in 73.6% of cases. The urate-lowering treatment was maintained for life by 57.8% of the interns, while it was stopped as soon as the therapeutic target was reached in 26.3% with retreatment if recurrence in 21% of the cases. Faced with a decrease in renal clearance, no intern stopped allopurinol and 78.9% of doctors prescribed it subject to monitoring. Once the therapeutic target had been reached, 84.2% of participants recommended monitoring uricemia every 6 to 12 months.ConclusionTunisian rheumatology interns do not fully follow the new French recommendations for the treatment of gout. Thus, medical training on the subject seems necessary in order to optimize the treatment of this pathology in Tunisian hospitals.References[1]Latourte A, Pascart T, Flipo R-Marc, Chalès G, Coblentz-Baumann L, Cohen-Solal A, et al. Recommandations 2020 de la Société Française de Rhumatologie pour la prise en charge de la goutte: traitement des crises de goutte. Revue du rhumatisme. 2020;87: 324-31. [2]Latourte A, Pascart T, Flipo R-Marc, Chalès G, Coblentz-Baumann L, Cohen-Solal A, et al. Recommandations de la Société Française de Rhumatologie pour la prise en charge de la goutte: le traitement hypouricémiant. Revue du rhumatisme. 2020;87:332-41.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundRheumatoid arthritis (RA) may have a negative impact on patients’ autonomy, quality of life and work productivity. Associated fibromyalgia may further accentuate this issue.ObjectivesWe aimed to assess the impact of RA-associated fibromyalgia on occupational productivity.MethodsWe conducted a cross-sectional study including RA patients (2010 ACR/EULAR criteria). Patients were divided into two groups: group 1 (G1) including patients with fibromyalgia associated to RA, and group 2 (G2) including patients with RA. Fibromyalgia screening was based on the Fibromyalgia Rapid Screening Tool (FIRST). All patients completed the following questionnaires: Workplace Activity Limitations Scale (WALS) which is composed of 11 items (total score varying between 0 and 33), Work Productivity and Activity Impairment (WPAI) and Euro-Qol (EQ-5D). We compared the two groups of patients using the Student’s t-test. The significance threshold was set at a p value of 0.05.ResultsOur study included 80 patients (G1: N=40 and G2: N=40) with an average age of 59±9 years [42-77] for G1, and 53 ±10 years for G2 [37-74]. The gender-ratio was 0.05. All the patients in G1 and 80% of patients in G2 held a job. The mean RA duration was 11.29±6.24 years. RA was erosive and ACPA/RF positive in 90% and 85% of cases, respectively. The mean delay between fibromyalgia and RA diagnosis was 49±7 months. The mean Disease Activity Score 28 (DAS28 ESR) was 5 in G1, and 3.97 in G2. The reduction of work activity was greater in G1 compared to G2: the mean WALS in G1 was 18±2.7 vs 10.2±1.5 in G2; p= 0.01. The WPAI showed that the mean number of work hours missed due to RA was significantly higher in G1 compared to G2: 10.2±8 hours vs 4.3±0.8 hours (p< 0.01). The mean absenteeism rate was higher in G1 compared to G2: 17.5 ±1.9% in G1 vs 10.2 ±0.5% in G2 (p= 0.02). The percentage of overall impairment of health related-activity was higher in G1 compared to G2: 50±8.6% in G1 vs 30±4.4% in G2 (p= 0.01). The mean self-rated health status using the EQ-5D VAS was 72.08 ±7% in G1 and 48 ±3.5% in G2 (p=0.05). The most affected dimensions in the EQ-5D for both groups were in the first place pain and discomfort, and secondly mobility. Loss of autonomy was found in 7 patients (37.5%) in G1 and 3 patients (7.5%) in G2. Depression and/or anxiety occurred in 45% of cases in G1, and 22.5% of cases in G2, respectively.ConclusionOur study showed that RA-associated fibromyalgia has a negative impact on work performance and productivity. This association also seems to alter the quality of life.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundCoxitis is a marker of severity in rheumatoid arthritis (RA) since it is associated with a functional disability. Therefore, it leads to a loss of autonomy with a significant psychological impact.ObjectivesWe aimed to assess the correlation between catastrophizing and functional disability associated with rheumatoid coxitis.MethodsWe conducted a cross-sectional study including patients with RA (2010 ACR/EULAR criteria). Clinical, biological and radiological data were collected. RA activity was assessed using the Disease Activity Score (DAS28 ESR). The quality of life was assessed using the Health Assessment Questionnaire (HAQ). Hip function was assessed using the Lequesne algofunctional index (IAF). Catastrophizing was evaluated by the Pain Catastrophizing Scale (PCS), which is composed of 13 items. PCS total score varies from 0 (no catastrophizing) to 52 (significant tendency to catastrophizing). The correlation between Lequesne IAF and PCS was evaluated using the Spearman test.ResultsWe included 80 patients (76 women and 4 men) with an average age of 47±12 years [37-77]. The average age at diagnosis was 29±7.5 years. The mean disease duration was 11±6.2 years. RA was erosive in 90% of cases. Rheumatoid factor and anti-citrullinated peptides antibodies were positive in 83% and 85% of cases, respectively. Seventy-five percent of patients were on corticosteroids with an average dose of 10 mg per day of Prednisone equivalent. All patients were on DMARDs: methotrexate (85%), leflunomide (11.2%), and bDMARDs (37.5%). The mean pain Visual Analog Scale was 5.5 cm. The mean overall patient assessment was 4 cm. The mean number of nocturnal awakenings was 1.5. The mean duration of morning stiffness was 45±7.5 minutes. The mean ESR was 29.4±6. The mean CRP was 19.5± 4.4. The mean DAS28 ESR was 4.5±2.2. The mean HAQ was 1.2±0.4. The mean PCS was 34±3. Coxitis was noted in 28.7% of patients. It was inaugural in 52.1% of cases and bilateral in 14 cases. The mean coxitis duration was 6.8 years. The mean Lequesne IAF was 10.5±3.2. A statistically significant correlation was noted between Lequesne IAF and PCS (r=0.41; p=0.01).ConclusionOur study showed that functional disability associated with rheumatoid coxitis was moderately correlated with catastrophizing. Comprehensive management, taking into account the cognitive behavioural sphere, is thus recommended in RA patients with coxitis.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundThe consequences of chronic inflammatory rheumatisms (CIR) on the sexuality and the relationships between the subject and his/her partner are still underestimated and insufficiently studied.ObjectivesThe aim of this study was to investigate the impact of CIR on conjugal relationships.MethodsWe conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). All the patients included in the study were married. We collected demographic data, and participants were asked to complete a questionnaire on their conjugal relationships.ResultsWe enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. The mean duration of marriage was 9.5 ± 2.6 years. The mean age at marriage was 27 ± 6.41 years [19-33]. The mean number of off-springs was 4. Forty-nine percent of patients and 22.3% of the partners had a profession, respectively. Forty one percent of the partners had a chronic disease: diabetes (n=12), hypertension (n=10), dyslipidemia (n=7), CIR (n=7), coronary disease (n=3), and other conditions (n=5). A psychiatric illness was noted in 22.6% of cases: depression (n=9), anxiety (n=6), and bipolar disorder (n=2). Sixty-four percent of patients consider their spouses sympathetic to their illness. Eighty-nine percent of participants have noticed a change in their life as a couple before and after the CIR onset. According to 64% of participants, the CIR had a negative impact on their married lives. The spouses’ emotional reactions to the disease were as follows: indifference (30.6%), denial (29.3%), anger (26.6%), and fear (13.6%). Patients reported being accompanied by their spouses to their medical appointments in 36% of cases, and 40% of them were asked questions by their spouses about their disease and treatment. The CIR has resulted in the termination of the marriage in 2.6% of cases.ConclusionPatients suffering from chronic diseases such as CIR are more frequently exposed to difficulties in their conjugal relationships. The disease has thus important consequences on the subject’s quality of life, emotional and interpersonal state. A better compliance with the chronic disease and its treatment may improve the couples’ relationships.Disclosure of InterestsNone declared

Fatigue is a common symptom in ankylosing spondylitis. Hypovitaminosis D is one of the factors influencing fatigue during inflammatory rheumatisms. This study aimed to determine the influence of vitamin D deficiency on fatigue in ankylosing spondylitis. In this cross-sectional study, 40 patients with ankylosing spondylitis and 40 patients suffering from low back pain were recruited. Clinical and laboratory data, including vitamin D dosage, disease activity, functional impairment, and quality of life, were evaluated using specific and validated scores. Fatigue was assessed by the FACIT-F score. Both groups of patients were compound of 27 men and 13 women with a mean of 43.55±12.26 years in the study group and 47.77±13.63 years in the case group, respectively. Ankylosing spondylitis was active according to the ASDASCRP score in 67.5% of cases. All patients were suffering from fatigue with a mean FACIT-F score of 21.13. Severe levels of fatigue were noted in 50% of cases. 92.5% of patients were vitamin D deficient with a mean vitamin D of 16.57±7.15 ng/mL. Factors associated with fatigue were: female gender (P=0.05), spinal pain (P<0.001), enthesitis (P<0.001), disease activity (P<0.001), functional impairment (P<0.001), and quality of life (P<0.001). However, smoking was the only factor related to vitamin D deficiency (P=0.05). Vitamin D level was not correlated with fatigue (r= -0.02, P=0.91). In our study, vitamin D status did not seem to have an impact on fatigue in patients with ankylosing spondylitis.

Background Health care workers (HCW) are the soldiers in the forefront of the fight against the coronavirus (COVID-19) pandemic. It is therefore a priority target group in the COVID-19 vaccination process. Objectives Our purpose was to assess the COVID-19 vaccination intentions of Tunisian HCW and the reason for fear in case of hesitancy. Methods We conducted an anonymous online questionnaire in the months of May and June 2021among HCW via social networks. The data collected included demographic characteristics, vaccination intentions, and reasons of hesitancy. Results Five- hundred HCW were included in the study. Participants were divided as follows: 74% doctors (15% seniors, 37% juniors, 22% interns), and 26% nurses. The mean age was 34 ± 5 years [24 – 58]. Seventy-three percent of participants were female. A history of chronic illness was noted 150 HCW (30%). A psychiatric disease was noted in 105 participants (21%): anxiety disorder (62%), depression (33%), and bipolar disorder (5%). A treatment was prescribed in 63% of cases: anxiolytics (84.2%), antidepressants (16.6%), and neuroleptics (10%). Psychotherapy was prescribed in 47% of cases. A personal and family history of COVID-19 infection was noted in 50.4 and 55% of cases, respectively. The infection was mild in 91.2% of cases. Four-hundred and five HCW (81%) had the intention to get vaccinated against COVID-19. Twenty participants (4%) refused the vaccine, and 75 (15%) were still hesitant. Vaccination hesitancy was linked to concerns about the safety of a rapidly-developed vaccine in 92% of cases: adverse reactions (95.8%), tolerance (75%), and efficacy (25%). Sixteen percent of hesitant respondents expressed concerns about the involvement of policy in vaccine development. Vaccines to avoid according to participants were: Astra Zeneca (62%), Synovac (26%), Sputnik (8%), and Pfizer (4%). Conclusion The intention to be vaccinated against COVID-19 reached 81% among Tunisian HCW. Acceptance of the vaccine, even among medically informed individuals, is based on a personal perception of the risks and benefits of vaccine safety. Hence the need for campaigns targeting both the general population and the HCW. Disclosure of Interests None declared

Bone involvement in sarcoidosis is rare; its estimated prevalence ranges between 3 and 13%. Osseous lesions usually occur in the phalanges of the hands and feet. Involvement of the axial skeleton is more uncommon. Osseous involvement may be asymptomatic. It is often incidentally discovered on imaging modalities. Radiological techniques can reveal sclerotic and/or destructive lesions. We present a case of a 61-year-old woman in whom osseous sarcoidosis of the sacrum was revealed by back pain and sciatica. To our knowledge, only one isolated case of sacral sarcoidosis has been reported in the literature. Sarcoid bone lesions can be present at disease onset without pulmonary involvement. A biopsy is often required in order to eliminate other conditions, especially malignancy. Treatment is not specific and also not needed in a significant number of cases.

Background Many experimental studies have emphasized the role of periodic fasting in the adaptive responses that reduce inflammation. Objectives Our purpose was to assess the impact of periodic fasting on the activity of chronic inflammatory rheumatisms (CIR). Methods We conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). CIR activity was assessed during the period of Ramadan (periodic fasting) and three months following Ramadan using clinical parameters including the Patient’s Global Assessment of disease activity (PGA), 10-cm Visual Analog Scale (VAS) pain score, morning stiffness, nocturnal awakenings, and joint count for RA (tender joint count (TJC) and swollen joint count (SJC)); biological parameters including C-reactive protein (CRP); disease activity scores including the SDAI, CDAI and DAS 28 CRP for RA, BASDAI and ASDAS CRP for SpA. An analysis of variance (ANOVA) was used to assess the statistical relationship between fasting and CIR activity. Results We enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. RA was erosive in 92% of cases. Rheumatoid factor and anti-citrullinated peptides antibodies were positive respectively in 82% and 84% of cases. Seventy-five percent of RA patients were on corticosteroids with a mean dose of 10.20 mg/day of prednisone equivalent, and 81% of SpA patients were on non-steroidal anti-inflammatory drugs. Eighty-three percent of our patients were treated with conventional synthetic DMARD, and 40% with biological DMARD. The following parameters were lower in the month of Ramadan compared to the period following Ramadan in RA patients: mean PGA 4.3 vs 4.6 (p=0.01); mean morning stiffness 1.1 vs 1.5 (p=0.01); mean SJC 4.7 vs 8.5 (p=0.01); mean DAS 28 CRP 3.56 vs 4.25 (p= 0.05); mean CDAI 17.5 vs 20.35 (p= 0.01), and mean SDAI 13.87 vs 18.44 (p=0.01). As for SpA, the following parameters were lower in the month of Ramadan compared to the period following Ramadan: mean morning stiffness 1.3 vs 2.1 (p= 0.01); mean ASDAS CRP 2.9 vs 3.3 (p= 0.01), and mean BASDAI 3.6 vs 4.9 (p= 0.05). However, we found no statistically significant correlation between periodic fasting and VAS pain score, nocturnal awakenings, TJC, and CRP. Conclusion Our study concluded that periodic fasting was associated to a lower CIR activity. The incorporation of periodic fasting may promote optimal health and reduce the activity of some chronic inflammatory diseases. Disclosure of Interests None declared