AB0697 PERFORMANCE OF DIFFERENT CRITERIA SETS FOR INFLAMMATORY BACK PAIN IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS IN DEMOCRATIC REPUBLIC OF CONGO

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1644-1645
Author(s):  
P. Lebughe ◽  
K. De Vlam ◽  
R. Westhovens ◽  
J. M. Mbuyi-Muamba ◽  
J. J. Malemba
Keyword(s):  
Back Pain ◽  
Clinical Judgment ◽  
Democratic Republic ◽  
Axial Spondyloarthritis ◽  
Democratic Republic Of Congo ◽  
University Hospital ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Asas Criteria ◽  
The University

Background:Inflammatory back pain (IBP) is the most prominent clinical feature for an early diagnosis of axial spondyloarthritis. The performance of the criteria sets for IBP has not yet been assessed in clinical practice in the Democratic Republic of Congo (DRC).Objectives:To assess and to compare the performance of different IBP criteria sets in axial spondyloarthritis (SpA) outpatients attending the rheumatology unit of the University Hospital of Kinshasa, DRC.Methods:One hundred and eight Congolese outpatients with axial SpA defined by rheumatologist’s clinical judgment were included in the spondyloarthritis cohort of the University Hospital of Kinshasa from March 1st2015 to February 28, 2017. Calin criteria, Berlin criteria and ASAS criteria sets for IBP were performed to assess their performance against clinical judgment. Detailed history, clinical examination and imaging of sacroiliac joints by plain radiography were obtained. Sacroiliac joint radiographic lesions were scored with the modified New York criteria. Magnetic resonance imaging and HLA B27 were not performed. Fifty additional patients with a diagnosis of chronic (>3 months) mechanical low back pain (MLBP) were included as control group. The performance of each item and different criterias was evaluated using sensitivity, specificity, and likelihood ratio (LR). Baseline characteristics of the mechanical and inflammatory back pain cohorts were compared with chi-square or Student t tests as appropriate.Results:The mean age was 43.8±15.1 years in SpA patients versus 62.4±9.1 years in controls (MLBP patients) with respective sex ratio (M/F) of 1/0.8 and 1/2.1. There were significantly more male patients in the ankylosing spondylitis (AS) group than in the non-radiographic axial spondyloarthritis group (p<0.01). Among the criteria sets, Calin criteria showed the best sensitivity (92.6%) while the Berlin criteria showed the best specificity (97.6%) in the detection of IBP patients. The new ASAS criteria for IBP compared to the two previous criteria sets did not show good sensitivity nor specificity (sensivity 80%, specificity 62%, LR+ 1.05 (0.90 – 1.22), LR- 0.52 (0.39 – 0.69), 95%CI).Conclusion:The Calin criteria set would be useful for epidemiological and clinical studies in DRC. The ASAS criteria set for IBP is not better than other criteria sets in the screening of IBP for Congolese patients with axSpA.References:[1]Heuft-Dorenbosch L, Landewe R, Weijers R et al.Performance of various criteria sets in patients with inflammatory back pain of short duration; the Maastricht early spondyloarthritis clinic Ann Rheum Dis 2007;66:92–98. doi: 10.1136/ard.2006.053918[2]Michele C. Battié M, LINDA J. CARROLL et al. Preliminary Validation of a Self-reported Screening Questionnaire for Inflammatory Back Pain. J Rheumatol 2012;39;822-829[3]Poddubnyy D, Callhoff J, Spiller I, et al. Diagnostic accuracy of inflammatory back pain for axial spondyloarthritis in rheumatological care.RMD Open. 2018;4(2):e000825. Published 2018 Dec 5. doi:10.1136/rmdopen-2018-000825[4]Wang R, Crowson CS, Wright K, Ward MM. Clinical Evolution in Patients With New-Onset Inflammatory Back Pain: A Population-Based Cohort Study.Arthritis Rheumatol. 2018;70(7):1049–1055. doi:10.1002/art.40460Disclosure of Interests:Pierrot Lebughe: None declared, Kurt de Vlam Grant/research support from: Celgene, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Eli Lilly, Galapagos, Johnson & Johnson, Novartis, Pfizer Inc, UCB, Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, Jean-Marie Mbuyi-Muamba: None declared, Jean-Jacques Malemba: None declared

scholarly journals SAT0380 ENHANCING RHEUMATOLOGY REFERRALS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1138.2-1138
Author(s):  
C. S. E. Lim ◽  
M. Tremelling ◽  
L. Hamilton ◽  
A. Macgregor ◽  
K. Gaffney
Keyword(s):  
Back Pain ◽  
Musculoskeletal Pain ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Inflammatory Back Pain ◽  
Aminosalicylic Acid ◽  
Research Support ◽  
Clinical Probability ◽  
Asas Criteria ◽  
History Of

Background:Axial spondyloarthritis (axSpA) is associated with inflammatory bowel disease (IBD). In IBD patients, the clinical probability of axSpA increases in those with chronic back pain (CBP) whose symptoms started before the age of forty-five years old. In practice, this should trigger a rheumatology review especially if accompanied by other symptoms suspicious of inflammatory disease. However, in any health system, the goal of identifying all possible cases need to be balanced with the practical realisation of the finite resources available.Objectives:The study aimed to define the clinical characteristics of a subgroup of IBD patients who are routinely managed in secondary care who have an increased clinical probability for axSpA. Identification of these characteristics may help improve the quality and specificity of referrals to Rheumatology from Gastroenterology clinics.Methods:An analytical cross-sectional study was undertaken. Consecutive IBD patients attending routine Gastroenterology clinics were sent a modified validated back pain questionnaire. The questionnaire included the presence or absence of a previous diagnosis of axSpA; components of validated inflammatory back pain criteria; diagrams to indicate the location of back pain and other musculoskeletal pain; personal and family history of known axSpA manifestations; and details of their IBD course, activity and treatment.IBD patients, with back pain duration > 3 months with onset before 45 years were considered to have a medium diagnostic probability (MDP) for axSpA. MDP-positive IBD patients were compared with MDP-negative IBD patients and logistic regression was used to model the association with clinical features.Results:Four hundred and seventy consecutive IBD patients (mean age 54 years; 46% male) were surveyed. Two hundred and nine patients (59%) replied, of whom 191 patients (69%) consented to participate. One hundred and seventy-three (91%) of those who consented had a valid completed questionnaire and were included for data analysis. Of these, 74% had Ulcerative Colitis and 26% had Crohn’s disease. Their mean age was 58 years, 39% male. Mean age at IBD diagnosis was 39 years, mean IBD disease duration 19 yrs. CBP (back pain greater than three months) was reported by 76%. Inflammatory back pain fulfilling Calin, Berlin, ASAS criteria was seen in 23%, 29%, and 15% respectively. In addition, 80% reported peripheral musculoskeletal pain. Self-reported personal history of enthesitis, reactive arthritis (ReA), acute anterior uveitis (AAU), skin psoriasis (PSO) and dactylitis were 50%, 30%, 24%, 15% and 0% respectively. Self-reported family history of IBD, ReA, PSO, axSpA and AAU were 60%, 36%, 22%, 11%, and 1% respectively.Ninety-one (53%) patients were MDP-positive and 82 (47%) patients were MDP-negative. The clinical characteristics associated with MDP (adjusted for age at invitation) were: the presence of inflammatory back pain using ASAS criteria [OR 8.84 (1.61,48.67); p=0.01], longer interval between symptom onset and gastroenterologist diagnosis of IBD [OR 1.09 (1.03,1.16); p=0.005], and use of rectal topical 5-aminosalicylic acid [OR 3.27 (1.11,9.68); p=0.03].Conclusion:Chronic back pain and peripheral musculoskeletal pain are common in a secondary care IBD population. In IBD patients, with back pain duration > 3 months and onset before 45 years, the presence of inflammatory back pain, longer diagnostic delay of IBD and the use of rectal topical 5-aminosalicylic acid were associated with a higher clinical probability of axSpA. The identification of these clinical features may not only improve the quality and specificity of Rheumatology referrals from Gastroenterology in this subgroup of patients but also lends real world evidence to current ASAS-endorsed recommendations for early referral of patients with a suspicion of axial spondyloarthritis.Disclosure of Interests:Chong Seng Edwin Lim Grant/research support from: AbbVie - Research support/grant but NOT for this study., Mark Tremelling: None declared, Louise Hamilton: None declared, Alexander Macgregor: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma

scholarly journals AB0493 WHAT IS THE DIAGNOSTIC VALUE OF IMPAIRED SPINAL MOBILITY MEASUREMENTS IN INFLAMMATORY BACK PAIN PATIENTS? DATA FROM THE DESIR COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1273.2-1274
Author(s):  
C. Lukas ◽  
G. Khoury ◽  
M. A. D’agostino ◽  
B. Combe ◽  
J. Morel
Keyword(s):  
Back Pain ◽  
General Population ◽  
Diagnostic Value ◽  
Spinal Mobility ◽  
Inflammatory Back Pain ◽  
Mobility Impairment ◽  
Research Support ◽  
Predictive Values ◽  
Asas Criteria

Background:The diagnostic process in a patient with early inflammatory back pain suggestive of axial spondyloarthritis (ax-SpA) requires assessment and integration of multiple aspects, including clinical examination, biological measurements and radiologic assessments. Among the physical examination features, alteration of spinal mobility is often observed in ax-SpA. However, whether mobility impairment might really increase diagnostic likelihood, and which of the measurements made have relevant diagnostic value remains unknown.Objectives:To describe the frequency and severity of mobility impairment in multiple traditional measurements in patients suspect of early ax-SpA at initial assessment time, and to analyze their individual diagnostic performances in reference to usual classification criteria applied after 2 years of follow-up.Methods:Data from the DESIR cohort, which included patients aged 18-50 with inflammatory back pain lasting for 3 months to 3 years and a clinical suspicion of ax-SpA diagnosis were used. Baseline measurements of Schober’s test (Schober), chest expansion (CEx), lateral spinal flexion (LatSpiFlex), cervical rotation (CervRot) and intermalleolar distance (IntMalDist) collected at baseline were classified according to reference data from the general population adjusted for age and -when appropriate- for height. Cutoffs were defined as above 2.5th, 5th, 10th and 25th percentiles. With ASAS classification for ax-SpA applied at 2 years follow-up visit as external reference, diagnostic performances (Sensitivity [Se], Specificity [Sp], Positive [PPV] and Negative [NPV] Predictive Values) were calculated.Results:Complete data were available for 575 patients (of whom 377 (66%) fulfilled the ASAS criteria at 2 years). Schober, CEx, LatSpiFlex, CervRot and IntMalDist were above 5th percentile in respectively 278 (48%), 82 (14%), 220 (38%) and 93 (16%) patients. None of the measurements showed a clinically relevant compromise between both Se and Sp, but Sp was highest for CEx-most impaired cutoffs (Figure 1). The highest PPV (73.6%) and NPV (39.4%) were observed for LatSpiFlex.Conclusion:Measures of mobility and their levels of impairment do not show sufficient individual diagnostic value for ax-SpA among patients with early inflammatory back pain. However, highest degrees of impairment when compared to general population are more specifically observed in patients finally classified with ax-SpA for CEx, which was –consistently- 1 of the 2 mobility measures that was retained in the modified New York criteria for ankylosing spondylitis.Disclosure of Interests:Cédric Lukas Speakers bureau: AbbVie; Lilly; Merck; Novartis; Pfizer; Roche-Chugai;, Consultant of: AbbVie; Bristol-Myers Squibb; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; UCB; Sanofi;, Grant/research support from: Pfizer: Novartis, Gisèle Khoury Grant/research support from: Pfizer, Maria-Antonietta d’Agostino: None declared., Bernard Combe Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai, Jacques Morel Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai.

scholarly journals P271 An analysis of short-term repeat MRI scans of vertebral corner lesions in suspected early axSpA: defining the prevalence and evolution of clinically significant spinal lesions without concurrent SIJ changes on imaging

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Saion Chatterjee ◽  
Helena Marzo-Ortega ◽  
Dennis McGonagle ◽  
Alexander N Bennett ◽  
Raj Sengupta
Keyword(s):  
Back Pain ◽  
Axial Spondyloarthritis ◽  
De Novo ◽  
Current Evidence ◽  
Inflammatory Back Pain ◽  
Short Term ◽  
Spinal Imaging ◽  
Asas Criteria ◽  
Mri Scans

Abstract Background MRI offers an enhanced opportunity to detect early spinal changes of axial spondyloarthritis (axSpA), by identifying characteristic inflammatory and structural lesions, so called Romanus lesions. These include bone marrow oedema lesions on the vertebral corners and fatty replacement of these lesions, both highly suggestive features of axSpA. Current evidence suggests that treatment of these lesions requires early biologic therapy, hence early identification is imperative. We evaluate the prevalence and variation of vertebral corner lesions on short-term repeat MRI scans in patients with suspected early axSpA. Methods 109 MRI scans were performed at baseline and at 4, 8 and 12-weeks on 30 patients with suspected axial spondyloarthritis, who fulfilled the ASAS inflammatory back pain criteria, and had normal sacroiliac joints (SIJs) on antero-posterior pelvis radiographs. The protocol included sagittal T1 and short-tau inversion recovery of the cervico-thoracic spine and thoracolumbar spine. Results 29 patients completed the study (66% were male, 72% HLA-B2-positive). All patients had ≥1 clinical spondyloarthritis (SpA) feature and 86% had ≥2. 13 patients used NSAIDs regularly over the 12-week study period. Overall, 40 corner lesions were present in participants at baseline scanning. 67 new vertebral corner lesion changes occurred at different time points over the follow-up period compared to baseline. 43 changes were new or worsening lesions, while 24 changes were an improvement or resolution of a lesion. 48.6% (14/29) of patients had a minimum of 1 corner lesion present at baseline. 78.5% (11/14) of patients with baseline corner lesions experienced either a decrease/improvement or increase/progression of spinal corner lesions. 20.7% (6/29) of patients demonstrated transient corner lesions at baseline or follow-up with resolution by the 12-week scan (likely artefact). 5/29 patients met spinal imaging criteria suggestive of AS (3 at baseline, 1 only transiently at 1 month, and 1 which persisted from interval scanning). At 12-weeks, 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present (minimum number needed for diagnostic significance). 75% of these patients did not have evidence of concomitant SIJ changes (10.3% of all patients). HLA-B27 status, gender, NSAID use, and number of SpA features were not associated with corner lesion development or improvement. Conclusion Approximately half of all patients who meet ASAS criteria for inflammatory back pain, but do not meet ASAS criteria for axSpA, demonstrated at least 1 vertebral corner lesion on MRI scan at baseline, which may represent artefact or a prelude to future disease progression. 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present on MRI at the conclusion of 12-weeks of follow-up. In cases of suspected axSpA with negative SIJ MRI imaging, 10.3% of patients had significant spinal evidence of axSpA on MRI, highlighting the importance of spinal imaging and monitoring as part of the diagnostic work-up for axSpA. Disclosures S. Chatterjee None. H. Marzo-Ortega None. D. McGonagle None. A. Bennett None. R. Sengupta None.

scholarly journals A Descriptive Study of Perinatal Asphyxia at the University Hospital of Kinshasa (Democratic Republic Of Congo)

2013 ◽  
Vol 59 (4) ◽  
pp. 274-279 ◽  
Author(s):  
T. Biselele ◽  
G. Naulaers ◽  
P. Bunga Muntu ◽  
E. Nkidiaka ◽  
M. Kapepela ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Perinatal Asphyxia ◽  
Descriptive Study ◽  
University Hospital ◽  
Republic Of Congo ◽  
The University

Prevalence of Inflammatory Back Pain and Axial Spondyloarthritis Among University Employees in Izmir, Turkey

2015 ◽  
Vol 42 (9) ◽  
pp. 1647-1651 ◽  
Author(s):  
Fatos Onen ◽  
Dilek Solmaz ◽  
Pinar Cetin ◽  
Ismail Sari ◽  
Ali Balci ◽  
...  
Keyword(s):  
Back Pain ◽  
Axial Spondyloarthritis ◽  
Age At Onset ◽  
Turkish Population ◽  
The United States ◽  
Classification Criteria ◽  
Inflammatory Back Pain ◽  
Face To Face ◽  
Asas Criteria ◽  
Asas Classification Criteria

Objective.To estimate the prevalence of inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society (ASAS) classification criteria among employees in a university.Methods.In the first stage of the study, a face-to-face interview was done using a standard questionnaire to investigate IBP in 381 subjects randomly selected from 2894 employees at Dokuz Eylul University in Izmir, Turkey. In the second stage, subjects with back pain for ≥ 3 months and age at onset < 45 years were evaluated for axSpA using the ASAS criteria. Both the European Spondyloarthropathy Study Group (ESSG) criteria and Amor criteria were used for the classification of the whole group of spondyloarthritis (SpA).Results.There were 131 male and 250 female subjects (mean age: 38.0 yrs). Twenty-five subjects (6.6%) were classified as having IBP according to the ASAS criteria. The prevalence of IBP according to the Berlin and Calin criteria was 7.1% and 21.5%, respectively. The prevalence of axSpA was estimated at 1.3% according to the ASAS classification criteria (0.5% for radiographic axSpA and 0.8% for nonradiographic axSpA). A total of 7 patients (1.8%) fulfilled both the Amor and ESSG criteria for the whole group of SpA.Conclusion.This is the first prevalence study of IBP and axSpA using ASAS classification criteria in the Turkish population. The prevalence estimates of IBP and axSpA reported here are within the upper range of other studies in European countries and the United States.

Hidradenitis Suppurativa Associated with Spondyloarthritis — Results from a Multicenter National Prospective Study

2014 ◽  
Vol 41 (3) ◽  
pp. 490-494 ◽  
Author(s):  
Pascal Richette ◽  
Anna Molto ◽  
Manuel Viguier ◽  
Karen Dawidowicz ◽  
Gilles Hayem ◽  
...  
Keyword(s):  
Back Pain ◽  
Hidradenitis Suppurativa ◽  
Chronic Inflammatory Disease ◽  
University Hospital ◽  
Musculoskeletal Symptoms ◽  
Inflammatory Back Pain ◽  
Asas Criteria ◽  
Careful Clinical Examination ◽  
Short Time ◽  
Crude Prevalence

Objective.To determine the prevalence and characterize the inflammatory musculoskeletal symptoms of hidradenitis suppurativa (HS), a chronic inflammatory disease of skin appendages.Methods.Patients with HS referred to 3 dermatology university hospital centers were systematically screened for peripheral arthritis, dactylitis, inflammatory back pain, or enthesitis. After careful clinical examination, patients were further classified according to clinical and imaging criteria for spondyloarthritis (SpA) using the Amor, European Spondyloarthropathy Study Group (ESSG), and ASsessment in ankylosing spondylitis (ASAS).Results.We screened 640 patients with HS; 184 had musculoskeletal symptoms. In all, 43 (mean age 39.4 yrs, ± 8.3; 80% women) had arthritis, inflammatory back pain, or enthesitis and were investigated further. Signs of HS preceded the onset of articular symptoms in 39 patients (90%), at a mean interval of 3.6 years. A total of 18 (41%), 24 (55%), and 15 (34%) patients fulfilled the Amor, ESSG, and ASAS criteria, respectively, while synovitis, acne, pustolosis, hyperostosis, and osteitis (SAPHO) syndrome was established in 4 patients. The crude prevalence of SpA in all 640 patients with HS was 3.7% by the ESSG criteria.Conclusion.SpA may occur in patients with HS, with the prevalence in this group exceeding that in the general population. The very short time between skin and joint symptom onset in some cases suggests common pathogenic mechanisms underlying HS and SpA.

scholarly journals Performance of Different Criteria Sets for Inflammatory Back Pain in Radiographic and Nonradiographic Axial Spondyloarthritis

2021 ◽  
Author(s):  
Md. Toufiqul Islam ◽  
Mohammad Imtiaz Sultan ◽  
Sujan Rudra
Keyword(s):  
Back Pain ◽  
Axial Spondyloarthritis ◽  
Positive Likelihood Ratio ◽  
High Sensitivity ◽  
Inflammatory Back Pain ◽  
Care Practice ◽  
Second Phase ◽  
Health And Nutrition ◽  
Asas Criteria ◽  
Expert Criteria

Introduction: It is important to recognise inflammatory back pain (IBP) for early diagnosis of ankylosing spondylitis (AS). The aims of this study were to develop a valid, reliable Bengali IBP tool and to assess the performance of different IBP criteria sets, including Calin, Berlin set 8a and 7b, and new Assessment of SpondyloArthritis International Society (ASAS) expert criteria, in radiographic axial spondyloarthritis (axSpA) and nonradiographic axSpA. Method: This case-control study was performed in three phases. The first phase involved development of an IBP tool by adding the fifth parameter of ASAS expert criteria to the National Health and Nutrition Examination Survey (NHANES) 2009–2010 arthritis questionnaires; the second phase assessed reliability by test-retest statistics among 87 participants at a 5-day interval. Finally, according to the imaging arm of ASAS axSpA classification criteria, 50 patients with axSpA were included as cases while 50 patients with chronic mechanical back pain (MBP) were included as a control. Results: The presence of IBP with SpA versus patients with MBP, detected by Calin criteria, were 76.0% versus 10.0%, by Berlin 8a were 72.0% versus 6.0%, by Berlin 7b were 58.0% versus 12.0%, and by ASAS were 64.0% versus 18.0%, respectively. Results suggested the Calin criteria set has the highest sensitivity (76.0%) and Berlin set 8a has the highest specificity (78.9%) in the differentiation of IBP from MBP. Conclusion: The performance of the new ASAS criteria was analogous to the other existing criteria sets. The highest positive likelihood ratio and odds ratio were found for Berlin set 8a criteria. The Berlin set 8a criteria can still be used in primary care practice at the first screening because of high sensitivity.

scholarly journals Retinoblastoma in the Democratic Republic of Congo: 20-Year Review from a Tertiary Hospital in Kinshasa

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Aimé Kazadi Lukusa ◽  
Michel Ntetani Aloni ◽  
Bertin Kadima-Tshimanga ◽  
Moïse Mvitu-Muaka ◽  
Jean Lambert Gini Ehungu ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Republic Of Congo ◽  
Bilateral Disease ◽  
Bilateral Retinoblastoma ◽  
Life Threatening ◽  
The University ◽  
Specialized Unit

Background.To determine clinical profile and management of retinoblastoma among children at Kinshasa in Democratic Republic of Congo.Patients and methods. The medical records of patients with a diagnosis of retinoblastoma seen at the University Hospital of Kinshasa from January 1985 till December 2005 were retrospectively reviewed. Demographic profile, clinical data, modes of treatment and outcome were analysed.Results. A total of 49 children, of whom 40 had adequate data on record were identified as retinoblastoma (28 males and 12 females). Nine cases had bilateral disease. The median age at the first symptoms was 9 months (range, 1 month to 6 years) for unilateral retinoblastoma and 18 months (range, 1 month to 3.5 years) for bilateral retinoblastoma. The median age at the first oncology consultation was 2.4 years (range, 6 months to 6 years) for unilateral retinoblastoma and 2.4years (range, 9 months to 4 years) for bilateral disease. Leukokoria was present in 67.5% of subjects. Seventy-five percent abandoned the treatment. The mortality was 92.5%.Conclusion. In Democratic Republic of Congo, retinoblastoma remains a life threatening disease characterized by late referral to a specialized unit and affordability of chemotherapy; all leading to an extension of the disease and high mortality.

scholarly journals THU0560 PRIMARY CARE PHYSICIAN PERSPECTIVES ON DELAYS IN DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: A QUALITATIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 521.1-521
Author(s):  
S. H. Liu ◽  
K. Lapane ◽  
D. Shridharmurthy ◽  
S. Khan ◽  
K. Ferrucci ◽  
...  
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
Primary Care Physicians ◽  
Laboratory Tests ◽  
Screening Tool ◽  
Axial Spondyloarthritis ◽  
Diagnostic Delay ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Average Delay

Background:The average delay in diagnosis for patients with any form of spondyloarthritis (SpA) ranges from 7 to 10 years [1–5]. In axial spondyloarthritis (axSpA), a subgroup of SpA, it is 5 to 14 years [4, 6, 7]. Factors that contribute to this delay include the lack of diagnostic criteria for axSpA and the difficulty in distinguishing inflammatory back pain (IBP), a key symptom of axSpA, from other highly prevalent forms of low back pain [8–10]. This impedes timely referral of these patients to rheumatologic care and initiation of appropriate treatment.Objectives:Describe understanding of, attitudes towards, and practices regarding axSpA among primary care physicians.Methods:We recruited 18 primary care physicians practicing in the United States as part of a larger qualitative study: theSpondyloArthritisScreening andEarlyDetection (SpA-SED) Study. We used purposive sampling with a goal of including an equal number of family medicine and internal medicine physicians who were balanced by gender. Physicians provided informed consent to participate in an in-depth interview (up to 60 minutes), conducted in person (n = 3) or over the phone (n = 15), between February and May 2019. The interview guide was developed by a multidisciplinary team, with input from rheumatologists. Topics included the physicians’ approaches to evaluating back pain, their awareness about axSpA, their differential diagnosis of axSpA, the laboratory tests and imaging studies ordered when axSpA is suspected, their referral patterns for patients with presumed axSpA, their thoughts about factors contributing to diagnostic delay in axSpA, and their opinions about an Inflammatory Back Pain Assessment – ASAS criteria screening tool [5].Results:Barriers to early diagnosis included patient factors (eg, multiple complaints, back pain not being the chief complaint), disease characteristics (eg, slow rate of disease progression), physician characteristics (eg, lack of rapport between patients and their primary care physicians), and structural/system issues (eg, lack of time). Most physicians reported that they would perform laboratory tests before referring a patient to a rheumatologist.Conclusion:Primary care physicians were surprised to learn of the average delay to axSpA diagnosis, considered that this lengthy delay was problematic, and agreed that improvements are needed in screening for and early detection of axSpA. Physicians believed that there would be a role for using a screening tool in the primary care setting to improve diagnostic delay, but that evidence to support its implementation is needed.References:[1]Dougados M et al.Arthritis Rheum.1991;34:1218–27.[2]Amor B et al.Rev Rhum Mal Osteoartic.1990;57:85–9.[3]van der Linden S et al.Arthritis Rheum.1984;27:361–8.[4]Deodhar A et al.Arthritis Rheumatol.2016;68:1669–76.[5]Sieper J et al.Ann Rheum Dis.2009;68:784–8.[6]Sykes MP et al.Rheumatology (Oxford).2015;54:2283–4.[7]Redeker I et al.Rheumatology (Oxford).2019;58:1634–8.[8]Strand V et al.Mayo Clin Proc.2017;92:555–64.[9]Proft F et al.Ther Adv Musculoskelet Dis. 2018;10:129–39.[10]Bohn R et al.Clin Exp Rheumatol.2018;36: 263–74.Acknowledgments:We thank the participants for sharing their insights as part of this study. This abstract was written using data from a research study originally funded by Novartis (Principal Investigator: Shao-Hsien Liu, Co-Investigators: Jonathan Kay, Kate Lapane, Catherine Dubé).Disclosure of Interests:Shao-Hsien Liu Grant/research support from: Novartis Pharmaceuticals Corporation, Kate Lapane Grant/research support from: Novartis Pharmaceuticals Corporation, Divya Shridharmurthy Grant/research support from: Novartis Pharmaceuticals Corporation, Sara Khan Grant/research support from: Novartis Pharmaceuticals Corporation, Katarina Ferrucci Grant/research support from: Novartis Pharmaceuticals Corporation, Catherine Dubé Grant/research support from: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Jonathan Kay Grant/research support from: Gilead Sciences, Inc., Pfizer, Novartis Pharmaceuticals Corporation, Consultant of: Alvotech Suisse AG; Arena Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Merck Sharp & Dohme Corp.; Mylan Inc.; Novartis AG; Samsung Bioepis; Sandoz, Inc; UCB, Inc.

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