Multiple Undifferentiated Pleomorphic Sarcoma (Malignant Fibrous Histiocytoma) with Extradural Involvement in a 7-Year-Old Labrador Retriever

A 7-year-old castrated male Labrador retriever was referred for evaluation of progressive hind limb paresis of 4 weeks’ duration. On computed tomography and magnetic resonance imaging examination, masses were found in several regions including the lung, right kidney, and peritoneum. Additionally, an extradural mass at the region of T13–L1 was identified, which is assumed to related to the chief complaint, progressive hind limb paresis. With the consent of the owner, a dorsal laminectomy was performed to remove the mass and surrounding tissues for the palliation of the hind limb paresis. Hematoxylin and eosin staining and immunohistochemical examination revealed the mass to be consistent with an undifferentiated (high-grade) pleomorphic sarcoma. The patient presented with recurrence of the hind limb paresis, respiratory discomfort, and urinary incontinence. The owner declined treatment and the dog was euthanized. Systemic metastasis was confirmed on postmortem microscopic examination. To the authors’ knowledge, this is the first report describing multiple undifferentiated high-grade pleomorphic sarcoma with extradural involvement developing into the vertebral canal through the intervertebral space, resulting in spinal damage, in a dog.

Potential disease trigger as a therapeutic option: infliximab for paradoxical reaction in tuberculosis of the central nervous system

A 36-year-old man of central Asian origin was diagnosed with subacute disseminated tuberculosis. Initially, central nervous system involvement was suggested by an encephalopathic condition and MRI showing extensive basal and spinal meningitis. After initiation of anti-tuberculosis drugs and corticosteroid therapy, clinical and radiological deterioration of spinal damage was noted. We interpreted this in the context of a paradoxical reaction, which is suggested to be an overshooting inflammatory response after reconstitution of the immune system. Despite increased dosage of corticosteroids, a gradual worsening of gait ataxia over several weeks was noted. After administration of infliximab, the patient’s condition progressively improved.

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years’ experience from a single center in Turkey

Background The aim of our study was to describe musculoskeletal system tuberculosis (TB) as a single-center experience. Methods This is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max). Results Overall, 31 patients (3.2 % of all TB cases) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of treatment was 12.9 ± 5.5 months. Of the 31 patients, six (19.4 %) had concomitant pulmonary TB. One of the patients was in the pediatrics age group, and two of them were in the geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9 %). Conclusions The physicians should be suspicious about the diagnosis of musculoskeletal TB disease. If the diagnosis and treatment are delayed, spinal damage and other consequences might be incurable.

POS0033 IN RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS, BRIDGING SYNDESMOPHYTES INCREASE RISK OF FACET JOINT ANKYLOSIS ON THE SAME VERTEBRAL LEVEL WHILE FACET JOINT ANKYLOSIS DOES NOT INCREASE RISK OF SAME LEVEL SYNDESMOPHYTES

Background:In radiographic axial spondyloarthritis (r-axSpA), spinal damage manifests as syndesmophytes and facet joint ankylosis (FJA).Objectives:Explore whether syndesmophytes and FJA seem to have a preferential order of development.Methods:Data were used from the Sensitive Imaging in Ankylosing Spondylitis cohort from Leiden and Herne. Patients underwent low-dose Computed Tomography (ldCT) at baseline and two-years. LdCT images were scored independently by two trained readers. Vertebrae were scored according to the Computed Tomography Syndesmophyte Score (CTSS) for presence and size of syndesmophytes; facet joints were scored as not-ankylosed and ankylosed. Analyses were performed on the vertebral unit (VU) level and using individual-reader data (Figure 1). Two hypotheses were tested: 1) presence of bridging syndesmophyte(s) is associated with FJA on the same VU two years later, and 2) presence of FJA is associated with syndesmophyte(s) on the same VU two years later. Generalized Estimating Equations (GEE) models were used to take into account the correlations between VUs from the same patient and adjusting for reader to account for individual reader scores. Two models were tested per hypothesis using different outcomes. Model 1 uses the presence of syndesmophytes or FJA as outcome adjusting for the outcome at baseline. Model 2 uses development of new syndesmophytes or FJA at two years plus an increase in the number of syndesmophytes or FJA.Results:In total, 50 patients were included (mean age 49, 84% male, 82% HLA-B27+). At baseline, there was a higher percentage of bridging syndesmophytes (range: 10-60%) than FJA (range: 8-36%) considering all VUs and both readers (Figure 1). In both models, presence of bridging syndesmophytes was associated with development of FJA two years later (OR (95%CI) Model 1: 3.35 (2.18-5.14); Model 2: 2.23 (1.19-4.16)) while presence of FJA at baseline did not have a statistically significant association with development of syndesmophytes two years later (Table 1).Conclusion:The data showed a higher occurrence of bridging syndesmophytes than FJA at baseline and showed significantly increased odds to develop FJA when bridging syndesmophyte(s) are present on the same VU two years prior. This mechanism did not hold true for the other direction. These results cautiously imply that bridging syndesmophytes precede FJA, rather than FJA preceding syndesmophytes.Figure 1.Percentage of occurrence of syndesmophytes and facet joint ankylosis per vertebral unit and per reader at baseline.Figure 1 displaying percentages of patients with a bridging syndesmophyte and with facet joint ankylosis at baseline, per reader. The image on the left illustrates the vertebral unit level (VU) at which analyses were performed. Seven VUs are illustrated in dashed boxes as example. Synd, syndesmophyte; FJA, facet joint ankylosis; BL, baseline.Table 1.Associations between facet joint ankylosis and syndesmophytesModel 1: development of new FJA/syndesmophytes at FUOR (95% CI)Model 2: development and/or increase FJA/syndesmophytes at FUOR (95% CI)Hypothesis 1Presence bridging syndesmophytes at BL on development of FJA at FU3.35 (2.18-5.14)2.23 (1.19-4.16)Hypothesis 2Presence FJA at BL on development of syndesmophytes at FU1.60 (0.88-2.91)1.12 (0.76-1.66)Disclosure of Interests:None declared.

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years’ experience from single center in Turkey

Background The aim of our study was to elaborate musculoskeletal system TB (tuberculosis) as a single-center experience. Methods This is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max). Results Overall, 31 patients (3.2%) (14 males, 17 females) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of disease was 12.9 ± 5.5 months. Of the 31 patients, six (19.4%) had concomitant pulmonary TB. One of the patients (3.2%) was in paediatrics age group, and two of them (6.4%) were in geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9%). Conclusions The physicians should be suspicious about the diagnosis of musculoskeletal TB infection. If the diagnosis and treatment is delayed, spinal damage and other consequences might be incurable.

Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review

Purpose Spinal collars were introduced in 1967 into the management of spinal trauma care as it was thought that this technique of immobilisation would prevent any further neurological or spinal damage in high-risk patients. The aim of this systematic review was to determine whether the use of spinal collars in the pre-hospital trauma patient was recommended by published literature. Methods A systematic search of the literature was conducted between 1990 and 2020, screening PubMed, Medline, Science Direct and Google Scholar. The consequent findings were then qualitatively synthesised with the aim of effectively evaluating the evidence to resolve the discrepancy between current practice and literature. Results Of the nine eligible studies, six deemed that spinal collars should not be used in pre-hospital trauma patients with the remaining three reporting uncertainty if spinal collars were best practice. Our results suggest that there is a discrepancy between current guidance and practice in that although the guidelines recommend the use of spinal collars in the pre-hospital setting the majority of the studies were against the use of spinal collars. Importantly, none of the studies reported any benefits of spinal collars. Conclusion Our study shows a disparity between current guidelines and the published literature and warrants further direct research to obtain a more comprehensive view of the use of spinal collars in a pre-hospital setting.

OP0076 CLINICAL DISEASE ACTIVITY, MRI SPINAL INFLAMMATION AND ENTHESITIS ARE KEY DETERMINANTS OF IMPAIRMENT OF SPINAL MOBILITY IN EARLY AXIAL SPONDYLOARTHRITIS – DATA FROM THE DESIR COHORT

Background:It has been shown that spinal mobility impairment in axial spondyloarthritis (axSpA) is independently determined both by irreversible spinal damage and by reversible spinal inflammation. However, these relationships have only been investigated in patients with longstanding disease (ankylosing spondylitis). Moreover, only the composite score Bath Ankylosing Spondylitis Metrology Index (BASMI) has been evaluated rather than individual mobility assessments.Objectives:Our aim was to investigate the determinants of spinal mobility in patients with early axSpA.Methods:We analysed longitudinal data from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort, collected during the first five years of follow-up. We selected patients with a definite diagnosis of axSpA according to the treating rheumatologist, at the end of follow-up (month 60). Associations were tested using generalised estimating equations (GEE), a multilevel approach that adjusts for within-patient correlation. The Bath Ankylosing Spondylitis Metrology Index (BASMI) or the individual components of BASMI (lateral spinal flexion, tragus-to-wall distance, cervical rotation, anterior lumbar flexion, maximal intermalleolar distance) were used as dependent variables, and clinical and demographic variables were used as independent variables in univariable models. Spinal MRI inflammation was assessed using the Berlin scoring system and radiographic structural damage was assessed using the modified Stoke ankylosing spondylitis spinal score (mSASSS)]. As physical function and quality of life are considered to be hierarchically superior to spinal mobility, they were not included in the analysis. Multivariable models were built, adjusting for potential confounding. Variables with a p-value <0.10 were re-tested in the multivariable models. Six models were built, one regarding the BASMI total score and five regarding the individual components of BASMI.Results:Data from 644 patients and 5152 visits were analysed. In the multivariable analyses (table), we found an independent association between higher BASMI values and age [adjusted B (aB)=1.02, confidence interval (CI)=1.01-1.03], Ankylosing Spondylitis Disease Activity Score-C Reactive Protein (ASDAS-CRP) (aB=1.23, CI=1.15-1.32), enthesitis score (aB=1.02, CI=1.01-1.04) and MRI inflammation score (aB=1.13, CI=1.05-1.23). All individual BASMI components were independently associated with ASDAS-CRP. Apart from maximal intermalleolar distance, all other mobility measures were associated with MRI spinal inflammation. Lateral spinal flexion, cervical rotation and maximal intermalleolar distance were associated with the enthesitis score. mSASSS was associated with lateral spinal flexion and a contributory factor to tragus-to-wall distance and cervical rotation.Conclusion:In early axSpA, spinal mobility impairment is independently determined by clinical disease activity, MRI spinal inflammation and the severity of enthesitis. Maximal intermalleolar distance (which is not a true measure of spinal mobility) was the only measure not associated with MRI spinal inflammation. The influence of spinal inflammation prevails in the early phase of axSpA while spinal damage becomes more relevant in later disease stages.References:None.Disclosure of Interests:Pedro Carvalho: None declared, Ana Marreiros: None declared, Joao Eurico Fonseca: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Pedro M Machado Consultant of: PMM: Abbvie, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Speakers bureau: PMM: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB

Electrofishing eel, salmon and trout: impact of waveform and frequency on capture-per-unit-effort and spinal damage

Performing fish survey protocols with different electrofishing equipment and settings can lead to difficulties in comparing the data obtained. In this study, we captured two fish taxa (i.e. the European eel and salmonids: Atlantic salmon and brown trout) in the field using four models of electrofishers that provided different waveforms: direct current (DC), pulsed direct current (PDC) and pulsed exponential current (PEC). This study aimed to assess effects of using different waveforms and frequencies, while considering environmental variables, on i) attraction, represented by occurrence and catch-per-unit-effort (CPUE) of fishes, and ii) spinal damage, based on ultrasound of the spinal column. For all species, DC and PDC yielded equivalent occurrences and CPUEs, regardless of the frequency. In contrast, PEC induced a significant decrease in occurrences and CPUEs of both eels and salmonids. The percentage of injured fishes increased as the frequency or length of the salmonids increased while waveform had no effect. Ultrasound was determined to be a good non-invasive method to detect injuries in fishes.

Axial spondyloarthritis in women: differences in disease onset, clinical presentation, and disease activity and functional indices

Background: Axial spondyloarthritis (axSpA) is frequent a group of chronic inflammatory disorders that predominantly affects the axial skeleton. It seems to occur more often in males than in females. There are gender differences in clinical presentation of axSpA. Women tend to have milder disease and may therefore be underdiagnosed. Male axSpA patients are more likely to develop radiographic spinal damage. Materials and Methods: A cross sectional study was conducted, during the period between January 2012 and December 2017, in a single rheumatology department in Morocco. In total, our study included patients with axial spondyloarthritis fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria 2010. The data was recorded and compared for both bivariate and multivariate analysis. Objective: The aim of our study is to demonstrate the particularities of female axial spondyloarthritis in comparison to the male form. Results: In total, 277 patients were included of which 147 were female and 130 were male. In fact, women were older (46 vs 35; p &amp;lt;0.001), had more arthritisis than enthesitis ( respectivally 63.3% vs 36.7% ; p = 0.01 et 59% vs 41%; p = 0.045). There were no significant differences in prevalence of extra-articular manifestations, disease activity (BASDAI) nor BASFI. Multivariate logistic regression analysis suggested that female sex was associated with a greater age at presentation, (IC: 1,053-1,103, OR=1,07, p&amp;lt;0,001), and arthritis (IC: 2,37-4,26, OR=2,3, p=0.004). Conclusion : Comparison between male and female patients suffering from axial spondyloarthritis found differences and similarities in the disease expression. This study showed that women had less severe forms of spondyloarthitis.

MANUAL MATERIAL HANDLING IN THE ‘KARUNG’ LIFTING PROCESS USING BIOMECHANIC AND PHYSIOLOGI APPROACH

This study was aimed at minimizing musculoskeletal disorder (MSDs) in heavers on traditional markets by completing facilities and improving lifting techniques that are in accordance with ergonomic aspects. This research was conducted in traditional markets with heaver objects which are often carried out in the process of moving goods. This study used biomechanics and physiology methods to be able to analyze body posture so that it can prevent spinal damage. The data were then analyzed using Maximum Permissible Limit (MPL), which previously carried out data collection on the size of the body posture. The analysis of the results was done to determine the value of the compression force (FC). FC values are the basis for comparison with Action Limit (AL). The results show that FC values = 10,018,078N, FC> MPL. Importantly, the position of the heavers’ posture is at a dangerous level. Proposed improvements using a tool and after being developed again will result in changes in FC values to 3370.94, FC <AL means the position of the body in a safe condition. The results of this study are expected to provide an assessment that helps prevent spinal damage.MANUAL MATERIAL HANDLING PADA PROSES PENGANGKATAN KARUNG MENGGUNAKAN PENDEKATAN BIOMEKANIKA DAN FISIOLOGI Penelitian ini bertujuan untuk meminimumkan keluhan Musculoskeletal disorder (MSDs) pada pekerja kuli panggul di pasar tradisional dengan merancang fasilitas dan memperbaiki teknik memindahkan barang yang sesuai dengan aspek ergonomis. Penelitian ini dilakukan di pasar tradisional dengan objek kuli panggul yang sering melakukan proses pemindahan barang. Penelitian ini menggunakan metode pendekatan biomekanika dan fisiologi untuk dapat menganalisis postur tubuh sehingga dapat mencegah cedera tulang belakang. Data kemudian dianalisa menggunakan Maximum Permissible Limit (MPL) yang sebelumnya dilakukan pengambilan data ukuran postur tubuh pekerja tersebut. Analisis hasil dari perhitungan dilakukan untuk mengetahui nilai dari force compresion (FC). Nilai FC menjadi dasar untuk dibandingkan dengan Action Limit (AL). Hasil dari analisa didapat nilai FC = 10.018,078N, FC>MPL. Artinya, posisi postur tubuh pekerja dalam level berbahaya. Usulan perbaikan dengan menggunakan alat bantu dan setelah dianalisis kembali maka akan menghasilkan perubahan nilai FC menjadi 3370,94; FC< AL artinya posisi tubuh dalam keadaan aman. Hasil penelitian ini diharapkan dapat memberikan rekomendasi alat bantu sehingga dapat mencegah cedera tulang belakang.