Search

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]

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]