M. Slouma

Cutaneous and pleural involvement in a patient with multiple myeloma.

Multiple myeloma (MM) is a malignant proliferation of a single clone of plasma cells and an excess of monoclonal immunoglobulin production. It is rarely associated with cutaneous and pleural involvement. We report a new case of a 62-year-old woman with a history of a symptomatic MM. Three months after chemotherapy initiation, she presented with subcutaneous nodules. Ultrasound-guided needle biopsy confirmed the diagnosis of cutaneous plasmacytomas. She underwent local radiation therapy leading to complete regression of subcutaneous nodules. One month later, she developed dyspnoea. Thoracic CT scan showed pleural thickening associated with pleural effusion. Pleural biopsy confirmed the diagnosis of pleural plasmacytoma. Chemotherapy including vincristine, doxorubicin and dexamethasone was administered. Cutaneous involvement and pleural effusion accompanying MM are uncommon. They are associated with poor prognosis.

Retinal vasculitis: a novel paradoxical effect of anti-TNFα?

Retinal vasculitis (RV) is extremely rare in spondyloarthritis associated with Crohns disease. Infliximab, a chimeric monoclonal antibody to tumour necrosis factor (TNF) α, is efficient in spondyloarthritis, Crohns disease and RV. We present the case of a 41-year-old man with a known history of spondyloarthritis associated with Crohn’s disease. He was under treatment with infliximab. Four days after his 12th infusion of infliximab, he presented with sudden blurred vision. Although his disease was in remission, ophthalmological examination revealed bilateral peripheral retinal occlusive vasculitis. The patient responded positively to the treatment by laser photocoagulation and peribulbar corticosteroid injection. Infliximab was not stopped. There was improvement in his eye disease. To the best of our knowledge, this is the first case of new onset of RV occurring under infliximab in a patient with Crohns related spondyloarthritis. This case illustrates the possibility of a paradoxical effect of this kind of therapy.

Renal cell carcinoma: an unusual case of sclerotic metastasis.

A 44-year-old man presented with a 3-month history of low back pain affecting mainly the left lumbar and gluteal regions. Physical examination revealed restricted back movement with tenderness over lumbar spinal processes. Straight leg raising test was negative. Laboratory examinations showed an elevated erythrocyte sedimentation rate (ESR; 116 mm) and a high level of alkaline phosphatase (1000 IU/L). Serum levels of calcium, albumin and phosphorus were within the normal range. The pelvis and …

AB0988 Effect of Football on Knee Cartilage Thickness: an Ultrasonographic Assessment

Background The effect of physical activity on Knee joint especially the cartilage is unclear. Objectives The aim of the study was to assess the ultrasonographic thickness measurements of knee cartilage in asymptomatic soccer players (SP) compared to sedentary controls. Methods A prospective comparative study including 28 males divided into 2 groups: (1) asymptomatic SP recruited from sporting clubs and (2) control group that had never been physically active on a regular basis. Ultrasonography (Esaote MyLab 60 machine and a 13 MHz linear array transducer) was performed on knee joints by a rheumatologist with theoretical and practical training in musculoskeletal ultrasonography and blinded to the identity of subject. With subjects sitting in a comfortable position on the examination table with their knees in maximum flexion, the probe was placed in an axial position on the suprapatellar area. The distal femoral cartilage was visualized as a strongly anechoic structure between the sharp bony cortex and the suprapatellar fat. Three (mid-point) measurements were taken from each knee: the right lateral condyle (RLC), the right intercondylar area (RIA), the right medial condyle (RMC), the left medial condyle (LMC), the left intercondylar area (LIA), and the left lateral condyle (LLC). Both statistical and descriptive analyses were performed. Results Fifteen SP and 13 healthy controls were enrolled. The mean age was 17±0.55 years in SP group and 17±2.23 years in control group. There were no statistically significant differences between the two groups in age. No history of fracture, surgical intervention or immobilization of the knee was noted in the 2 groups. All SP had practiced sports since the age of 10±1.98 years. The number of hours of training was 10±1 hour weekly. The number of participating to competition was 30.86±7.95 yearly. Matches have been played on synthetic turf soccer fields using soccer shoes with plastic cleats in all cases. Physical examination revealed genu varus in 12 cases in SP group versus 6 cases in control group (p<0.005). No ligament instability was found in all cases. In control group cartilage thickness in different sites was: RIA, RMC, LMC, RLC and LLC were 3.32±0.48 mm, 2.61±0.55 mm, 2.59±0.37 mm, 2.6±0.58 mm and 2.7±0.64 mm respectively. RIA, RMC, LMC, RLC and LLC were 3.72±0.64 mm, 2.68±0.32 mm, 2.84±0.45 mm, 2.83±0.45 mm and 2.89±0.39 mm respectively. The cartilage was thicker in SP group in the three sites (p>0.05). The median cartilage thickness in LIA was 3.2±0.55 mm in the group control versus 3.82±0.57 mm in the SP, the difference was statistically significant (p=0.007) Conclusions Our study showed that cartilage thickness can be increased in response to sport especially soccer. Thus, physical activity is associated with an increase in cartilage thickness suggesting that soccer can exert a chondroprotective effect when compared to a sedentary lifestyle. Given that optimizing cartilage health is important in preventing osteoarthritis, these findings indicate that physical activity is beneficial to joint. Our study is consistent with previous study showing a positive relationship between physical activity and tibial cartilage volume. References Donna M. Urquhart, Jephtah F. L. Tobing et al. What is the Effect of Physical Activity on the Knee Joint? Med Sci Sports Exerc. 2011;43(3):432-442. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5362

THU0293 Characteristics of Infectious Spndylodiscitis in Rheumatology

Background Infectious spondylodiscitis is characterized by infection involving the intervertebral disc and adjacent vertebrae. Smaller studies indicate that the incidence of spondylodiscitis is increasing, possible related to expanding elderly and immunocompromised populations, the increasing use of invasive spinal procedures and the use of immunosuppressive therapies. Objectives The aim of this study is to determine the epidemiological, clinical, radiological and bacteriological characteristics of spondylodiscitis in Tunisia. Methods A retrospective study including patients diagnosed as spondylodiscitis in the Rheumatology department between 1995 and 2013. The diagnosis was established basing on bacteriological features or a set of presumption arguments. Results Forty one patients are included in this study. There were 21 males and 20 females. The mean age was 61.66 years, ranged from 25 to 89 years. Predisposing factors were found in 17 patients (41%): diabetes in 8 cases, long-term corticosteroid for chronic inflammatory rheumatism in 4 cases, cirrhosis in 2 cases and chronic renal failure in 3 cases. Duration of symptoms varied from 20 to 90 days. All patients presented with back pain. Fever was noted in 38 cases. A neurological deficit was noted in 7 patients. An increase of erythrocytes sedimentation rate and C-reactive protein was noted in 87% of cases (n=36). Spine X-ray showed a disc space narrowing and irregularity of the end-plates in 39 cases. Lumbar region was the most common infection sites (58%) followed by dorsal spine (32%) and cervical spine (10%). A multi stage spondylodiscitis was found in 4 cases. Only 27 patients had MRI showing epiduritis in 12 patients and paravertebral abscess in 8 patients. Spndylodiscitis was associated with a septic arthritis in one case and Tuberculosis spondylodiscitis was associated with hepatic tuberculosis in another case. The causative microorganism was identified in 25 cases (61%): staphylococcuc in 4 cases, Gram negative germ in 5 cases, streptococcus in 3 cases, mycobacterium tuberculosis in 12 cases and brucella in 4 cases. Multi-bacterial spondylodiscitis was found in 2 patients. All patients underwent initially adapted antibiotics and immobilization leading to recovery in 73% of cases (n=30). Seven patients were lost during follow up. Neurological complication occurred in 3 cases and sepsis in 1 case. Conclusions Infectious spondylodiscitis necessitate a high index of suspicion in a patient presenting with significant back pain and laboratory evidence of an acute inflammatory process. The diagnosis is based on symptoms, clinical findings, and imaging and laboratory results. MRI remains the most sensitive radiological examination for early detection of spondylodiscitis. Identifying the germ incriminated in infectious spondylodiscitis is imperative. Early diagnosis is necessary to avoid life threatening complications and neurological squeals. References Lucy Cottle, Terry Riordan. Infectious spondylodiscitis. Journal of Infection 2008; 56: 401–412 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5428