Risk factors for implant failure of custom-made acetabular implants in patients with Paprosky III acetabular bone loss and combined pelvic discontinuity

BACKGROUND: Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. OBJECTIVE: The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. METHODS: Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. RESULTS: The average follow-up was 41.9 ± 34.8 months (range 1.5–120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. CONCLUSION: Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.

POS0356 THE RELATIONSHIP OF GENETICS AND CLINICALLY SUSPECT ARTHRALGIA IN RA DEVELOPMENT ASSESSED USING HC, CSA AND RA PATIENTS

Background:The identification of a pre-RA stage of patients with clinically suspect arthralgia (CSA) has proven to be beneficial in the early detection of Rheumatoid disease. Similarly, genetic susceptibility studies have identified important genetic risk factors for the development of (CCP positive) RA.1 The question that arises is whether these findings represent independent etiological pathways and could therefore be complimentary in the early diagnosis of RA.Objectives:To corroborate the knowledge of genetic differences between HC and RA patients and extend it to include the CSA stage of disease.Methods:We used three datasets sampled from the same region in the Netherlands: 1,085 healthy controls (HC), 530 CSA and 1,277 RA patients. CSA patients were monitored for a median of 2 years for conversion into clinically apparent inflammatory arthritis (CSAc) or not (CSAnc).2 We assessed the association between HLA SE and disease stage using logistic regression. The analysis was repeated in the CCP positive and CCP negative strata of both the CSA and the RA populations.Results:Consistent with previous studies, HLA SE was significantly enriched in RA patients compared to HC (OR 2.28) (Figure 1). HLA SE also differentiated HC vs CSAc (OR 1.69), CSAnc vs CSAc (OR 1.74), and CSAnc vs RA (0R 2.35). No difference was found in HC vs CSAnc and CSAc vs RA.Conclusion:HLA SE is more prevalent in patients who developed (rheumatoid) arthritis than in both healthy controls and CSA patients who do not progress to arthritis. The results presented here seem to indicate a clear distinction between CSA patients who develop arthritis and those who do not. We therefore believe that known RA genetics play a role in the development of arthritis rather than the CSA symptoms. While this relationship varies by CCP status, an independent effect remains. Studies into the broader role of genetics beyond HLA SE are currently underway.Figure 1.Distinguishing ability of HLA SE across HC, CSAc, CSAnc and RA in the full populations as well as in the CCP positive and negative stratifications. The arrowhead indicates the “case” status in each logistic regression. OR’s (95% CI) derived from regression coefficients indicate the change in odds ratio attributable to HLA SE positivity.References:[1]van der Helm-van Mil, A. H., et al. Arthritis and rheumatism, 2006. 54(4): p. 1117–1121.[2]van Steenbergen, H.W., et al. Ann Rheum Dis, 2017. 76(3): p. 491-496.Disclosure of Interests:None declared

The Art Of Living With Amavata (Rheumatoid Arthritis) : Therapeutic Potential Of Psychotherapy In Ayurveda With Special Reference To Sattwavajaya Chikitsa

Acharya Charaka was the first person who used the word ‘Sattwavajaya’ but only once and was also the last one. He explains the Ayurveda in the form of Trisutra i.e. Hetu(causative factor), Linga(symptoms of the disease) and Aushadha(medicine).(1) Chikitsa means the process in which vitiated Doshas are brought to normal state and this equilibrium state of Doshas will be maintained.(2) It is classified on different basis; as Dwividha, Trividha and Chaturvidha Chikitsa.Sattwavajaya Chikitsa is one among the Trividha Chikitsa.(3) The word Satwa refers to Mana(mind)(4) and Avajaya refers to conquering or win over.(5) Hence Sattwavajaya therapy aims at control of mind by restraining the mind from wholesome Arthas(objects).(6) Self control of mind is one of the most difficult to the tasks and warrants a perfect combination of desire, determination and dedication.The word Mano-Nigrahani means control of mind.(7) This mind control can be both subjective and objective. The objective type of Mano-Nigraha is the actual Sattwavajaya and warrants physician’s interference with patient’s mind control. Amavata which is popularly correlated with Rheumatoid disease, is characterized by its eternal course, uncertain progression and unpredictable series of exacerbation and remissions. In Ayurveda the impact of the Amavata over psychological setup of the patient is well recognized. So Sattwavajaya plays major role to get rid of these problems.

Neglected Achilles tendon rupture associated with rheumatoid arthritis: a case report and a brief review of the literature

We report a case about a 69-year-old man, suffering from rheumatoid arthritis, diagnosed with a neglected Achilles tendon rupture. Considering the large Achilles tendon gap and the bad quality of the autologous tendons caused by rheumatoid disease, a reconstruction using an Achilles tendon with calcaneus bone block allograft was performed, with excellent clinical and functional outcomes.

Association between rheumatoid arthritis with gender, age, obesity and smoking among middle aged and old aged population - A Survey

As the population of teenagers and middle-aged humans increases, the number of smokers and the people associated with various diseases due to this habit also increase. The reason for the number of increased smokers arises due to peer pressure and other factors such as anxiety and stress. One such disease associated with smoking is rheumatoid arthritis which is characterised by inflammation of joints. The present study was conducted to understand the influence of various factors such as gender, age and smoking with the risk of occurrence of rheumatoid arthritis. For the present study, a self-administered questionnaire comprising 15 questions was prepared and circulated via an online google form link. The results obtained were recorded and analysed using the SPSS software version 22, and the statistical test used was descriptive statistics. From the present study, it was observed that a majority of the participants were aware of the rheumatoid disease arthritis and believed that hormones such as estrogen could increase the risk of rheumatoid arthritis. Majority of the population also found that nicotine from cigarettes can increase the occurrence of RA. The present study concluded that RA could be prevented by following a balanced diet and by creating awareness on the same.

AB0259 THE RELATIONSHIP BETWEEN MICROVASCULAR DAMAGE AND DISEASE ACTIVITY IN PATIENT WITH RHEUMATOID ARTHRITIS – ASSESSMENT BY VIDEOCAPILAROSCOPY

Background:Rheumatoid arthritis (RA) is an autoimmune disease characterized by erosive synovitis (causing severe joint damage) and systemic damage. Rheumatoid vasculitis (RV) is an extra-articular manifestation of rare but serious rheumatoid disease that involves the damage of small and medium sized vessels.Objectives:The purpose of the study was to evaluate the incidence of damages occurred on cutaneous level in patients diagnosed with RA and to detect capillaroscopic microangiopathy changes in the activity of rheumatoid disease.Methods:101 patients were included in the study, all were diagnosed with RA according to the ACR/EULAR 2010 criteria. RV diagnosis was based on the clinical examination. The capillaroscopic evaluation was performed with a 3.0 VideoCap device at a 200x magnification (200x magnification contact lenses). Capillaroscopic examination was performed on fingers II-V of both hands, being considered pathological if the capillaroscopic changes are present in at least two fingers. The activity of disease was calculated using DAS 28 ESR score.Results:18% of examined patients was male and 82% female, with the mean age of 56,2years±10.16SD, and the mean duration of the disease in years of illness was 8.65±5.31SD. 3 patients had periungual vasculitis with cutaneous ulceration and gangrene, 12 patients had palpable purpura. 29% of the patients had vasospastic skin changes. The activity score of RA was associated with the capillaroscopic changes in peripheral microangiopathy p-0.037. Capillaries images were heterogenous in aspects and distribution, tortuous capillaries, microhemorrhages, giant/dilated capillaries, avascular areas were observed.Conclusion:Vascular microangiopathy evidenced by capillaroscopic examination is present in patients with cutaneous vasculitis having a medium, severe activity of rheumatoid diseases.References:[1]Cutolo M, Paolino S, Smith V. Nailfold capillaroscopy in rheumatology: ready for daily use but care in terminology. Clinical Rheumatology 2019; 38:2293-2297http://doi.org/10/s10067-019-04716-w[2]Lambova N, Müller-Ladner U. Capillaroscopic pattern in inflammatory arthritis. Microvascular Research 2012; 83:318-322Dilated, giant capillaries, microhemorrhage bleedings, avascular areaReduced blood flow (observed in dynamics)Disclosure of Interests:Mirela Parvu Speakers bureau: Not for this subject, theme, Anca Cozos Speakers bureau: Not for this subject, theme, Anna-Iuliana Biro Speakers bureau: Not for this subject, theme, Horatiu Valeriu Popoviciu Speakers bureau: Not for this subject, theme