P095 Camptodactyly, arthropathy, coxa-vara, pericarditis syndrome: a case report

Background Camptodactyly, arthropathy, coxa vara, pericarditis (CACP) syndrome is a rare genetic disorder with autosomal recessive transmission including camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and non-inflammatory pericarditis. We report the observation of a case. Observation S.Y aged 8.5 years, from a consanguineous marriage, presented with a chronic arthropathy affecting wrists, knees and ankles that had been evolving for 6 years and currently, elbows are also affected. The history includes surgery for claw deformity of the hands at the age of 3. No similar cases in the family. Osteoarticular examination showed symmetrical swelling of the elbows, wrists (Fig. 1),knees (Fig. 2) and ankles (Fig. 3.The affected joints were neither red, painful nor warm on palpation, with normal mobility. The onset of symptoms could not be determined due to the indolence of the condition and the rest of the clinical examination was unremarkable. Discussion CACP syndrome is a more common condition in the Middle East and North Africa, with about 20 cases reported worldwide. This syndrome is still poorly understood and is often confused with juvenile idiopathic arthritis. It should be suspected in the presence of any congenital claw deformity of the hands (camptodactyly) with a chronic non-inflammatory arthropathy, which are constant signs. Coxa-vara and pericarditis (found respectively in 60 and 30% of cases) should be systematically sought. The consanguinity reported in the literature is also present in our case. However, there are no similar cases in siblings. The diagnosis is important, thus avoiding the initiation of unnecessary treatments such as corticosteroids, DMARDs or biotherapy. Biology no inflammatory syndrome, FAN negatives. Standard X-ray of the pelvis presence of a coxa-vara on the right Joint ultrasound common tenosynovitis of the extensors of the fingers, effusion with synovial hypertrophy without a Doppler catch of the elbows, knees and ankles Myelogram without abnormality. Cardiac ultrasound without pericarditis. The diagnosis of CACP was made in view of: a history of camptodactyly, chronic non-inflammatory arthropathy and coxa-vara. Analgesic treatment was instituted in case of pain, with cardiac monitoring by ultrasound every 6 months. Conclusion CACP syndrome is a rare disease often confused with juvenile idiopathic arthritis. Congenital camptodactyly and non-inflammatory arthropathy are very evocative of the diagnosis. The absence of similar cases in siblings makes our observation special.

Tietze Sendromu: Bir Olgu Sunumu

Tietze’s Syndrome: A Case Report Tietze syndrome (TS) is a rare inflammatory arthropathy characterized by tenderness, pain, and non-purulent swelling of the costosternal, costochondral and sternoclavicular joints. It often involves the costosternal joints and sternoclavicular jointinvolvement is rare. In this case report, we present a 72-year-old female patient suffering from pain and swelling in the right upper chest wall fo rabout 2 years. Physical examination revealed tenderness in the right sternoclavicular joint and an approximately 2x2 cm moderate swelling. Ultrasonic imaging of the swelling area revealed increased echogenicity and edema in the right sternoclavicular joint area. Laboratory findings were normal. The patient was diagnosed with TS and a local injection of a corticosteroid and local anesthetic mixture was administered. The patient’s complaints decreased significantly after the infiltration. In this case report, we present a TS case with sternoclavicular joint involvement that we treated with local injection. Keywords: Tietze’s syndrome, sternoclavicularjoint, costochondritis

Urate Crystals; Beyond Joints

Gout is the most common inflammatory arthropathy caused by the deposition of monosodium urate (MSU) crystals. The burden of gout is substantial with increasing prevalence of gout globally. The prevalence of Gout in the United States has increased by over 7% in the last two decades. Initially, it was believed that MSU crystal deposits occur only in the joints with the involvement of the periarticular soft tissues, but recent studies have shown the presence of MSU crystal deposition in extra-articular sites as well. Human plasma becomes supersaturated with uric acid at 6.8 mg/dl, a state called hyperuricemia. Beyond this level, uric acid crystals precipitate out of the plasma and deposit in soft tissues, joints, kidneys, etc. If left untreated, hyperuricemia leads to chronic gout characterized by the deposition of tophi in soft tissues such as the joints, tendons, and bursae. With the advent of newer imaging techniques such as DECT, MSU crystals can be visualized in various extra-articular sites. Extra-articular deposition of MSU crystals is believed to be the causative factor for the development of multiple comorbidities in gout patients. Here, we review the literature on extra-articular deposition of urate crystals and the role of dual-energy computed tomography (DECT) in elucidating multi-organ involvement. DECT has emerged as an invaluable alternative for accurate and efficient MSU crystal deposition detection. Future studies using DECT can help determine the clinical consequences of extra-articular deposition of MSU in gout patients.

POS1480-HPR IMPLEMENTATION OF TELEMEDICINE IN RHEUMATOLOGY: VIRTUAL CONSULTATION AS A TOOL FOR DIRECT COMMUNICATION WITH PRIMARY CARE

Background:Virtual consultation is defined as the provision of a healthcare service when there is a distance between the subjects and information and communication technologies are used to carry out the consultation. This tool has been successfully implemented in different specialties. It is useful for providing quick solutions, improving the overload of the medical care and for the early detection of inflammatory diseases1. In our centre, virtual consultation from Primary Care (PC) to Hospital Care (HC) has been implemented.Objectives:The main objective is to describe our experience with the use of virtual consultation and its value as a new modality of specialised medical care. The second aim is to identify the most frequent reasons for consultation and diagnoses, to assess the concordance between the two and to analyse the trend over time of the number of virtual consultations and their relationship with the different waves of the COVID 19 pandemic.Methods:Retrospective observational study. The virtual consultations made from PC (47 centres) to Rheumatology during 2020 were analysed. They were carried out through a computer programme, using the “Andalusian Health Service Virtual Consultation Platform” tool. A specific agenda was established for virtual consultations. The reason for the referral and the rheumatologist’s diagnosis were collected. The response given to the PC was divided into four models: NON-TRIBUTARY (not related to the speciality), DISCHARGE (a diagnosis and therapeutic response is concluded), APPOINTMENT FOR CONSULTATION and FOLLOW-UP (new contact is requested, completing the information). The reasons for consultation, diagnoses, time and type of response were analysed.Results:47 virtual consultations were carried out. 54.5% (n 298) were closed as DISCHARGE. 27.4% (n 150) were APPOINTMENT FOR CONSULTATION, and 17.7% (n 97) indicated FOLLOW-UP. Only 0.4% (n 2) were NOT TRIBUTARY.The average response time was 2 days 15 hours and 56 min.The most frequent reason for consultation was polyarthralgias (26.7%, n 146) and after the rheumatologist’s assessment a diagnosis was established in 89% of them. Inflammatory arthropathy accounted for 30.8% (n 45), osteoarthritis for 19.9% (n 29), fibromyalgia for 12.3% (n 18), polymyalgia rheumatica (PMR) for 6.9% (n 10), osteoporosis for 2.7% (n 4) and connective tissue disease for 2.1% (n 3).Another frequent reason for consultation was osteoporosis (13.5% n 74), of which 85.1% (n 63) had a confirmed diagnosis and/or need for revision.A diagnosis could be made via telematics in 89.6% of the consultations. 15.5% were osteoporosis (n 85), 14.9% osteoarthritis (n 81), 10.5% soft tissue injuries, 8.8% mechanical/nonspecific pain (n 47), 7.1% rheumatoid arthritis (n 39), 6.5% fibromyalgia (n 34), 6.2% connective tissue disease (n 34), 5.7% PMR (n 31), 4.9% suspected spondyloarthritis (n 26), 4.2% psoriatic arthritis (n 23) and 4.2% microcrystalline arthritis (n 23).27.4% (n 150) of the virtual consultations were required for assessment in a face-to-face appointment. We analysed the distribution over time (Figure 1). In the COVID 19 confinement phase (14 March - 21 June), the number of consultations increased, peaking in June, a behaviour that has persisted in the other mobility phases (October/November).Conclusion:More than half of the virtual consultations carried out were resolved without face-to-face assessment, with a diagnosis being established in almost 90%. It is an effective tool for rapid access to Rheumatology, detecting pathology requiring preferential attention, with a face-to-face appointment, as well as for the early diagnosis of inflammatory arthropathy, which was detected in a quarter of the consultations, as well as for the diagnosis and follow-up of osteoporosis. Virtual consultation facilitates a quick response, playing an even more relevant role in the current SARS CoV-2 pandemic situation.References:[1]B. Tejera, S. Bustabad. A new form of communication between rheumatology and primary care: The virtual consultation. Reum Clin., 12 (2016), pp 11-14Disclosure of Interests:None declared

POS0047 OUTCOMES IN INFLAMMATORY ARTHROPATHY PATIENTS HOSPITALIZED FOR COVID-19

Background:Covid 19 is a new and rapidly spreading corona virus which has reached pandemic proportions. As of 5/22/20 there are 5.08 million confirmed cases and 332,000 deaths worldwide. Primary manifestations are respiratory, with a subset developing severe hypoxic respiratory failure. Several risk factors predispose patients to worse outcomes including age, obesity, hypertension, chronic kidney disease, COPD, asthma, CHF, and diabetes. This is a retrospective cohort analysis of patients with Rheumatoid arthritis, Ankylosing spondylitis, or Psoriatic arthritis who were hospitalized for COVID-19 infection across 165 HCA hospitals from 1/1/2020 to 5/30/2020. We compared endpoints and calculated odds of ICU admission, invasive ventilation, mortality compared to control as well as length of stay and discharge location.Objectives:Our objectives include measuring the outcome of Patients in two arms, the first being those with Rheumatoid arthritis, Ankylosing spondylitis, and Psoriatic arthritis who are infected with COVID 19 to an age matched and comorbidity matched arm (using the Charlson comorbidity index) for the composite endpoint of ICU admission, invasive ventilation, and death. We believe the inflammatory arthropathy arm will have a worse composite endpoint then the control arm. we will also attempt to calculate a hazard ratio of this arm vs the control to the composite endpoint. We will also examine the length of stay as well as inflammatory markers mentioned in between the two arms. We suspect initial inflammatory markers will be lower in the inflammatory arthropathy arm, particularly CRP and LDH, due to chronic immune modulating medication and these markers will not correlate as closely with severe illness represented by the composite endpoint as in the control arm.Methods:We analyzed 86,217 patients admitted with COVID-19 comparing 751 patients who had inflammatory arthropathy to patients who did not. T tests were used for parametric outcome and chi square tests for non-parametric outcomes. Multivariate analysis included potential confounders such as age, and comorbidities such as diabetes, heart disease, etc.Results:The odds ratio for mortality in the arthropathy arm was 1.37 with a confidence interval of 1.09 to 1.71 with a p value of 0.006. The odds ratio for ventilation was 1.35 with CI of 1.09 to 1.67 and p value of 0.006. The odds ratio of ICU admission was 1.46 with CI of 1.24 to 1.72 and P value of 0.000. The average length of stay of the arthropathy arm was 8.51 days +/- 10.02 vs 4.59 days +/- 8.26 of the control, p < 0.001. The discharge disposition of the arthropathy arm vs control group is as follows, 13.32% died inpatient vs 5.87% in the control, 56.72% were discharged home vs 77.19%, 6.79% went to hospice care vs 3.10%, 4.79% remained inpatient at the end of the study interval vs 3.45%, 17.18% were discharged to rehab vs 8.43%, and other discharges not included in the above groupings were 1.2% vs 1.96%, p<0.001. 31.29% of the arthropathy group required ICU admission vs 16.32% and 13.98% required ventilation vs 6.9%, p <0.001. The average age was higher in the arthropathy arm vs control at 66.56 years old vs 51.53, p <0.001. Charlson comorbidity index was also higher in the arthropathy arm at 2.72 vs 0.96, p <0.001.Conclusion:This is a large analysis of inflammatory arthropathy patients hospitalized with COVID-19. While the arthropathy group was older, and had more co-morbidities, when adjusting for potential confounders, inflammatory arthropathy patients had a higher risk of death and mechanical ventilation, as well as longer length of stay.Disclosure of Interests:None declared.

THE MANAGEMENT OF AMAVATA (RHEUMATOID ARTHRITIS) WITH VATARI GUGGULU AND BRIHAT SIMHANADA GUGGULU

The detail knowledge on Amavata was first explained by Madhavakar, whereas Chakrapani Dutta first gave knowledge about principle and management of the disease. Amavata is a clinical entity very much similar to the chronic but active inflammatory arthropathy, the Rheumatoid arthritis. Till now, the etio-pathogenesis of Rheumatoid arthritis is not known precisely but among the hypothesis, entero-pathy along with autoimmune have important role regarding this disease. In Amavata, due to impaired functioning of 'Kayagni' the anna-rasa undergoes fermentation resulted formation of ama (biotoxin) which combines with vitiated Vata (biophysical force for movement) to form Amavata.(1) So, two important entities one is toxin and other is movement, when comes together kha vaigunya concept the disease formed which is worst one. That’s why swelling, severe pain, and restricted movements are the main features of Amavata. Severe pain, difficulty in movements, and swelling on the joints along with fever etc makes the patient’s life miserable. Although Ama and Vata are chiefly pathogenic factors, Kapha and Pitta are also invariably involved in its pathogenesis (Samprapti). The therapeutic approach should be on Vata dosha, Kapha dosha and correction of Amadosha and of Agni viz. Pitta. The line of treatment for amavata also includes langhanam, swedanam, tiktam, deepana, katu drugs and sodhana treatment like virechana, basti etc. The shamana drugs which are having Vatashamaka, Amapachaka, Ama Shoshaka, and Deepniya properties can be used in the treatment of this disease. Vatari Guggulu and Brihat simhanada guggulu carries indication for Amavata according to Bhaisajya Ratnavali. The compositions in it are approachable lieu of principles of treatment of Amavata. The clinical research shows that in TG I, 7 (46.67%) patients were got Moderate im-provement while 8 (53.33%) patients were got Mild improvement. In TG II 10 (66.67%) patients were get Moderate improvement while 5 (33.33%) patients were got Mild improvement.

Osteoarthritis, osteoarthrosis and osteoarthropathy: What is the difference?

Osteoarthritis, osteoarthrosis, and osteoarthropathy are diseases that doctors encounter daily in their practice. The use of all three terms is customary, often without a clear justification as to why a particular term is used for a particular case. In the past several decades, doctors mainly differentiated among these diseases based on clinical presentation and radiography. In the past several years, however, significant progress has been made in the field of biochemical, immunological, and cytohistological research, which has provided explanations for the pathogenesis of these conditions, enabled defining differences amongst them and facilitated the use of appropriate terms for each one of these diseases. The term arthritis (osteoarthritis) should be used exclusively for primarily inflammatory joint diseases-rheumatoid arthritis, juvenile arthritis, reactive arthritis (Reiter's syndrome). If the etiology is infectious, this must also be emphasized-septic (purulent) arthritis, tuberculous arthritis. Arthrosis (osteoarthrosis) relates to changes in the joints occurring due to pathological processes within the joint itself, but which, in their basis, are not inflammatory. Arthropathy is a term for joint disease stemming from another diseased organ or system of organs.