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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]

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]

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]