A Yoga Exercise App designed for Patients with Axial Spondylarthritis: a development and user experience study (Preprint)

BACKGROUND Besides anti-inflammatory medication, physical exercise represents a cornerstone of modern treatment for patients with Axial Spondylarthritis (AS). Digital health applications (DHA) like the Yoga App "YogiTherapy" could empower patients to autonomously and correctly perform exercises remotely. OBJECTIVE This study aimed to develop, design, and test the usability of the smartphone-based app YogiTherapy for patients with Axial Spondylarthritis. METHODS The development of the app and the user experience study took place between October 2020 and March 2021. The DHA was designed by students, rheumatologists, and AS patients. After the initial development process, a pilot version of the app was evaluated prospectively by 5 patients and 5 rheumatologists. Participants had to complete different predefined tasks using the app. Then the competition rate and the experience questionnaire (Attractiveness, Perspicuity, Efficiency, Dependability, Stimulation, and Novelty) were finalized by patients. RESULTS The results of the post-test questionnaires showed that the majority of the patient group was already familiar with digital applications (80 % of the patients). The task completion rate of the usability test was 100 % in tasks i and ii, which included selecting and starting a yoga lesson and navigating to an information page. Rheumatologists felt even more experienced in digital devices (40 % experts, 60 % intermediates). In this case, the task completion rate of the usability test was 100 % (5 /5). In the user experience questionnaire completed by rheumatologists, attractiveness (2.267 SD 0.401) and stimulation (2.250 SD 0.354) achieved the best results compared to dependability (2.00 SD 0.395). Patients reported attractiveness with 2.167 SD 0.565 and stimulation with 1.950 SD 0.873. The lowest mean score was scaled for perspicuity (1.250 SD 1.425). CONCLUSIONS The newly developed and tested DHA YogiTherapy demonstrated high usability among rheumatologists and AS patients, suggesting simple implementation into clinical routine care. The app might potentially be used by patients with AS as a complementary treatment. Prospective trials are needed to prove the benefit of the app.

MicroRNAs in Axial Spondylarthritis: an Overview of the Recent Progresses in the Field with a Focus on Ankylosing Spondylitis and Psoriatic Arthritis

Purpose of Review To highlight the recent discoveries and lines of evidence on the role of microRNAs in ankylosing spondylitis (AS) and psoriatic arthritis (PsA), focusing on their expression profiling and mechanisms of action. Recent Findings AS and PsA are chronic inflammatory musculoskeletal diseases with axial manifestations and represent an excellent model for studying microRNAs contribution to the disease pathogenesis, particularly through immunomodulation, inflammation, and bone remodelling, or their value as candidate diagnostic and prognostic biomarkers. Summary MicroRNAs are single-stranded nucleotides able to regulate gene expression. They are a key component of the epigenetic machinery, involved in physiological and pathological processes. The contribution of microRNAs in AS and PsA (such as miR-29a in regulating bone metabolism) is highlighted by several works in the field but their utility as possible markers must be still confirmed, particularly in larger patients’ cohorts.

AB0074 NO DIFFERENCE BETWEEN THE SEROLOGIES OF DENTAL GERMS AND THE PHENOTYPES OF SPONDYLOARTHRITIS WITHIN THE DESIR COHORT

Background:Porphyromonas gingivalis (PG) and Prevotella Intermedia (PI) are two oral pathogens involved in the pathophysiology of chronic periodontopathies. Several studies have determined a role of these periodontal pathologies in the pathophysiology of rheumatoid arthritis (1) while the link with spondyloarthritis is not clearly established with currently contradictory studies (2,3,4).Objectives:The purpose of this work is to investigate a link between spondylarthritis and the presence of chronic periodontopathy evaluated by PG and IP serologies.Methods:The positivity and quantity of anti-PG and anti-PI antibodies were determined by ELISA method in patients from the DESIR cohort with one of the spondyloarthritis phenotypes compared to patients with common low back pain (n=50) (population control). Patients with spondyloarthritis were classified according to the following phenotypes (diagnosis chosen at 3 years in the DESIR cohort): axial spondylarthritis (n=126), psoriatic rheumatism (n=101), spondyloarthritis associated with chronic inflammatory bowel disease (n=36), undifferentiated spondylitis (n=241), reactive arthritis (n=2), SAPHO (acronym for Synovite, Acne, Pustulose, Hyperostosis and Osteitis. Correlations between patients’ serological status, and smoking status, body mass index and age were sought.Results:According to the general characteristics, the control group was significantly older than the axial spondylarthritis (p<0.001), and the psoriatic rheumatism group had a higher body mass index than the control population (p<0.05). The positivity and concentration of anti-PG and anti-PI antibodies were similar between different groups of spondyloarthritis compared to the control group. However, the subgroups “reactive arthritis” and “SAPHO” could not be analyzed due to insufficient staffing. Smoking status and body mass index were not related to antibody concentrations, however there was a statistical correlation between anti-PG antibody concentrations and age. After adjusting on age, there was no difference between the axial spondylarthritis and control groups.Conclusion:Our results therefore suggest the absence of a link between periodontal germs involved in chronic periodontopathies and spondyloarthritis, provided that the two phenotypes involving germs in their pathophysiology could not be analyzed. Our results from a population of beginner spondylitis are therefore not in favour of the involvement of oral flora in the pathophysiology of spondyloarthritis, as is the case in rheumatoid arthritis (1). The associations found previously could therefore be favoured by a systemic inflammatory phenomenon. In conclusion, our study suggests no link between chronic periodontopathy and the occurrence of spondyloarthritis. However, the effect of chronic periodontopathy on the evolution of spondylarthritis remains to be explored.References:[1]Detert J, Pischon N, Burmester GR, Buttgereit F. The association between rheumatoid arthritis and periodontal disease. Arthritis Res Ther. 2010;12(5):218.[2]Ratz T, Dean LE, Atzeni F, Reeks C, Macfarlane GJ, Macfarlane TV. A possible link between ankylosing spondylitis and periodontitis: a systematic review and meta-analysis. Rheumatology. 2015;54(3):500-10.[3]Pischon N, Pischon T, Gülmez E, Kröger J, Purucker P, Kleber B-M, et al. Periodontal disease in patients with ankylosing spondylitis. Ann Rheum Dis. janv 2010;69(01):34-8.[4]Sezer U, Erciyas K, Pehlivan Y, Üstün K, Tarakçioğlu M, Şenyurt SZ, et al. Serum cytokine levels and periodontal parameters in ankylosing spondylitis: Ankylosing spondylitis and periodontal diseases. J Periodontal Res. juin 2012;47(3):396-401.Disclosure of Interests:None declared

Bifocal Tuberculosis with Adalimumab Revealed by Laryngeal Involvement: Case Report

Introduction. Anti-TNF treatment has transformed the treatment of chronic inflammatory rheumatism. Although the therapy can be highly effective, anti-TNF drugs are associated with an increased risk of tuberculosis, especially extra-pulmonary tuberculosis. Laryngeal tuberculosis is rare and its symptoms are not specific. Laryngeal tuberculosis is often secondary to another localization, particularly pulmonary. In the use of anti-TNF therapy, its development is unusual. Case report. We report a case of bifocal tuberculosis: laryngeal and pulmonary tuberculosis revealed by laryngeal involvement in a patient aged 41 years with axial spondylarthritis treated with Adalimumab. Conclusion. This presentation highlights the importance to consider the rare possibility of laryngeal tuberculosis in the presence of atypical otorhinolaryngologic signs under anti-TNF therapy and underlines the importance of looking for other tuberculosis involvement.

Interleukin-17A Interweaves the Skeletal and Immune Systems

The complex crosstalk between the immune and the skeletal systems plays an indispensable role in the maintenance of skeletal homeostasis. Various cytokines are involved, including interleukin (IL)-17A. A variety of immune and inflammatory cells produces IL-17A, especially Th17 cells, a subtype of CD4+ T cells. IL-17A orchestrates diverse inflammatory and immune processes. IL-17A induces direct and indirect effects on osteoclasts. The dual role of IL-17A on osteoclasts partly depends on its concentrations and interactions with other factors. Interestingly, IL-17A exerts a dual role in osteoblasts in vitro. IL-17A is a bone-destroying cytokine in numerous immune-mediated bone diseases including postmenopausal osteoporosis (PMOP), rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). This review will summarize and discuss the pathophysiological roles of IL-17A on the skeletal system and its potential strategies for application in immune-mediated bone diseases.