Fondation Arthritis

BackgroundLow back pain is a major public health problem that is increasing with the aging of the population. It is the leading cause of disability in most countries [1]. The recommendations of Inserm (2019) include personalized physical activity programs according to the individual characteristics (motivation, preferences, attitude towards physical activity) and life context of each patient (family and professional load, socioeconomic level, living place) [2]. However, the current management of chronic low back pain includes rehabilitation programs that are costly and/or not always personalized, which reduces their effectiveness.ObjectivesThe objective of this research is to better understand the characteristics of people with chronic low back pain to identify main motivational profiles that will allow us to offer personalized coaching via a mobile application.MethodsAfter a review of the literature and following advice from experts in the management of chronic low back pain, we selected 8 scales to characterize patients: General Health Status (MYMOP), Treatment Burden (TBQ), Quality of Life (EQ-5D-5L), Level (IPAQ), Fears and Beliefs (FABQ-AP), and Motivation (EMAPS) for physical activity, Emotional Status (PHQ-9), and Sense of Self-Efficacy (FC-CPSES). These questionnaires were administered online to participants in the ComPaRe (Community of Patients for Research) chronic low back pain cohort. An initial descriptive analysis of the results allowed us to describe our sample. In order to distinguish different motivational profiles of patients towards physical activity, we performed a Agglomerative Hierarchical Clustering (AHC) and a principal component analysis (PCA) of the results of the EMAPS, PHQ-9, FABQ-AP and FC-CPSES scales.ResultsA total of 193 patients with chronic low back pain were included (m ≃ 54years, s ≃ 13years; majority women (74%); duration of low back pain: m ≃ 15years, s ≃ 12years; occupational status: 44% employed, 22% on disability, 19% retired). Clustering analysis allowed us to distinguish 4 main profiles that we named as follows: (1) “Amotivated,” characterized by the lowest motivation and highest amotivation toward physical activity (i.e. they do not understand why it is useful), (2) “Cautious” with low motivation and having the highest fears and beliefs toward physical activity, (3) “Depressed” with good intrinsic motivation but also a significant level of depressive symptoms, and (4) “Confident” also showing good intrinsic motivation and having the highest sense of self-efficacy.ConclusionThe main novelty of this research is a new classification of 4 motivational profiles in the low back pain population determined by a clustering method. This typology is in line with the HAPA model of behavior change [3]. It will allow us to make recommendations for the design of a personalized mobile coaching application. Future work will aim to test and evaluate the personalization of e-coaching according to these profiles.

Career situation of first and presenting authorStudent for a master or a PhD.IntroductionPrimary Sjögren’s syndrome (pSS) is a chronic auto-immune disorder characterized by lymphocytic infiltrates and destruction of the salivary glands (SG). Chronic B cell activation, the secretion of autoantibodies and the critical role of BAFF have been demonstrated. However, mechanisms leading to B cells dysregulation remain partially understood.ObjectivesTo establish transcriptomic maps of the B cells sorted from the SG and from blood in pSS patients and controls using RNASeq.MethodsPatients had pSS according to 2016 EULAR/ACR criteria and controls had sicca symptoms without any antibodies and with normal SG biopsy. B cells were sorted from SG biopsies and from blood using a FACS ARIA. RNASeq profiling was performed using MiSeq. Statistical analysis identified differentially expressed genes between pSS and controls in B cells sorted from SG (9 pSS, 4 controls), from blood (16 pSS, 7 controls); and between B cells sorted from SG and blood in the same patients (4 pSS patients). Functional enrichment analysis used Ingenuity Pathway Analysis.ResultsThe pSS vs controls comparison in B cells sorted from SG identified up-regulated genes involved in activation of B cells including CD48, CD22 and CD40. TLR10, which is involved in innate immunity was also up-regulated in pSS.In blood B cells, TLR7 and the downstream signaling molecule IRF7 were up-regulated in pSS. Additionally, IL-6 which is involved in B cells growth was up-regulated. Enrichment analysis highlighted EIF2 signaling pathway, interferon (IFN) signaling pathway and role of JAK in IFN signaling.The paired comparison between B cells from SG and from blood identified up-regulated genes including CD138, a plasma cell marker, IL-6, TLR5 and IFN induced genes.The confirmation by qPCR of these results is ongoing.ConclusionsThis study allowed to explore the mechanisms that support B cell activation in pSS focusing on tissue resident and circulating cells. Data confirmed B cell activation and differentiation through several markers and highlighted the role of innate immunity and key pathways including IFN and JAK signaling. Precise understanding of these dysregulations should offer development of new targeted therapeutic perspectives.Disclosure of InterestNone declared.