Search

Rheumatoid arthritis (RA) is a systemic autoimmune disease that can be associated with extra-articular manifestations including vasculitis that occurs exceptionally in the retina. To present two active RA cases with retinal vasculitis (RV) and compare them to similar cases presented worldwide. The first case was a 44-year-old male patient with seropositive and erosive RA with a sudden bilateral blurred vision and myodesopsias and developed bilateral occlusive venous RV. It occurred concomitantly with an increased disease activity (disease activity score 4.4) that was treated with high doses of prednisolone. Then the patient had a recurrence of RV with another flare-up of his RA disease. Workup of RV included markers of infection, antinuclear antibody (ANA) and anti-neutrophil cytopasmic antibody (ANCA) and all were negative. The patient received pulse intravenous corticosteroids and was transitioned to oral steroids with the addition of methotrexate 20 mg/week with a favorable outcome. The second case was a 33-year-old female with history of bilateral retinal detachment treated surgically, followed for seronegative non-erosive RA. She presented with left RV complicated by a preretinal hemorrhage. Workup of RV included markers of infection and autoimmune markers were negative. A magnetic resonance imaging (MRI) hands showed bony erosions at the metacarpophalangeal joints with bilateral active synovitis. Systemic steroids were initiated with articular and visual improvement. The retina should be examined for evidence of vasculitis in RA and RV should be kept in mind as an ocular complication or association. [ABSTRACT FROM AUTHOR]

Objectives: To determine factors associated with fatigue in patients with rheumatoid arthritis (RA), and to identify baseline predictors of persistent fatigue at 12 months of follow‐up. Methods: We enroled patients with RA fulfiling the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Fatigue was assessed using the Arabic version of the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT‐F). Using univariate and multivariate analyses, we examined baseline variables associated with fatigue and persistent fatigue (if the FACIT‐F score was less than 40 at baseline and 12 months of follow‐up). Results: We included 100 RA patients of whom 83% reported fatigue. At baseline, the FACIT‐F score was significantly associated with older age (p = 0.007), pain (p < 0.001), global patient assessment (GPA) (p < 0.001), tender joint count (TJC) (p < 0.001), swollen joint count (p = 0.003), erythrocyte sedimentation rate (ESR) (p < 0.001), disease activity score (DAS28 ESR) (p < 0.001), and health assessment questionnaire (HAQ) (p < 0.001). At 12 months of follow‐up, the percentage of patients who reported persistent fatigue was 60%. The FACIT‐F score was significantly associated with age (p = 0.015), symptom duration (p = 0.002), pain (p < 0.001), GPA (p < 0.001), TJC (p < 0.001), C‐Reactive Protein (p = 0.007), ESR (p = 0.009), DAS28 ESR (p < 0.001), and HAQ (p < 0.001). Pain was an independent baseline predictor of persistent fatigue (OR = 0.969 (95% CI [0.951–0.988]), p = 0.002). Conclusions: Fatigue is a frequent symptom in RA. Pain, GPA, disease activity and disability were associated with fatigue and persistent fatigue. Baseline pain was the only independent predictor of persistent fatigue. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) and plantar fasciitis share similar risk factors including ageing, occupation, obesity, and inappropriate shoe wear. However, the association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date. Aim: We aimed to assess the prevalence of plantar fasciitis using ultrasound in patients with knee OA and to identify factors associated with plantar fasciitis in these patients. Patients and methods: We conducted a cross‐sectional study including patients with Knee OA, fulfiling the European League Against Rheumatism criteria. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the Lequesne indexes were used to evaluate pain and function of the knees. The Manchester Foot Pain and Disability Index (MFPDI) was used to estimate foot pain and disability. Each patient underwent a physical examination, plain radiographs of the knees and the heels, and an ultrasound examination of both heels to find signs of plantar fasciitis. Statistical analysis was performed using SPSS. Results: We included 40 knee OA patients, with a mean age of 59.85 ± 9.65 years [32–74] and a male‐to‐female ratio of 0.17. The mean WOMAC was 34.03 ± 19.9 [4–75]. The mean Lequesne for knees was 9.62 ± 4.57 [3–16.5]. Among our patients, 52% (n = 21) experienced heel pain. The heel pain was severe in 19% (n = 4). The mean MFPDI was 4.67 ± 4.16 [0–8]. Limited ankle dorsiflexion and plantar flexion were noted in 47% of patients (n = 17) each. High and low arch deformities were seen in 23% (n = 9) and 40% (n = 16) of patients. Ultrasound revealed a thickened plantar fascia in 62% (n = 25). An abnormal hypoechoic plantar fascia was noted in 47% (n = 19), with the loss of normal fibrillar architecture in 12 cases (30%). No Doppler signal was exhibited. Patients with plantar fasciitis had significantly limited dorsiflexion (n = 2 (13%) versus n = 15 (60%), p = 0.004) and plantar flexion (n = 3 (20%) versus n = 14 (56%), p = 0.026). The range of supination was also less important in the plantar fasciitis group (17.73 ± 4.1 vs. 12.8 ± 6.46, p = 0.027). The low arch was statistically more present in patients with plantar fasciitis (G1: 36% [n = 9] vs. G0: 0% [n = 0], p = 0.015). However, the high arch deformity was statistically more present in patients without plantar fasciitis (G1: 28% [n = 7] vs. G0: 60% [n = 9], p = 0.046). Multivariate analysis showed that the risk factor for plantar fasciitis in knee OA patients was limited dorsiflexion (OR = 3.889, 95% CI [0.017–0.987], p = 0.049). Conclusion: In conclusion, our work showed that plantar fasciitis is frequent in knee OA patients, with reduced ankle dorsiflexion being the main risk factor for plantar fasciitis in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Fibromyalgia (FM) is a chronic painful condition frequently associated with rheumatoid arthritis (RA), which may falsely increase RA activity. The aim of our study was to compare clinical scoring and ultrasound (US) assessment in RA patients with concomitant FM with those without FM. Methods: A cross‐sectional study including patients with RA according to the ACR/EULAR 2010 criteria was conducted. Patients were divided into two groups: RA patients meeting ACR 2016 FM criteria (cases) and RA patients not meeting FM criteria (controls). Clinico‐biological and US assessments of RA activity were performed on the same day for each patient. Results: Eighty patients distributed into 40 patients in each group were recruited. Biologic DMARD prescription was more frequent in RA with FM patients than the control group (p = 0.04). DAS28 was significantly greater than DAS28 V3 in RA with FM group (p = 0.002). FM group had significantly less US synovitis (p = 0.035) and less Power Doppler (PD) activity (p = 0.035). Grey scale US score (p = 0.87) and DP US score (p = 0.162) were similar in the two groups. The correlation between the clinical and the ultrasonographic scores was strong to very strong in both groups with the strongest correlation found between DAS28 V3 and US DAS28 V3 (r = 0.95) in RA + FM group. Conclusion: Our study confirms the overestimation of disease activity by the clinical scores in RA with concomitant FM. DAS28 V3 score and US assessment would represent a better alternative. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis. Methods: This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included. Results: Three studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p<0.05). Similarly, prior BMS in RA patients was significantly associated with reduced odds ratios for all the morbidities and in-hospital mortality compared with no prior BMS (36.5% vs 54.6%, OR = 0.45, 95% CI (0.42, 0.48), p< 0.001) and (0.4% vs 0.9%, OR = 0.41, 95% CI (0.27–0.61), p < 0.001) respectively. Conclusion: To conclude, published data indicate that BMS seems a promising alternative in reducing RA disease activity as well as morbidity and mortality in patients with obesity. [ABSTRACT FROM AUTHOR]

Objectives: Psoriatic arthritis (PsA) can mimic rheumatoid arthritis (RA) at an early stage, especially when psoriasis is lacking. In the absence of specific radiological and immunological markers, the differential diagnosis between these two diseases can be challenging. We aimed to determine whether hands ultrasonography (US) may be useful in the differential diagnosis between PsA and RA. Methods: We conducted a cross‐sectional study including patients with PsA and RA. All wrists and small joints of the hands were examined using gray‐scale and Power Doppler US. The evaluated US lesions were: synovitis, tenosynovitis of extensor carpi ulnaris, extensor communis and flexor tendons, enthesitis of extensor tendons at distal interphalangeal joints, peritendon inflammation of extensor tendons, and soft tissue edema. Results: Six hundred joints in 20 PsA patients and 900 joints in 30 RA patients were assessed. Extensor enthesitis was significantly more observed in PsA compared with RA (39.4 vs 26.3%, P =.006) with a significant higher frequency of enthesophytes and calcifications (P =.022 and P =.002, respectively). Peritendon inflammation of extensor digitorum tendons was observed in 13% of metacarpophalangeal joints in PsA patients versus 3% in RA patients with a significant difference (P <.001). Soft tissue edema was exclusively observed in PsA (1.5 vs 0%, P =.033). Power Doppler synovitis was significantly more frequent in RA (9.2 vs 5%, P =.002). Extensor carpi ulnaris tenosynovitis was significantly more frequent in RA (18.3 vs 2.5%, P =.017). Conclusion: Extrasynovial US findings may be helpful to distinguish PsA from RA especially in patients with immunonegative polyarthritis and no evidence of psoriasis. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Ultrasonography (US) emerged as a useful imaging tool in the diagnosis of gout. However, its accuracy is still unclear. We conducted a systematic review to evaluate the performance of US in diagnosing gout. We systematically reviewed PubMed database, and all the references of eligible articles were manually screened for additional relevant papers. Studies were included if they (1) examined the performance of US in diagnosing gout, (2) used a cross-sectional design in patients presenting with acute or chronic arthritis where gout was suspected, and (3) confirmed the diagnosis of gout using microscopic identification of monosodium urate crystals as the gold standard. Seven studies were included in the present systematic review. We evaluated the diagnostic properties of three typical US signs of gout: double contour (DC), tophi, and aggregates. The sensitivity and specificity of DC for gout varied, respectively, from 42% to 87.8% and 64.1% to 97%. The sensitivity of tophi for gout was between 19% and 46% and its specificity between 93% and 100%. The sensitivity and specificity of aggregates for gout ranged, respectively, between 30.3% and 78.9% and 65% and 90.9%. When any of these US features was present, the sensitivity for the diagnosis of gout increased up to 96% while the specificity decreased to 68%. Inversely, when all three signs were observed, the specificity tended to 100% but with a poor sensitivity of 17%. US had high specificity for the diagnosis of gout in patients presenting with undifferentiated arthritis. Its sensitivity depends on which US signs are taken into account and the joints being assessed. [ABSTRACT FROM AUTHOR]

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterised by sterile bone lesions. We report a case of a seven-year-old female patient who presented at a university hospital in 2010 and 2018 with CRMO. While the most promising results have been observed in patients under treatment with bisphosphonates (BPs), the initial decision to treat the current patient with a dose of zoledronic acid every six months was recalled as the patient developed tonic-clonic seizures immediately following the second dose BP administration. Following recall, the patient maintained a prompt response at follow-up and her disease remained controlled with non-steroidal anti-inflammatory drugs. The current case report speculates a possible relationship between BP use and a possible seizure threshold reduction, thereby emphasising the need for closer monitoring when BPs are used. [ABSTRACT FROM AUTHOR]

Objectives: Remission is the ultimate purpose of treatment in rheumatoid arthritis (RA). However, even when the most stringent composite scores are used, structural damages can occur; hence, ultrasonography (US) appears to be the best way to assess real remission. This study aimed to investigate the validity of different RA remission scores using US as a reference. Methods: An analytic diagnostic study, of 30 RA patients in remission (according to the Disease Activity Score in 28 Joints [DAS28]) and a control group with active RA, was conducted between January and October 2018 at Mongi Slim Hospital in Tunis, Tunisia. Among them, patients in remission were identified according to their Simple Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and the Boolean American College of Rheumatology/European League against Rheumatism activity index (ACR/EULAR) remission scores. The validity of each activity score for remission was calculated by considering the absence of power Doppler (PD) signals as a gold standard. Results: All patients were in remission according to the DAS28, with an average score of 2.03 (1.1--2.6). US examination showed PD signals in 57% of patients. A total of 26 patients were in remission according to the CDAI; a Doppler signal was detected in 58% of those cases. SDAI remission was accomplished in 19 patients, with PD activity in 53% of cases. Of the 14 patients in remission according to the Boolean ACR/EULAR criteria, synovial hyper-vascularisation was found in 64%. Considering true remission as the absence of PD signals, the most sensitive and specific score was the DAS28 (93% and 68%, respectively). Conclusion: Considering remission in RA as the absence of vascularised synovitis, the DAS28 is the most sensitive and most specific score. [ABSTRACT FROM AUTHOR]

The pandemic caused by Coronavirus-19 Disease (COVID-19) is having negative effects on healthcare workers (HCW) mental health due to the tremendous amount of stress to which they are exposed to. We aimed to assess the number of mental health outcomes among HCW treating patients with COVID-19. This cross-sectional study collected demographic data and mental health measurements from HCW in different hospitals using an online questionnaire. Participants were asked to complete the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Insomnia Severity Index (ISI), and the 7-item Generalized Anxiety Disorder scale (GAD-7). One hundred and forty-one participants with a mean age of 30.6±25 years and a sex ratio of 0.3 completed the online questionnaire. Participants from major university-hospital centers of northern Tunisia were divided into two groups: 78% medical and 22% paramedical staff. Twenty-two participants (15.6%) had a chronic disease, and 21 (14.9%) had a history of depression. Nineteen (13.4%) of the participants were infected with COVID-19. Thirteen percent of participants experienced the same anxiety level as the first-time taking care of COVID-19 patients, while 65% were rather an at ease compared to the first time. Forty-seven percent of participants felt the need for psychological support, and 16.7% of them had consulted a psychiatrist. Mild depression was detected in 14.1% of cases, moderate depression in 4.2% of cases, and severe depression in 2.1% of cases. As for anxiety, 36.1% of participants suffered from mild anxiety, 14.9% from moderate anxiety, and 4.9% from severe anxiety. Mild insomnia was detected in 44.6% of cases, moderate insomnia in 14.9% of cases, and severe insomnia in 9.9% of cases. Female gender (depression: P=0.05; anxiety: P=0.05; insomnia: P=0.02), having friends or relatives with COVID (depression: P=0.01; anxiety: P=0.05), psychiatric illness (depression: P=0.05; anxiety: P=0.01; insomnia: P=0.01), and chronic disease (depression: P=0.02; anxiety: P=0.03) were significantly associated with more severe mental health symptoms. Tunisian HCW experienced psychological burdens and a high rate of anxiety, depression, and insomnia. HCW should be protected in order to promote mental well-being. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the different delays of rheumatoid arthritis (RA) patients' journey from disease onset to treatment initiation and to identify possible influencing factors. Patients and methods: This cross-sectional study included a total of 100 patients (14 males, 86 females; mean age: 56.5±12.4 years; range, 26 to 82 years) who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for RA between January 2019 and January 2020. Demographic and clinical data and disease characteristics were collected from the patient interviews and medical files. Five different intervals were defined from symptom onset until the initiation of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Results: The mean age at RA onset was 46.6±12.4 years. Median delays from onset of symptoms until general practitioner (GP) and rheumatologist consultations were six (range, 0.25 to 240) months and 12 (range, 0 to 242) months, respectively. Median delays from onset of symptoms to RA diagnosis and treatment with csDMARDs were 15.7 (range, 2 to 252) months and 18 (range, 2 to 270) months, respectively. The mean number of consultations was 7.3±4.2 and the median number of physicians visited before the diagnosis was three (range, 1 to 8). The RA diagnosis delay was associated with rural geographic environment (p=0.02), lack of social insurance (p=0.027), progressive symptoms onset (p=0.006), morning stiffness (p=0.023), being initially examined by a GP (p=0.02), number of consultations (p<0.001; r=0.49), and number of physicians consulted before diagnosis (p=0.001; r=0.33) respectively. Based on the patients' self-perception, the main causes of this long delay were lack of financial means (33%), wait times until exploration results (31%), wait times until the first GP or rheumatologist visit (26%), and geographical difficulty in accessing healthcare services (18%). Conclusion: Our study results suggest that patients with RA experience a significant delay until diagnosis and initiation of treatment. Healthcare providers should urgently consider factors related to diagnosis delay to shorten RA patients' journey. [ABSTRACT FROM AUTHOR]

Brown tumors (BTs) are due to a proliferation of multinucleated giant cells in osteolytic lesions. They complicate the course of hyperparathyroidism. Thanks to an early screening of bone metabolism disorders; BTs are nowadays rare bone manifestations. We demonstrate through these two cases reports unusual locations of BTs in hyperparathyroidism. [ABSTRACT FROM AUTHOR]

Purpose of Review: Intravesical BCG therapy (ivBCG) is a treatment for bladder cancer that complements surgery and prevents tumor progression. Reactive arthritis (ReA) is a rare osteoarticular manifestation that can complicate this treatment. An updated systematic literature review has been investigated to identify clinical, biological, and therapeutic data of this pathology. Recent Findings: A systematic literature was performed on October 2020 to identify papers published from 2000 to 2020. Study eligibility criteria included case reports, case series, cohort studies, systematic reviews, meta-analysis, and letters to the editor, in English and French. Independent extraction of articles was performed by two investigators. Thirteen studies met the search criteria for the systematic review with a good quality assessment. The total number of patients was 107, with an average age of 61.5 [24–80]. The symptoms of ReA appeared after a mean number of 5.71 instillations and 13.9 days. Arthritis was the most common symptom (98.13%) followed by fever (80.76%) and conjunctivitis (64.42%). Human leukocyte antigen (HLAB27) was positive in 28.97% of patients. Therapeutic modalities included non-steroidal anti-inflammatory drugs (NSAIDs) (51.4%), corticosteroids (27.1%), conventional synthetic disease-modifying antirheumatic drugs (3.84%), antitubercular drugs (14.42%), and tocilizumab (0.93%). BCG therapy was discontinued in 29.9% of patients. Remission was achieved in 92.3% of patients and one patient progressed to spondyloarthritis. Summary: ReA is a rare complication of BCG therapy. Clinical signs are similar to those of typical ReA and treatment is primarily based on NSAIDs and corticosteroids. [ABSTRACT FROM AUTHOR]

Inflammatory arthritis has been reported after SARS‐COV‐2 infection. We present a case of a 38‐year‐old female patient who developed polyarthralgia 1 month after SARS‐COV‐2 infection. Musculoskeletal examination was significant for synovitis of hands and wrists. Antinuclear antibody (ANA), rheumatoid factor (RF), and anti‐cyclic citrullinated peptide (CCP) antibodies were positive. Magnetic resonance imaging of the hands showed synovitis of the metacarpophalangeal joints and proximal interphalangeal joints of the hands, wrist joints, and tendinitis with tenosynovitis. The patient was diagnosed with seropositive nonerosive rheumatoid arthritis (RA) and initiated on therapy using nonsteroidal anti‐inflammatory agents and disease‐modifying anti‐rheumatic drug methotrexate leading to an improvement in symptoms. Cases of autoimmune and auto‐inflammatory diseases triggered after COVID‐19 have been reported. We report the case of a 38‐year‐old female patient who developed seropositive, nonerosive rheumatoid arthritis (RA) one month after SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

Vogt-Koyanagi-Harada (VKH) syndrome is a systemic autoimmune disorder that targets tissues containing melanocytes such as the eye, inner ear, meninges and skin. Despite a common genetic susceptibility, the association between VKH syndrome and rheumatoid arthritis (RA) has been rarely reported. To report a rare case with RA who developed incomplete VKH syndrome. The case is described and a review of the literature on similar cases is presented. A 26 year-old Tunisian woman, with a medical history of Hashimoto's thyroiditis, was diagnosed on 2011 with seropositive and erosive RA treated with Leflunomide. She presented to the emergency department on June 2018 with bilateral blurred vision associated with photophobia, vomiting and severe headache that had gradually progressed over the preceding five days. Ophthalmological examinations showed typical findings of VKH syndrome. The patient received intravenous infusions of methylprednisolone at a daily dose of 1000 mg for 3 days that was followed orally with 2 mg/kg of prednisone equivalent. Given the lack of improvement in visual acuity after 3 weeks of treatment, azathioprine was added and VKH remission was achieved on September 2018 as confirmed on optical coherence tomography. However, the patient passed away on October 2018 due to infectious complications of the immunosuppressant agents. Treatments and outcomes of VKH are variable. Pharmacological management of such an association between RA and VKH may be challenging, so care must be taken to balance treatment escalation with adverse events in patients at risk. [ABSTRACT FROM AUTHOR]

The sacroiliac joint is rarely affected by tuberculosis. Only few cases have been reported. Consequently, the diagnosis is often delayed. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection. [ABSTRACT FROM AUTHOR]

To evaluate sexual function in Tunisian men with spondyloarthritis (SpA) and rheumatoid arthritis (RA) compared to healthy controls. The association between erectile dysfunction (ED) and specific parameters of SpA and RA was also studied. The study included 37 SpA, 13 RA patients and 50 healthy age matched controls. Sexual function of patients and controls was evaluated by the International Index of Erectile Function-5. ED was considered if the score was <21. Pain during intercourse and sexual desire were also assessed. The mean age of the SpA and RA patients and control were comparable (42.5 ± 11.4 years, 49.6 ± 12.8 years and 48.8 ± 13.9 years). The prevalence of ED in rheumatic disease patients (SpA and RA) was 80% versus 70% in controls. A significant difference was found in the severity of the ED between patients and control (p = 0.04) and between SpA and RA patients (p = 0.012). There was also a higher prevalence of pain during intercourse (p < 0.0001), lower intensity of sexual desire (p = 0.005) and more dissatisfaction in relation with the partner (p < 0.0001) in the RD patients. ED in SpA and RA patients was significantly associated with higher age (p = 0.001), marital status (p = 0.007), higher age of disease's onset (p = 0.027), pain during intercourse (p = 0.05) and lower sexual desire (p < 0.0001). On regression analysis, only sexual desire was significantly associated with ED (p = 0.03). This work suggests that patients with SpA or RA have a more severe ED in comparison with healthy control. However, specific disease parameters were not linked to ED. [ABSTRACT FROM AUTHOR]

Context: Paget's disease of bone is a common bone disease with a striking variation in its incidence and characteristics in different parts of the world. It is uncommonly reported in African patients. Aims: Given the lack of studies describing the characteristics of patients with Paget's disease of bone in North Africa, we aimed to describe demographic, clinical, biochemical, and imaging characteristics, as well as treatment outcomes of Tunisian patients with Paget's disease of bone. Subjects and Methods: This bicentric and retrospective study included patients with Paget's disease of bone. Clinical, laboratory, radiological profile, and response to treatment were analyzed. Results: Sixty-nine patients were identified. The mean age was 64.9 ± 11.6 years and 52.2% were women. One patient reported a positive family history. Seven patients were asymptomatic. Bone pain was the most common presenting symptom. Eight patients had a history of malignancy. In three patients, Paget's disease of bone was diagnosed as part of a metastatic workup. Monostotic disease was found in half of the cases. The most commonly involved sites were pelvis (43.5%), femur (21.7%), and spine (21.7%). The mean serum alkaline phosphatase level at presentation was 591 U/L (68–8380). Two patients received salmon calcitonin (2.8%) and 47 patients (68.1%) received bisphosphonates. After a mean follow-up of 55 months (2–240 months), bone pain improved in 43.1% of patients and the serum alkaline phosphate levels had normalized in 22 of them (43.1%). During follow-up, there was no malignant transformation. Conclusions: In this series of Tunisian patients, Paget's disease of bone had a female predominance and was usually monostotic. The clinical and radiological presentations were similar to the European series. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of back and neck pain is common in children and adolescents, and in some series the numbers are alarming. Various risk factors have been identified, although some are controversial. Objective To determine the prevalence of neck and back pain in children and adolescents and to investigate the potential association with various risk factors identified in the literature. Methods We established a questionnaire targeting parents of children and adolescents aged between 6–18 years old in Tunisia. The recruitment of participants was done online using the Google Forms application. The questionnaire was divided into 2 parts: Part one collected the sociodemographics characteristics of the participants: age, gender, body mass index (BMI), exposure to passive smoking, the practice of a physical activity, puberty status and age at puberty if applicable, type and weight of the schoolbag, mean daily time spent on electronic devices, type of school the child attends (private/public), mode of transport from home to school, parental history of neck and/or back pain, posture of the sitting position of the child, and finally whether the child reports neck/back pain. The second part was aimed at parents whose child reported neck and/or back pain. We asked about the weekly frequency of neck/back pain, school absenteeism due to neck/back pain, whether it prevented the child from practicing physical activity and, finally, whether the child had ever seen a doctor/chiropractor/physiotherapist for their neck/back pain. For all statistical tests, the significance threshold was fixed at 0,05. Results Eighty-two participants (sex-ratio = 1) answered the questionnaire. Mean age was 11.4 ± 3.8[6–18]. Thirty (36.6%) were pubescent. Fifty-three children practiced regularly an extracurricular physical activity (swimming n  = 11, basketball n  = 9, football = 9, tennis = 9, gymnastics= 6, ballet = 5, horseback riding n  = 3, krav maga = 2, running n  = 1, volley ball n  = 1). Mean schoolbag weight according to the participants was 7.6 ± 1.6 kg [1–9]. Fifty-seven children (69.5%) attended private school. Mode of transport was walking, taking public transport and driving the family car respectively in 10 and 1 and 71 children. Parental history of neck and/or back pain was positive in 47 participants (57.3%). Forty-four participants (53.7%) reported bad sitting position of their child. Neck pain, dorsal pain and low back pain (LBP) were reported respectively in 21 (25.6%), 15 (18.3%), 25 (30.5%) participants. Four children (4.9%) had neck, dorsal and low back pain. Among participants who reported neck or back pain, the average weekly frequency was 1.6 [0–7] and 3.7% had a history of missing school due to neck/back pain with a mean truancy per trimester of 3.6 times [1–12]. Spinal pain prevented 9 participants from engaging in physical activity. Twelve participants (14.6%) revealed that their spinal pain made them see a doctor and three (3.7%) a chiropractor/physiotherapist. The analytical study didn't show an association between neck/back pain and gender, physical activity, type of school and mode of transport to school. A positive parental history of neck or back pain was significantly associated with the presence of neck, dorsal and LBP (P  = 0.043, P  = 0.011 and P  < 0.0001 respectively). The presence of neck pain and LBP were both associated with a bad sitting position (P  = 0.05 and P  = 0.02 respectively). Presence of LBP was associated with a positive puberty status (P  = 0.016), use of a backpack (P  = 0.05), and exposure to passive smoking (P  = 0.001). No significant correlations were found between neck/back pain and age at puberty, time spent daily on electronic devices, weekly duration of physical activity, schoolbag weight and absenteeism rate. LBP was significantly associated with higher BMI (P  = 0.001) and higher age (P  = 0.003). Similarly, dorsal pain was associated with higher age (P  = 0.03). Conclusion The prevalence of spinal pain was frequent in our series. A positive parental history of spinal pain, a bad posture while sitting, passive smoking, use of backpack, higher age and higher BMI were potential associated factors. [ABSTRACT FROM AUTHOR]

Background Juvenile Idiopathic Arthritis (JIA) is a debilitating condition that can negatively impact the life of children [1]. Indeed, because of a prolonged course of active disease, patients may experience several limitations and tend to have their unique perception of their illness. Objectives This study aimed to to investigate the illness perception of patients with JIA. Methods We conducted a cross-sectional study including children with JIA (according to the International League of Associations for Rheumatology (ILAR)), recruited from our rheumatology department. Sociodemographic data and disease characteristics were collected. The patients were invited to answer the Brief Illness Perception Questionnaire (BIPQ) to quantify their perception of the disease and how it affects their life. For the patients under the age of 11 years old, we asked the parents to answer the questionnaire. The BIPQ is a nine-item questionnaire rated using a 0-to10 response scale that assesses cognitive illness representations: consequences, timeline, personal control, treatment control, identity, emotional representations and illness comprehensibility [2]. Result Our study involved 31 patients with an average age of 28.7 [9–45] years and consisted of 12 (38.7%) males and 19 (61.3%) females. The mean age at onset and the duration of the disease were 6.6 years [2–13] and 255.84 [36–444] months, respectively. The distribution of the different forms of JIA was as follows: oligoarticular (n  = 6), enthesitis-related arthritis (n  = 4), polyarticular with positive rheumatoid factor (RF) (n  = 9), polyarticular with negative RF (n  = 7) and systemic form (n  = 5). Regarding treatment modalities, 13 (41.9%) were on corticosteroids, 21 (67.7%) were treated with Cs-DMARDS and 11 (39.3%) were on anti-TNF alpha. Eleven patients required total hip replacement. The mean PGA was 27.6/100. Only eight patients had moderate to severe disease activity. All the patients responded to the entire BIPQ questionnaire with an average score of 46.48/80 [18–68]. Regarding the first question assessing the impact of the disease on life, our patients responded with an average score of 4.7/10 reflecting a healthy perception of the disease. There was a significant association between how much patients experience their symptoms and the emotional impact of the disease (r = 0.8; P  = 0.001). Moreover, patients who had a personal and treatment control, were less prone to be affected by the disease emotionally (r = -0.006; P  = 0.9). Conclusion Our work highlighted the importance of assessing illness perception of patients with JIA. This condition should be evaluated from different perspectives in order to implement a personalized management strategy. Ethics This work is ethically approved Key words: Juvenile idiopathic arthritis, illness perception References 1. Wipff J, Sparsa L, Lohse A, Quartier P, Kahan A, Deslandre CJ. Impact of juvenile idiopathic arthritis on quality of life during transition period at the era of biotherapies. Joint Bone Spine 2016;83:69–74. 2. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006;60:631–7 [ABSTRACT FROM AUTHOR]

Background Surgical intervention in a child represents a challenging and overwhelming event for the parents. Studies have shown that parents' preoperative preparation and satisfaction with their child's preoperative care are important components of a better clinical outcome and a stronger healthcare system. Objective To investigate the preoperative and postoperative preparation of parents whose children have scoliosis and have undergone surgery, and its possible association with postoperative clinical outcomes. Methods We conducted a cross-sectional study including children and adolescents who underwent surgery for scoliosis. Disease related characteristics were reported. Successful surgery was defined as a postoperative cobb angle less than or equal to half the initial cobb angle. A questionnaire in the Tunisian dialect consisting of 10 Yes/No questions related to the preoperative and perioperative phase was established. The parents answered the questionnaire by telephone and informed oral consent was obtained. An arbitrary cutoff of 7 positive answers was set to define a well-prepared parent. Results Thirty-six children were included (sex-ratio= 0.38, mean age at surgery = 16.05 ± 2.63 [11–23]). Etiologies of scoliosis were idiopathic (n  = 29), neuromuscular (n  = 4) and congenital (n  = 3). Twenty-two children (61.1%) had successful surgery. Regarding the questionnaire, table 1 reports the parents' answers to the 10 questions. Question two had the most negative response with 55.5% parents reporting that during the pre-operative phase, the medical staff didn't mention the possible complications of the surgery. Thirty-three per cent of the parents reported that the doctor didn't explain more about the operation and the post-operative course during the peri-operative period and about 30% revealed that, on the day of surgery, the doctor didn't explain to them the induction of anesthesia. Forty-seven per cent of the parents mentioned that the doctor didn't inform them about the possible restrictions in occupation for their child later. Seventy-two percent of parents had ≥7 positive answers indicating that they were well prepared for the surgery, among them 52% had children in whom surgery was successful, P  = 0.14. No correlation was found between a good parental preparation and age at surgery (P  = 0.736). A significant association was found between success of surgery and a positive response to Q9, P  = 0.032. OA04 Table 1. Parents' answers to the questionnaire Questions.  Parents answers:.  Yes (n).  No (n).  Q1: Has your doctor explained the importance and benefits of surgery?  32  4  Q2: Before surgery, did your doctor explain the possible complications of the surgery?  16  20  Q3: Did your doctor reassure you before surgery?  33  3  Q4: Did your doctor include you in the therapeutic decision?  32  4  Q5: During the two days before the surgery, did your doctor explain more about the operation and the post-operative course?  24  12  Q6: On the day of surgery, did the doctor explain to you the induction of anesthesia?  25  11  Q7: In the immediate postoperative period, did the doctor inform you about the course of the operation?  30  6  Q8: Did the doctor/nurse inform you about your child's pain management in the immediate postoperative period?  29  7  Q9: Did you receive sufficient information on how to provide postoperative care at home?  30  6  Q10: Did your doctor tell you about the possible restrictions in occupations for you child later?  19  17  Questions.  Parents answers:.  Yes (n).  No (n).  Q1: Has your doctor explained the importance and benefits of surgery?  32  4  Q2: Before surgery, did your doctor explain the possible complications of the surgery?  16  20  Q3: Did your doctor reassure you before surgery?  33  3  Q4: Did your doctor include you in the therapeutic decision?  32  4  Q5: During the two days before the surgery, did your doctor explain more about the operation and the post-operative course?  24  12  Q6: On the day of surgery, did the doctor explain to you the induction of anesthesia?  25  11  Q7: In the immediate postoperative period, did the doctor inform you about the course of the operation?  30  6  Q8: Did the doctor/nurse inform you about your child's pain management in the immediate postoperative period?  29  7  Q9: Did you receive sufficient information on how to provide postoperative care at home?  30  6  Q10: Did your doctor tell you about the possible restrictions in occupations for you child later?  19  17  Q: question, n=number of parents. Open in new tab OA04 Table 1. Parents' answers to the questionnaire Questions.  Parents answers:.  Yes (n).  No (n).  Q1: Has your doctor explained the importance and benefits of surgery?  32  4  Q2: Before surgery, did your doctor explain the possible complications of the surgery?  16  20  Q3: Did your doctor reassure you before surgery?  33  3  Q4: Did your doctor include you in the therapeutic decision?  32  4  Q5: During the two days before the surgery, did your doctor explain more about the operation and the post-operative course?  24  12  Q6: On the day of surgery, did the doctor explain to you the induction of anesthesia?  25  11  Q7: In the immediate postoperative period, did the doctor inform you about the course of the operation?  30  6  Q8: Did the doctor/nurse inform you about your child's pain management in the immediate postoperative period?  29  7  Q9: Did you receive sufficient information on how to provide postoperative care at home?  30  6  Q10: Did your doctor tell you about the possible restrictions in occupations for you child later?  19  17  Questions.  Parents answers:.  Yes (n).  No (n).  Q1: Has your doctor explained the importance and benefits of surgery?  32  4  Q2: Before surgery, did your doctor explain the possible complications of the surgery?  16  20  Q3: Did your doctor reassure you before surgery?  33  3  Q4: Did your doctor include you in the therapeutic decision?  32  4  Q5: During the two days before the surgery, did your doctor explain more about the operation and the post-operative course?  24  12  Q6: On the day of surgery, did the doctor explain to you the induction of anesthesia?  25  11  Q7: In the immediate postoperative period, did the doctor inform you about the course of the operation?  30  6  Q8: Did the doctor/nurse inform you about your child's pain management in the immediate postoperative period?  29  7  Q9: Did you receive sufficient information on how to provide postoperative care at home?  30  6  Q10: Did your doctor tell you about the possible restrictions in occupations for you child later?  19  17  Q: question, n=number of parents. Open in new tab Conclusion In our series, the lack of information about the possible complications of the surgery, during the peri-operative phase and about the induction of anesthesia was noted. Interestingly, receiving sufficient information on how to provide postoperative care at home was significantly associated with a success of surgery. [ABSTRACT FROM AUTHOR]

The screening for latent tuberculosis infection (LTBI) is mandatory before initiating biologics in patients with chronic immune-mediated inflammatory disease (IMID). The recommendations are based on the tuberculin skin test (TST) and interferon-gamma release assay (IGRA). To evaluate the agreement between the two tests in the diagnosis of LTBI and to identify risk factors associated with positive TST and IGRA results. Medical records of 105 IMID patients going to receive a biologic agents were extracted in a cross sectional study (2015–2017). No biologics was undertaken before LTBI screening. All patients underwent IGRA and chest radiography. TST was performed in 94 cases. The mean age of the patients was 47.7 ± 14.4 years and disease duration of 11.2 ± 7.6 years. Agreement between the 2 tests results was low (κ coefficient = 0.08). The sensitivity of TST and IGRA was equally low but the specificity of IGRA was higher. Replacing TST results by positive IGRA showed that number of patients who would take anti-tuberculous chemoprophylaxis will be significantly reduced by 46.5% (from 40.9% to 21.9%; p = 0.0002). TST results were significantly less positive for patients receiving immunosuppressives than for those receiving no treatment (35.1% vs 42.5%, p = 0.031). IGRA results were associated with absence of Bacilli Calemtte-Guérin vaccination. Age was the only risk factor for LTBI associated with both IGRA and TST positivity (p = 0.031, p = 0.011 respectively). TST and IGRA have a low agreement. Both tests should be included in the strategy to diagnose LTBI prior to biologic therapy in IMID patients. [ABSTRACT FROM AUTHOR]

Background In the past few years, many advances have been made in the subspecialty of pediatric rheumatology in emerging countries. However, some gaps were identified requiring an update of rheumatologists' knowledge in this field [1]. Our study aimed to assess rheumatologists' knowledge and common practices when managing children with rheumatic diseases. Methods We conducted an anonymous cross-sectional study including Tunisian rheumatologists. They were invited to answer an online questionnaire. The survey included demographic data, as well as outcomes of interest: rheumatologists' knowledge and attitudes towards the management of patients with rheumatic diseases. We also inquired about the scores used to evaluate children with juvenile idiopathic arthritis (JIA). The level of confidence in the management of the pediatric population was assessed by the Likert scale. Results At the end of the survey, 51 responses were collected. The participants were rheumatology specialists (63%), university hospital assistants (21%), and residents (16%). Sixty-two percent of responders worked in the hospital. The mean number of years of practice (including years of residency) was 16.3 ± 5.9 [2–36]. Two rheumatologists reported that they managed over 10 children per month for rheumatic disorders. Four rheumatologists reported that they managed from 6 to 9 children per month for rheumatic disorders. Forty rheumatologists reported that they managed from 1 to 5 children per month for rheumatic disorders. And 5 rheumatologists reported that they do not manage any children with rheumatic disorders. Only 10 (20%) doctors received training in pediatric rheumatology during their curriculum: online training (6), national training program (2) and international training program (2). Regarding the scores used to assess the different subtypes of JIA, 23 (45%) rheumatologists were not aware of the JADAS 10 score and 39 (76%) did not know the JSPADAS score. When inquiring about the level of confidence in the management of the pediatric population the average level of confidence was 2.49 ± 1.82 [0–5]. Only 2% were not confident at all. A pediatric specialist was requested for a second opinion upon diagnosis in 51% of difficult cases and in 12% of less challenging cases. Only 19 respondents managed the patients by themselves without referring them to other specialists. The rheumatologists' apprehension regarding the management of the pediatric population was attributed to the lack of training in pediatric rheumatology (94%), the absence of pediatric internship during the specialization curriculum (43%) and the lack of mastery of children's examination (12%). Conclusion Our study highlighted that only a few Tunisian rheumatologists considered themselves confident in the management of children with rheumatic disorders. The establishment of training programs in pediatric rheumatology could enhance rheumatologists' knowledge in this field and give them more confidence in the management of this population. [1] Zisman D, Samad A, Ardoin SP, et al. US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults with Rheumatic Conditions. Arthritis Care Res (Hoboken). 2020; 72(3):432–40. This was an anonymous cross-sectional study. All subjects participated voluntary. [ABSTRACT FROM AUTHOR]

Background Primary care medicine is the first line of defence in the management of all diseases, and pediatric rheumatology is no exception to this rule. The aim of our work was to assess the management of rheumatological manifestations in the pediatric population, particularly in cases of suspected juvenile idiopathic arthritis (JIA). Methods A self-administered survey via google forms, was conducted among Tunisian primary care practitioners, during the month of February 2023. They were asked about their usual practice when children with articular symptoms consulted them. Results Our work included 33 practitioners, 25 of whom were women and eight men, with a female to male ratio of 3:1 and a mean age of 26 years [25–57]. Eighty-eight percent were family medicine residents (n  = 29), nine percent were public health physicians (n  = 3) and three percent were private physicians (n  = 1). The average number of years in practice was three years [1–26]. Fifty-eight percent (n  = 19) practiced in a university hospital, 18% (n  = 6) in a regional hospital, 21% (n  = 7) in a local dispensary, and three percent (n  = 1) in a private practice. Regarding the number of pediatric-aged consultations per week, 70% (n  = 23) reported seeing less than five patients and 21% more than ten per week (n  = 7). A rheumatological reason for these patients was found in less than five consultations per week according to 94% of practitioners (n  = 31). Forty-eight per cent (n  = 16) of participants expressed anxiety when asked how they felt about managing a rheumatological case in this population, nine per cent (n  = 3) were confident, 21% felt fearful (n  = 7), 27% (n  = 8) were indifferent and three per cent (n  = 1) were alert. Forty-two per cent (n  = 14) suspected JIA in a patient. In 77% of cases, the patients were seen repeatedly for polyarthralgia, 47% for arthritis, 18% for spinal pain, and 47% for systemic manifestations. 79% believe that early management of JIA brings a benefit in terms of health costs. When asked about their sources of training in JIA, 76% said it was through clinical courses and nine per cent through medical days, six per cent webinars and workshops and three per cent felt they had not received any training. As for sources of information, 31% through peer groups, 49% on medical websites, 27% through medical journals and 49% through medical school courses. To the question 'On a scale of 0–5, how would you rate your training in the management of rheumatological manifestations in children and adolescents' the answers were 0 in 21% of cases, 1 in 42% of cases, 2 in 12% and 3 in 24%. When faced with a suspicion of JIA, 49% of practitioners referred patients to pediatrics, 64% to rheumatology, 55% initiated a biological and imaging work-up and 18% prescribed symptomatic treatment. For the treatment, 67% prescribed paracetamol, 58% NSAIDs, 15% corticosteroids, 9% did not prescribe any treatment and three percent admitted not knowing what to prescribe in this situation. Conclusion JIA may affect functional and even vital prognosis of young patients. The detection and early management of the disease depend on the reinforcement of training and awareness for primary care physicians. [ABSTRACT FROM AUTHOR]

Background Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood. It is frequently associated with chronic pain and physical disability. Moreover, it can persist over many years and can lead to disability and dysfunction in adulthood. Objectives The aim of this study was to investigate the factors associated with school or work absenteeism and poor school functioning in patients with JIA. Methods We conducted a cross-sectional study including patients with JIA according to the International League of Associations for Rheumatology (ILAR). Sociodemographic data as well as disease characteristics were collected from patient's medical records. A detailed questionnaire was completed for each participant by interviewing them about their school level and their educational and work performance. The rate of absenteeism due to health complications was noted. The data were analyzed using SPSS version 11.5. A P -value cut-off of 0,05 to determine significance was fixed. Results We studied 31 JIA patients. There were 11 males (35.5%) and 20 females (64.5%). The mean age of participants was 28.6 years [9–45]. The mean age at onset was 6.65 years [2–13]. The mean disease duration was 256.5 months [36–444]. The distribution of the different subtypes in patients was as follows: RF-positive polyarthritis (n  = 10), oligoarthritis (n  = 7), RF-negative polyarthritis (n  = 6), Enthesitis-related arthritis (n  = 4) and systemic arthritis (n  = 4). Nineteen patients were receiving corticosteroids. Disease-modifying anti-rheumatic drugs were used by 18 patients: methotrexate (n  = 11), sulfasalazine (n  = 3), leflunomide (n  = 4) and biologics (n  = 13). Twelve patients developed complications: coxitis (n  = 11), growth retardation (n  = 9) and uveitis (n  = 4). Joint replacement was required in 7cases. The mean DAS28 ESR was 2.71 [0.76–5.23] and the mean CHAQ was 0.85 [0–2.30]. The mean number of tender and swollen joints was 0.45[0–8] and 0.29 [0–5] respectively. The mean amount of CRP and ESR was respectively 12.71 mg/l [0–91] and 21.23 mm/h[0–84]. Seven patients were illiterate (26.9%), 11 had dropped out of school (42.3%). Twenty-two patients (70.9%) reported repeated absences due to illness. A year of schooling was repeated by 43.6% of patients. Fourteen out of 26 patients over the age of 20 attended university. Almost 77% of patients were exempted of physical education. Among the adult patients, 10 had an intellectual job (38.4%), 12 had a manual job (46.1%) and 4 were unemployed (15.3%). A total of 37% of the schooled patients and 18.4% of adult patients missed 2 weeks or more of school or work during the past year. A total of 26.3% of the patients had poor school functioning. A significant association was found between absenteeism and tender joints (P  = 0.044). However, there were no significant association between the school-related problems, the socio-demographic characteristics and the other parameters of clinical and biological activity studied. Conclusion Our study suggested that JIA negatively affected patients schooling and adults work performances. Therefore, proper management of these patients is important to increase their academic and professional performance. [ABSTRACT FROM AUTHOR]

Background Juvenile idiopathic arthritis (JIA) is a common pediatric condition that is often associated with chronic pain and physical disability. Moreover, it is also comorbid with sleep problems which considerably affects the patient's daily functioning [1]. Objectives The aim of this study was to assess sleep disturbances among JIA patients. Methods We conducted a cross-sectional study including patients with JIA according to the International League of Associations for Rheumatology (ILAR). Sociodemographic data as well as disease characteristics were collected. Sleep disturbance was assessed by two questionnaires: the BEARS Sleep Screening algorithm and PROMIS sleep disturbance short form according to the age of the patients (<18 years old, >18 years old respectively). The BEARS is an instrument divided into major sleep domains: bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep and snoring. PROMIS is an 8-item questionnaire that assess sleep quality. A higher T score corresponds to a poorer the sleep quality. Results The study included 31 patients. The mean age of the participants was 28.67 years [9–45 years]. There was a female predominance: 35.5% males vs 64.5% females. The mean age at onset was 6.6 years [2–13] and the mean disease duration was 256.5 months [36–444]. The distribution of the different subtypes was as follows: Enthesitis-related arthritis (n  = 4), RF-positive polyarthritis (n  = 10), RF-negative polyarthritis (n  = 6), oligoarthritis (n  = 7) and systemic arthritis (n  = 4). Nineteen patients were receiving corticosteroids. Disease-modifying anti-rheumatic drugs were used by 18 patients: methotrexate (n  = 11), sulfasalazine (n  = 3), leflunomide (n  = 4), biologics (n  = 13). Twelve patients developed complications: coxitis (n  = 11), growth retardation (n  = 9), uveitis (n  = 4). The majority of the respondents (90.3%) reported using screens daily before going to sleep. Among patients aged <18 years, 2 had an individual bedroom while 8 shared theirs with their siblings. Among the ten patients who answered the BEARS Sleep Screening algorithm, 40% had an excessive daytime sleepiness, 20% had night awakenings and 30% suffered from a snoring problem. Regularity and duration of sleep was respected in 6 out of the 10 patients. The most common bedtime problem mentioned were refusal to go to bed (73%) as well as bedtime stalling (23%). As for the PROMIS form, the mean score was 55.52 [27–66]. None to slight, mild, moderate and severe sleep disturbance were found in 16.1%, 19.3% and 6.4% of cases respectively. There was a significant association between poor sleep quality and higher disease activity (DAS28 ESR) (P  < 0.043). However, we did not find a significant association between the sleeping disturbances and age at onset (P  = 0.08), disease duration (P  = 0.073), the CHAQ score (P  = 0.059), corticosteroid use (P  = 0.063) and the screen use (P  = 0.092). Conclusion This study highlights the high prevalence of sleep disturbance among JIA patients which may affect their physical, emotional and cognitive well-being. It is important to screen for sleep problems for a better management of the disease. [1] Owens J. Classification and epidemiology of childhood sleep disorders. Prim Care 2008; 35(3):533–46 [ABSTRACT FROM AUTHOR]

• The assessment of the functional impact of the involvement of the feet during rheumatoid arthritis is relevant given that it is common in this chronic inflammatory rheumatism and that it can affect the functional prognosis of patients. • To assess the functional impact, we used a validated self-questionnaire with good reproducibility and easily understandable by our patients: the Functional Foot Index (FFI). • Due to the high frequency of foot involvement and its significant functional impact, meticulous examination of the feet and assessment of their functional impact must be one of the parameters for monitoring the disease. A better understanding of the peculiarities of the rheumatoid foot and the factors predicting its functional impact would optimize the care of patients with RA and thus improve their quality of life. We aimed to evaluate the impact of foot involvement in patients with rheumatoid arthritis (RA) using the functional foot index (FFI) and to identify predictive factors of the functional impact of foot abnormalities in RA patients. This was a cross-sectional study including patients with RA meeting the criteria of the American College of Rheumatology and the European League Against Rheumatism 2010. The main epidemiological data, results of podoscopic and clinical examination of the foot and ankle, biological tests and radiological findings were collected. The presence of foot pain was assessed by a visual analogic scale (0–10), and the functional impact of foot involvement was assessed based on the validated French version of the FFI. Fifty RA patients with an average age of 59.3 ± 9.9 years [39–79] were included, and 80% of them had foot involvement. Foot pain was present in 32 patients (64%), most frequently situated in the forefoot (56%). The average FFI score was 33.67 ± 30.53 [0–92.67]. The following factors had a significant association with the FFI score: an occupation soliciting the feet (p = 0.001), disease duration (p = 0.033, r = 0,302), the Health Assessment Questionnaire (p = 0.0001, r = 0,480), body mass index (p = 0.0001, r = 0,654), the presence of podiatric abnormalities (p = 0.0001) and Visual Analog Scale foot pain (p = 0.0001, r = 0,854). A significant association was also found between the FFI score and the presence of a hallux valgus (p = 0.004), a spread of the forefoot (p = 0.029), a claw of the toes (p = 0.002), a triangular forefoot (p = 0.0001), a quintus varus (p = 0.002), flat feet (p = 0.0001) and a valgus of the hindfoot (p = 0.001). Due to the high frequency of foot involvement and its significant functional impact, meticulous examination of the feet and assessment of their functional impact must be one of the parameters for monitoring the disease. Its impact on one's quality of life can be important. 4 (cohort studies, non experimental, observational studies). [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Collagenous colitis is a recent cause of chronic diarrhea. Cooccurrence with spondylarthropathy is rare. We describe two cases: one man and one woman of 33 and 20 years old were suffering from spondylarthropathy. They then developed collagenous colitis, 4 and 14 years after the onset of spondylarthropathy. The diagnosis was based on histological features. A sicca syndrome and vitiligo were observed with the female case. The presence of colitis leads to therapeutic problems. This association suggests a systemic kind of rheumatic disease of collagenous colitis. [ABSTRACT FROM AUTHOR]

Background Chronic recurrent multifocal osteomyelitis (CRMO) also known as aseptic osteomyelitis is a rare auto-inflammatory disease with an incidence estimated at 4/100 000 population [1]. The aim of our work was to report two cases of CRMO that illustrate challenges in the diagnosis of this rare disease. Method We report the case of two patients diagnosed with CRMO. Clinical, biological and radiological data as well as disease outcomes were described. We also collected data about treatment modalities. Results Two patients aged of 7 and 10 years respectively, without any notable pathological history, presented recurrent episodes multifocal painful swelling of limbs. In the first case, the symptoms concerned the left ankle and knee as well as the left hip, all associated with lameness and an altered general condition, with neither fever nor skin manifestations. In the second case, the swelling involved the right shoulder, right hip and the left ankle. There was no elevated CRP or ESR in any of patients. Immunological status (RF, anti-CCP, AAN) as well as the HLA-B27 antigen test were negative. In the first patient, standard radiographs showed lytic lesions of the proximal metaphysis of the tibia, the greater trochanter and the left lateral malleolus. MRI of the pelvis, knee, and sternum of the first patient revealed edematous involvement of the left greater trochanter, the right ilium, the proximal metaphyseal region of the tibia and the right edge of the sternum, whereas in the second patient, a whole-body MRI showed inflammatory signs over the left greater trochanter, the insertion of the gluteus medius and obturator externus, right trochanteric bursitis and oedema of the entire right ilium. In the first patient, bone scintigraphy showed intense uptake of radioisotopes in the left ilium, the 7 th right costo-vertebral junction, the trochanteric mass, the upper end of the tibia and the lower end of the left fibula. Bone biopsy showed bone remodeling in both cases without evidence of infection or tumor. The diagnosis of CRMO was retained, supported by the prompt response to NSAIDs and short-term corticosteroid therapy. However, the second patient presented, 8 years later, pain in the sterno-clavicular joint as well as the right hip. A relapse of the disease was confirmed by MRI. Therapeutic escalation with zoledronic acid 0.025 mg/kg intravenous infusion every six months allowed the resolution of the symptoms. Conclusion These observations illustrated a rare disorder in children, characterized by lytic lesions predominantly in the metaphysis of long bones. Bone scintigraphy allowed an early assessment of disease extension and histological examination ruled out a malignant tumor and an infection. The first-line treatment is anti-inflammatory drugs. In case of failure, bisphosphonates seem to be effective. [ABSTRACT FROM AUTHOR]

Introduction: Shared decision-making between rheumatologists and patients has become an overarching principle in current treatment recommendations in rheumatoid arthritis (RA). Therefore, in the present study, we aimed to assess the satisfaction of patients with RA with their treatment and to investigate the associated factors. Material and methods: A cross-sectional study was carried out in the Rheumatology Department of Mongi Slim Hospital. We included adults with RA receiving their current disease-modifying antirheumatic drugs for at least 12 months. Satisfaction among patients was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM) and it was defined by a score ≥ 80%. The factors indirectly influencing patient satisfaction that were assessed were: satisfaction with medical care management, disease activity, functional impact, professional impact, and the impact of RA. Multivariable regression analysis was applied to determine the predictors of satisfaction. Results: We included 70 patients (63 female/7 male) with a mean age of 57.8 ±10.6 years. The mean disease duration was 13.71 ±7.2 years. Mean TSQM scores were 65.42 ±14.77 for convenience, 68.71 ±18 for effectiveness, 70.60 ±24.5 for side effects, and 67.95 ±17.10 for global satisfaction. Satisfaction rates were: 20% for convenience, 39% for effectiveness, 46% for side effects and 30% for global satisfaction. In multivariable analysis, the predictors of global dissatisfaction were Rheumatoid Arthritis Impact of Disease (RAID) overall score (p = 0.003) and the degree of physical difficulties (p = 0.001). Satisfaction with the physician was correlated with better global satisfaction (p = 0.029). Difficulties in adapting to RA (p = 0.043) and current treatment with biologics (p = 0.027) were predictors of dissatisfaction with convenience. Predictors of dissatisfaction with efficiency were the RAID overall score (p = 0.032) and the difficulties of adapting to RA (p = 0.013). The predictors of satisfaction with side effects were a lower degree of interference with domestic work (p = 0.02) and better involvement of the patient in the treatment decision (p = 0.014). Conclusions: The satisfaction with the attending physician, the participation in the treatment decision, and the impact of RA seem to influence treatment satisfaction the most. These data suggest that a better understanding of patients’ medical needs and preferences would improve satisfaction outcomes. [ABSTRACT FROM AUTHOR]