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Introduction: the aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment. Methods: cross- sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized. Results: a total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti- TNF in 3rd position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type. Conclusion: our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono- therapy in RA patients. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Objective. We conducted a telephonic survey to determine the prevalence of chronic pain with neuropathic characteristics (NC) in the Moroccan general population. Design. We performed a large nationwide tele-phonic survey based upon a random sampling of households in the 16 administrative regions of Morocco to determine the prevalence of chronic pain with NC in the general population. We used a stratified sampling taking into account the number of residents in each region. A sample of house-holds was drawn for each of the 16 regions using systematic sampling. Outcome Measures. A questionnaire aimed at iden-tifying chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration, and body locations was used. The Moroccan validated version of DN4 questionnaire was used to identify neuropathic characteristics. Results. A total of 5,328 respondents participated in the survey. 21% of the respondents (1,074) (95%CI: 19,9-22,2), reported chronic daily pain for more than 3 months. The point prevalence of chronic pain with NC, was 10.6% (95% CI: 9,75-11,45). The prevalence was higher in women and individuals older than 60. Chronic pain with NC was significantly more preva-lent in women, elderly, Illiterate respondents, and respondents from lower social class. It was more frequently located in the lower limbs, and its inten-sity and duration were higher in comparison with chronic pain without neuropathic characteristics. Conclusion. Chronic pain with neuropathic charac-teristics is probably more prevalent in the general population than was previously thought and is gen-erally more severe than other chronic pain. [ABSTRACT FROM AUTHOR]

La mono arthrite avec la présence de lésions lytiques intra-articulaires au cours des néoplasies solides sont peu fréquentes, non spécifiques, et exceptionnellement révélatrices. Le but de notre étude est d'en analyser les différentes présentations cliniques. Nous décrivons une série de 6 cas de néoplasie solide, dont le diagnostic a été posé à l'occasion d'une mono arthrite avec lésions lytiques intra-articulaires. Nous avons exclu les patients déjà diagnostiqués comme cancer solide. Nos rapportons six cas de néoplasie solide colligés au service de rhumatologie découverte par un tableau de monoarthrite avec des lésions lytiques intra-articulaires. Cinq cas étaient des hommes, l'âge moyen était de 64,57 ans, les circonstances de diagnostic de la néoplasie solide étaient : trois cas devant un bilan de mono arthrite du genou, trois cas devant un bilan d'une coxopathie avec tableau de spondylarthrite clinique et un cas devant une arthrite de la cheville gauche. Le diagnostic de cancer solide a été suspecté chez nos patients devant la présence de signes généraux, les douleurs osseuses accompagnant la symptomatologie articulaire, l'absence d'autres signes en faveur d'un rhumatisme inflammatoire ou une origine infectieuse et la présence de lésions lytiques sur les radiographies standards confirmées par une tomodensitométrie de l'articulation correspondante. Des métastases osseuses concomitantes étaient présentes chez trois malades. La sacroiliite était présente chez les trois malades présentant le tableau de coxopathie. La confirmation histologique de l'arthrite métastatique a été faite chez trois malades. La tumeur primitive était : trois cas d'adénocarcinome prostatique, un adénocarcinome vésiculaire de la thyroïde, un carcinome canalaire du sein, cancer bronchopulmonaire et un carcinome cutané squameux sur cicatrice d'une brûlure cutanée. Deux malades sont décédés après la découverte du cancer solide, les autres sont toujours en vie et en cours de traitement. Le recul moyen est de 2 ans. Bien que l'arthrite métastatique est une entité rare. Il faut y penser devant la présence de signes généraux, des douleurs osseuses associées ou en présence d'une arthrite inclassée. Plusieurs néoplasies solides ou lymphomes peuvent mimer une vraie spondylarthrite qui peut être un diagnostic de facilité. Ceci pour inciter sur l'importance des diagnostics différentiels même quand les critères de classification sont satisfaisants. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to study the therapeutic maintenance of tumour necrosis factor α inhibitors (TNFα-I) for spondyloarthritis patients enrolled in the Moroccan biotherapy registry and to analyse the reason and the predictive factors of stopping TNFα-I., Methods: Data were collected from a historical-prospective multicentre registry of adult patients with spondyloarthritis, treated with biological treatment, in the 10 rheumatology departments in Morocco. Maintenance was defined as the interval between the introduction and the suspension of the same TNFα-I., Results: 190 patients under TNFα-I were included, their average age was 40.2 +/-13.6 years. The male gender predominated. On average, the duration of the disease was 11.7 years +/-6.7 years. The ongoing therapeutic maintenance of all TNFα-I drugs in our study was relatively high and exhibited a decline over time, decreasing from 63.8% at 1 year to 45% at 3 years. At the 36-month follow-up, 27.7% had stopped their treatment. It was found that taking nonsteroidal anti-inflammatory drugs (NSAIDs) between visits and having a high average Ankylosing Spondylitis Disease Activity Score with C-reactive protein on the day of the visit were identified as predictive factors for therapeutic discontinuation in multivariate analysis., Conclusion: The therapeutic maintenance level of TNFα-I in our study was satisfactory and comparable to other series. our study provides a more comprehensive understanding of the factors that contribute to the improved maintenance of treatment with TNFα-I. It delves into the reasons influencing treatment continuity and identifies predictive factors of discontinuation., Competing Interests: The authors declare no conflict of interest., (© The Author(s).)

Competing Interests: The authors declare no conflict of interest.

In 2017, the Moroccan Society of Rheumatology (SMR) issued guidelines for the treatment of severe ankylosing spondylitis. The emergence of new therapeutic classes, the update of international guidelines for axial SpA and psoriatic arthritis, and the diagnostic and therapeutic challenges encountered by rheumatologists has led to the development of recent SMR guidelines for the management of SpA patients. A group-work included rheumatologists, specialists in physical medicine and rehabilitation, and epidemiologists from various sectors was tasked with writing these recommendations based on a literature review, then adapting them to the national context. Thus, 33 recommendations were selected and organized into two sections: diagnostic and therapeutic. The diagnostic section included three general principles and fourteen recommendations. The first, second, and third recommendations concerned the definition and diagnostic criteria for psoriatic arthritis and psoriatic arthritis. In the management of SpA, Recommendation 4 prioritized the importance of opportunity windows. The recommendation5 concerned the diagnostic and prognostic significance of HLAB27. The sixth and seventh recommendations related to imaging of the sacroiliac joints and the spine. The eighth recommendation focuses on the diagnosis and evaluation of perivascular thrombosis activity. The ninth and tenth recommendations concerned the evaluation of SpA activity and psoriatic arthritis. The eleventh and twelfth recommendations concern the evaluation of function and structural progression. The recommendation number thirteen concerned the diagnosis and treatment of coxitis. Recommendation 14 focuses on the most common co-morbidities and extra-rhinitological manifestations observed in SpA., Competing Interests: All authors do not report any conflict of interest., (© 2023 The Mediterranean Journal of Rheumatology (MJR).)

The advent of new therapeutic classes and the updating of international recommendations have justified the development of recent recommendations by the Moroccan Society of Rheumatology. Methods Guidelines were drafted by a core steering committee after performing a literature search. A multidisciplinary task force, including three fellows, eleven rheumatologists, a specialist in physical medicine and rehabilitation, an epidemiologist from hospital-university, hospital and liberal sectors and one patient assessed the Best Practice Guidelines using 2 rounds of anonymous online voting by modified Delphi process. Thus, 19 recommendations were developed. Recommendation 1 concerns the therapeutic principles, recommendation 2 insists on the information and education of the patient, recommendation 3 concerns the general measures to be adopted, namely physical activity, smoking cessation and psychological support, recommendation 4 concerns Non-Steroidal Anti-Inflammatory Drugs which constitute the first-line treatment, recommendations 5 to 7 concern the use of analgesics, of general and local corticosteroid therapy and conventional synthetic disease-modifying antirheumatic drugs, recommendations 8 to 13 deal with the use of biologic agents, including new classes and their indications in radiographic and nonradiographic axial and peripheral spondyloarthritis, follow-up and management in case of failure or remission, recommendation 14 deals with the indication for Janus kinase inhibitors drugs, recommendation 15 deals with physical treatment and recommendation 16 deals with the indication of surgery. Recommendations 17 to 19 deal with special situations, namely fibromyalgia, vaccination and pregnancy. A well-defined therapeutic strategy with first- and second-line treatments has been established., Competing Interests: The authors declare no conflict of interest., (© 2023 The Mediterranean Journal of Rheumatology (MJR).)

Objectives: To describe and analyse the prevalence of extra-articular manifestations (EAMs) including acute anterior uveitis (AAU), psoriasis and inflammatory bowel disease (IBD) in patients with ankylosing spondylitis (AS) in the Moroccan registry of biological therapies in rheumatic diseases RBSMR (Registre des Biothérapies de la Société Marocaine de Rhumatologie)., Methods: A cross-sectional, multicentre and analytical study based on the RBSMR database, which included 170 AS. Incidence rates for the development of AAU, psoriasis and IBD were calculated, and risk factors were analysed., Results: Prevalence of EAMs in AS was 13.5%, 4.7% and 11.2% for AAU, psoriasis and IBD respectively. No significant differences were found while establishing a comparison of the prevalence of these EAMs between AS patients with and without peripheral arthritis. Interestingly, AAU was the most common EAM, and was positively associated in multivariable regression with family history of spondyloarthritis (OR= 7.21, CI 95%: 2.23-23.24)., Conclusions: AAU was the leading EAM in patients with AS included in the Moroccan biotherapy registry (RBSMR) and it was associated with family history of spondyloarthritis., (© 2022 The Mediterranean Journal of Rheumatology (MJR).)

Objectives: The aim of this study was to determine the therapeutic maintenance level of methotrexate for rheumatoid arthritis patients enrolled in the Moroccan biotherapy registry and to identify predictive factors for discontinuing MTX treatment., Methods: A cross-sectional study was conducted using the baseline data of the Moroccan biotherapy registry for RBSMR (a multicentric study that aims to evaluate tolerance of biological therapy on patients affected with rheumatic diseases). Demographics and disease features were compared using descriptive statistics. Therapeutic maintenance levels were determined according to a Kaplan-Meier survival curve and a univariate Cox proportional hazards regression model was used to compare the strength of potential factors, followed by a multivariate Cox model to identify significant predictors of MTX discontinuation. Statistically significant results were considered for p values less than 0.05., Results: 224 patients with rheumatoid arthritis were included in this study. The mean age of patients was 51.83±11.26 years with a majority of females (87.50%). The median duration of disease was 12 [1.66-41.02] years. The therapeutic maintenance level of MTX was 91.1% at 1 year, 87.1% at 2 years, and 68.3% at 5 years. The median of treatment duration was 2, 02 [0, 46-27,76] years. Causes of treatment interruption were side effects (66/88=75%), inefficiency (12/88=13.63%), and other reasons (10/88=11.36%). Predictive factors for stopping MTX were presence of rheumatoid factor (HR 2.24; 95% CI 1.14-5.15; p =0.02) and the access to education (HR 0.37; 95% CI 0.16-0.88; p =0.02)., Conclusion: The therapeutic maintenance level of MTX in our study was satisfactory and comparable to other series, and influenced by many factors such as the occurrence of a side effect. It is necessary to sensitise medical practitioners on symptomatic prevention and management of side effects., (© 2022 The Mediterranean Journal of Rheumatology (MJR).)