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Objectives To compare the prevalence of ultrasonographic gout specific signs at the dorsal and plantar surfaces of the metatarsophalangeal joints (MTP). Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B mode. 150 articular sites were studied at their dorsal and plantar surfaces. The ultrasound has objectified the presence of two signs: hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) and the tophaceous deposits at the joint cavity. We compared the prevalence of the two signs between the dorsal and palmar surfaces at each site studied. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1. Conclusions Our study suggests that globally, DC predilect significatily in dorsal than in plantar surfaces of MTP joints. These results should be verified on a larger population. Disclosure of Interest None declared

Objectives To compare the prevalence of ultrasonographic gout specific sign double contour between the dorsal and palmar surfaces of the hand joints. Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B and Doppler modes. 560 articular sites were studied at their dorsal and palmar surfaces. We compared the prevalence of the hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) between the dorsal and palmar surfaces at each site studied. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1 Conclusions Our study suggests that globally, DC predilect significatily in dorsal than in palmar surfaces of hand joints. These results should be verified on a larger population. Disclosure of Interest None declared

Objectives To evaluate the prevalence of ultrasonographic gout specific signs of hand and fingers joints. Methods This is a cross-sectional study which includes 15 patients with chronic gout, defined according to the American College of Rheumatology criteria (ACR 1977). Ultrasound (US) examination was performed using a high-frequency linear probe (Toshiba Xario®, frequency (8–14 MHz)) in B mode. 540 articular sites were studied at their dorsal surface. The ultrasound has objectified the presence of two signs: hyperechoic band over the superficial margin of the articular cartilage described as a double contour (DC) and the tophaceous deposits at the joint cavity. Results The mean age at onset was 54.7±12,6 years, and the median diagnosis duration was 0 (0.3) years). The results of the US examination are summarized in Table 1. Conclusions This study showed a predilection for the gout specific ultrasound signs (DC and tophaceous deposits) of the wrist and MCP joints. The contribution of musculoskeletal ultrasound seems to be very interesting to objectify the presence of gout specific signs in the hand and fingers joints. Disclosure of Interest None declared

The aims of this study are to evaluate vitamin D status in 1413 RA patients of COMORA study from 15 countries and to analyze relationship between patients’ RA characteristics and low levels of vitamin D. All demographic, clinical, and biological data and RA comorbidities were completed. The results showed that the average of vitamin D serum dosage was 27.3 ng/mL ± 15.1 [0.1–151]. Status of vitamin D was insufficient in 54.6% and deficient in 8.5% of patients. 43% of RA patients were supplemented with vitamin D and absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency (p<0.001). Finally, our study shows that the status of low levels of vitamin D is common in RA in different countries and under different latitudes. Absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency. Low levels of vitamin D were associated with patients characteristics (age, BMI, and educational level), RA (disease activity and corticosteroid dosage), and comorbidities (lung disease and osteoporosis therapy). This suggests the need for a particular therapeutic strategy to improve vitamin D status in RA patients.

The aim of this study was to assess the responsiveness to change of the quality of life evaluated by the EuroQol Five Dimensions Questionnaire (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) after biological treatment in a population of rheumatoid arthritis patients. A cohort of patients with RA (n = 29) treated with tocilizumab (TCZ) were analyzed in the study. The inclusion criteria were patients aged between 18 and 65 years, fulfilling American College of Rheumatology 1987 criteria for RA. All patients had inadequate response to methotrexate and with no prior biologic exposure. They were evaluated clinically including Disease Activity Score 28 (DAS28), and the European Quality of Life 5 Dimensions (EQ-5D) to measure the quality of life, and HAD assessed the anxiety and depression status at the initiation of treatment with anti-IL 6 receptor antibody agent and after 6 months. Sensitivity to change was quantified by the effect size (ES) before and after the treatment with TCZ. Among 29 patients with RA included in the study, 25 were females and 4 males. The mean age was 42 years ± 13.4 (SD). Three patients were excluded from the study before 24 weeks because of serious side effects, and five have missing data. The study population exhibited significant decreases in all measures of disease activity at 24 weeks. Physical activity expressed by the Health Assessment Questionnaire (HAQ) score increased through the observation period (for all p

Abnormal puberty is often reported in children suffering from many chronic diseases. Juvenile idiopathic arthritis (JIA) is the most common joint disorder in developing children. The aim of this study was to assess sexual maturation of Moroccan children with JIA and to compare the development of secondary sexual characteristics in children with JIA to children in the general population. Forty children with JIA and 74 healthy controls were included in a cross-sectional study. The diagnosis of JIA was made according to the criteria of the International League of Association of Rheumatology. Every child was examined for the development of genitalia as per criteria given by Tanner. The children with JIA were also divided into 3 groups: pre-puberty (stage 1), puberty (stages 2-3) and post-puberty (stage 4-5), and the association between puberty and cumulative dose of steroids, disease duration, disease activity, height, weight and age was investigated. Forty children with JIA were included (22 male, 18 female); the mean of age of the patients was 11 ± 4.23 years. Puberty in the patients (mean of tanner 2.43 ± 1.36) was lower than controls (2.55 ± 1.36). The prevalence of the children in prepuberty was of 15 (37.5 %) and 8 (20 %) in postpuberty. The prevalence of the children having a delayed puberty was of 6 (15 %) versus 1(1.4 %) in healthy controls (p = 0.005). There was an association between dose of corticosteroids, age at the administration of corticosteroids and the delayed puberty in boys (p = 0.009). In addition, there was no significant association in both sex between this poor puberty and duration of JIA (p = 0.45 in boys and p = 1.99 in girls) and its activity calculated by the DAS28 (p = 0.73 in boys and p = 1). Our study suggests that the puberty is retarded in Moroccan patients with JIA comparing to healthy children and that the dose of corticosteroid and the age at its administration may contribute to delayed puberty in boys.

Objective: To examine whether vitamin D deficiency is a determinant risk factor of chronic low back pain (LBP) in Moroccan postmenopausal women. Methods: A biochemical assay of serum calcium, phosphate, 25(OH)D, and parathormone (PTH) was performed for 105 patients complaining from a chronic LBP with no obvious causes and compared to those of 45 healthy patients. All participants were postmenopausal. Patients were matched with controls for age and body mass index (BMI). Vitamin D deficiency was defined as a circulating level of 25(OH)D below 20 ng/ml. Results: Vitamin D deficiency was significantly more common in patients suffering from chronic LBP than in controls (79 p vs 61.4 p; P= 0.02). Falls antecedent was also associated with chronic LBP (37.1 p in patients vs 20.5p in controls; P< 0.01). There was no significant association between chronic LBP and age, BMI, smoking status, nor with number of pregnancies. In multiple logistic regression, after adjusting for potential confounders factors potentially influencing chronic LBP (age, BMI, smoking status, number of pregnancies), the main determinants of chronic LBP were vitamin D deficiency [OR 2.5 (95p IC, 1.1-5.8; P = 0.04)] and falls antecedent [OR 3 (95p IC, 1.2-7.2; P = 0.01)]. Conclusion: Our study shows a significant association between vitamin D deficiency and chronic LBP in Moroccan postmenopausal women. Further studies are clearly warranted to determine the effectiveness and the mechanism(s) of this links between vitamin D deficiency and chronic LBP.

Resume Dans de rares circonstances les depots de microcristaux a apatite peuvent interesser des localisations inhabituelles. C’est le cas du rachis cervical ou toutes les structures anatomiques peuvent etre concernees (tendons, ligaments, disques intervertebraux, articulations interapophysaires posterieures, pseudotumeurs inflammatoires du foramen magnum…). Comme dans le rhumatisme a pyrophosphate de calcium, le tableau clinique peut etre tres bruyant et trompeur et peut conduire inutilement a des conduites diagnostiques et therapeutiques invasives. La connaissance de ces pathologies peut aider le clinicien a porter rapidement le diagnostic et a decider d’un traitement conservateur en l’absence de retentissement neurologique significatif.

Objectives The patient acceptable symptom state (PAccSS) is the value beyond which patients consider themselves well. Our aim was to determine the PAccSS of chronic pain in Moroccan outpatients suffering from chronic rheumatic diseases and to identify contributors to PAccSS. Methods A 4-week prospective study of 387 outpatients suffering from chronic rheumatic diseases was carried out. Pain level was evaluated using a 0–100 mm visual analog scale. An anchoring method based on patient's opinion was used. The PAccSS was defined as the 75th percentile of the score for patients who considered their state satisfactory. Pearson's chi-square and binary logistic regression were used to analyze the data. Results The underlying disease of the patients (mean age 50 ± 13 years; female sex 70%) was rheumatoid arthritis (N = 102), ankylosing spondylitis (N = 100), peripheral osteoarthritis (N = 100), and degenerative back pain (N = 85). The mean disease duration was 7.4 ± 6.7 years. At the time of the study, the level of pain was 44 ± 23 mm. One hundred ninety (49%) patients considered their state as satisfactory, and the PAccSS threshold was 50 mm. Significant contributors to PAccSS were high educational level, high socioeconomic status, higher functional status scores, and shorter term disease duration. Conclusion Half of patients were satisfied of their disease state, while the PAccSS threshold of pain was unexpectedly high. This could be explained by an overestimation of the pain intensity or a Moroccan patients' high tolerance to pain. The main protective factors that contribute to achieving the PAccSS were high educational level, high socioeconomic status, higher functional status, and shorter term disease duration.

Objective.To establish cutoffs for the minimum clinically important improvement (MCII) and the patient-acceptable symptom state (PASS) for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in patients with ankylosing spondylitis (AS).Methods.Patients with AS who started nonsteroidal antiinflammatory drugs were included. After 4 weeks, the PASS and the MCII were defined using external anchor questions (for the PASS, patients considering their condition of AS over the prior 48 h as “acceptable” forever; and for the MCII, those reporting moderate or slightly important improvement). Consistency of the MCII and PASS were tested according to HLA-B27 status, presence/absence of SpA extraarticular manifestations, age, sex, disease duration, and baseline BASDAI/BASFI score. The 75th percentile of the cumulative distribution was used to determine the MCII and PASS.Results.In total, 283 patients from a multinational cohort were included. Overall cutoffs for the PASS were 4.1 in the BASDAI and 3.8 in the BASFI. Cutoffs for the MCII were 0.7 and 0.4 for the BASDAI and BASFI, respectively. Subgroup analyses revealed that disease duration and baseline BASDAI/BASFI were significantly associated with the PASS and MCII. In a subanalysis limited to patients with active disease (baseline BASDAI ≥ 4), the MCII was 1.1 for the BASDAI and 0.6 for the BASFI.Conclusion.The conceptual viability of the PASS for the BASDAI is questionable because levels approach those required for the start of biological therapy. Because the MCII is less variable than the PASS, we propose its exclusive use, with cutoffs of 1.1/0.6 for the BASDAI/BASFI in patients with active disease. Because these values are based on a subset of the study population, we recommend confirmation in larger studies focused on patients with baseline BASDAI ≥ 4.

Evaluate the prevalence of sarcopenia on patients with rheumatoid arthritis (RA), the influence of sarcopenia on disease activity and factors associated with sarcopenia. One hundred and twenty-three patients aged over 18 years with RA based on the 1987 ACR/EULAR classification criteria were enrolled. We performed a whole body DXA scan using a dual-energy X-ray absorptiometry (DXA) scanner lunar prodigy to measure fat mass, lean mass, and bone mass in the whole body and body parts. According to the anthropometric equation by Baumgartner et al., sarcopenia was defined as Relative skeletal mass index (RSMI)

Introduction: Chronic pain in rheumatology often has a psychic impact, which may aggravate the daily life of patients. Chronic neck pain, as an example, is a frequent reason for consultation. The aim of this study is to assess the prevalence of anxiety and depression in patients with neck pain, and identify risk factors associated with their occurrence. Methods: it was a cross-sectional study that concerned 80 patients with neck pain lasting for more than 3 months, seen in rheumatology consultations. All patients with symptomatic neck pain or psychological history or receiving psychotropic medication were excluded from the study. For each patient, we determined the sociodemographic characteristics and clinical ones. The anxious and depressed mood was assessed by the Hospital Anxiety and Depression Scale (HAD). Results: Of the 80 patients, 67 (83.8%) were women. Average age of our population was 51.8± 11.8 years. Median duration of symptoms was 24 months [12, 48]. Mean VAS pain was 63.9% ± 12.5, mean VAS functional discomfort was 60.9% ± 14.2 and mean VAS disability was 59.8% ± 14.7. 32 patients (40%) were illiterate and 18 (22.5%) had university level. Anxiety was found in 54 (68.4%) and 44 (55.7%) patients were depressed. In univariate analysis, VAS disability was statistically linked to anxiety (OR:1.05; 95%CI: 1.01-1.08; p = 0.02). The cervicobrachial neuralgia (CBN) was significantly associated with depression (OR: 3.33; 95%CI: 1.20-9.23; p=0.02). Primary education level had a statistically significant relationship with anxiety (OR: 6.00; 95%CI: 1.03-34.84; p=0.04) and depression (OR: 5.00; 95%CI: 1.09-22.82; p=0.03). In multivariate analysis, VAS disability and CBN were independently associated with anxiety and depression respectively. Conclusion: This study underlines the fact that anxiety and depression are prevalent in chronic neck pain (CNP) patients. Furthermore, disability and CBN which are linked to CNP can predict which patient is at higher risk of psychological distress.The Pan African Medical Journal 2016;24

In Morocco, the patients affected by ankylosing spondylitis (AS) presents a high frequency of coxitis. Our study reports, for the first time, the polymorphism of Human Leukocyte Antigen (HLA) class I and class II molecules in the Moroccan patients.Forty-six patients diagnosed with an AS and coxitis were compared to a group of 183 healthy controls matched by age, sex and ethnic origin. The HLA typing was performed using microlymphocytotoxicity for the class I (-A, -B) and PCR-SSP for the class II (-DR, -DQ).We found a significant increase of the HLA-B27 antigen frequency (P0.0001, RR=20.9) in AS patients (29.3%) compared to the controls (3.2%) and a significant decrease in the frequency of HLA-B12 and HLA-B18 antigens. Examination of HLA class II distribution shows a significant increase of the HLA-DRB1*11 allele frequency in patients (P0.0001). Concerning HLA-DQB1* alleles, no significant difference between patients and controls was appreciable.The HLA-B27 antigen is involved in the predisposition to the AS with coxitis in the Moroccan population. However, the low frequency observed in our population suggests the existence of other genetic and/or environmental factors. Other HLA genes seem to confer a predisposing effect (DRB*11) or a protective effect (B12 and B18) against the disease.

We aimed to assess the aspects of health-related quality of life (HRQoL) in Moroccan patients with rheumatoid arthritis (RA) and to evaluate the disease-related parameters influencing it. Two hundred fifty-five patients with RA were consecutively included. We assessed sociodemographic characteristics, cigarette smoking status, disease duration, diagnosis delay, joint pain intensity (on a 0-100-mm visual analogue scale), disease activity (by the disease activity score (DAS 28) and biological tests), structural damage (by radiographs scored using the Sharp's method as modified by Van der Heijde), functional disability (by the Health Assessment Questionnaire), extra-articular manifestations, immunological status, and treatments. The Arabic version of the Medical Outcomes Study Short Form 36 Health Survey (SF-36) was applied to assess HRQoL. All domains of SF-36 were deteriorated in a significant way comparing to the general population. The most affected subgroups of SF-36 were role limitation, role emotional, vitality, and social functioning. Women had significantly lower scores of SF-36 compared to men. Patients with decreased levels of education and low socioeconomic status had significantly lower scores of SF-36 (for all p ≤ 0.01). Current and ex-smokers had lower scores in physical domains of quality of life. Patients treated with methotrexate had better scores of mental health. Furthermore, patients receiving biologic agents had better scores of physical and social domains. Decreased scores of SF-36 were significantly correlated with disease duration, joint pain intensity, clinical and biological disease activity, functional disability, and radiographic damage. The level of antibodies against citrullinated peptides had significant correlations with the impairment of physical domains of SF-36. Physical as well as mental aspects of HRQoL in our RA patients were significantly deteriorated. Recognizing complicated relationships between HRQoL and disease-related variables among our RA patients can help to develop further management strategies to improve patients' daily living particularly with the advent of new treatments.

Resume L’association d’une paraplegie et d’une amputation du membre inferieur complique le processus de reeducation et de readaptation et diminue les chances de recuperation de la position debout et de la marche. Cet article decrit le cas d’une paraplegie de niveau T11 avec une amputation tibiale. Apres 11 mois de prise en charge en reeducation, la patiente a pu deambuler a l’aide de deux cannes canadiennes, avec un grand appareillage de marche associant une orthoprothese a gauche et une orthese pelvipedieuse classique a droite.

Background and objective: The aim of this study was to evaluate the association between dietary intake and bone mineral density in children with juvenile idiopathic arthritis (JIA). Methods: A cross-sectional study carried out in Morocco between May 2010 and June 2011, covering out patients with JIA. The characteristics of patients were collected. The nutritional status was assessed by a food questionnaire including data of food intake during 7 consecutive days using 24-hour dietary recall. Food intake was quantified using the software Bilnut (Bilnut version 2.01, 1991). Bone mineral density (BMD in g/cm2) was measured by DXA method (X-ray absorptiometry) on a Lunar Prodigy. Results: The study consisted of 33 patients with JIA (4 - 16 years old). The median age of patients was 10.4 ± 4.3 years. Median disease duration was 2 (1 - 4.5) years. The group of patients with low dietary intake of proteins was associated with low BMD (p = 0.03). Low BMD was related with low intake of magnesium (p = 0.007) and vitamin C (p = 0.04) in children aged between 4 and 9 years. Low intake of vitamin E and folate was associated with high BMD in the other range of children (p < 0.001). Conclusion: This study suggests that low intake of protein and of some micronutrients (magnesium, vitamin C, vitamin E and folate) influence bone mass in children with JIA. Prospective studies with a larger number of patients seem to be necessary in order to confirm our findings.

EXTRACTSous le Haut Patronage de Sa Majesté Le Roi Mohammed VI, l’Université Mohammed VI des Sciences de la Santé a eu le privilège de recevoir l’Académie de médecine de France, qui pour sa première séance délocalisée à l’étranger, a choisi le Maroc et notre établissement.Parce que cette rencontre peut légitimement être considérée comme historique, il est bon d’en rappeler les éléments marquants. Son projet a particulièrement été défendu et porté, avec l’appui inconditionnel du Pr Abdelaziz Maaouni, Président Directeur Général, ....

Fatigue is a frequent symptom during ankylosing spondylitis (AS) often under estimated which needs to be measured properly with respect to its intensity by appropriate measures, such as the multidimensional assessment of fatigue (MAF). The aims of this study were to translate into the classic Arabic version of the MAF questionnaire and to validate its use for assessing fatigue in Moroccan patients with AS. The MAF contains 16 items with a global fatigue index (IGF). The MAF was translated and back-translated to arabic, pretested and reviewed by a committee following the Guillemin criteria (J Clin Epidemiol 46:1417–1432, 1993). It was then validate on 110 Moroccan patients with AS. Reliability for the 3-day test–retest was assessed using internal consistency by Cronbach’s alpha coefficient and the intra-class correlation coefficient (ICC). External construct validity was assessed by correlation with pain, activity of disease and other keys variable. The reproducibility of the 15 items was satisfactory with a kappa statistics of agreement superior to 0.6. The ICC for IGF score reproducibility was good and reached 0.98 (IC 95%, 0.96–0.99). The internal consistency was at 0.991 with Cronbach’s alpha coefficient. The construct validity showed a positive correlation between MAF and the axial (r = 0.34) and peripheral (r = 0.32) visual analogical scale, the Bath ankylosing spondylitis disease activity index (BASDAI) (r = 0.77), the first item of BASDAI (r = 0.85), the functional disability by the Bath ankylosing spondylitis functional index (r = 0.64), the erythrocyte sedimentation rate (r = 0.43) and the C reactive protein (r = 0.30) (for all P

Background: The evaluation of emotional status is an important parameter in management of rheumatic diseases. There are few studies evaluating the psychological status in ankylosing spondylitis (AS) and its relationships with disease parameters and quality of life. Objective: In this study, we evaluated the psychological status in Moroccan patients with AS and its relationships with the activity of the disease, the functional status, and the quality of life. Patients: One hundred ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Psychological status was assessed by the Hospital Anxiety and Depression Scale (HADS) including the depression and anxiety subscales. The quality of life was evaluated by the Short Form 36. Results: Depression was found in 55.5% and anxiety in 60% among our patients. The HADS depression and anxiety subscales were significantly correlated with clinical parameters and with worsening in all domains of the Short Form 36. Multivariate logistic regression analysis revealed that role limitations due to emotional problems, vitality, and general health perception were independent risk factors of anxiety. The Bath Ankylosing Spondylitis Functional Index, vitality, and role limitations due to emotional problems were the independent factors that influenced the risk of depression. Conclusion: This study suggests that depression and anxiety are frequent in AS. Impaired quality of life and functional disability seemed to be independent risk factors of psychological disorders. Therefore, assessment and management of patients with AS should take into account the evaluation and management of their psychological disorders and improvement of their functional disability.

Resume Objectif L’objectif de cette etude etait d’evaluer la remission chez les patients avec polyarthrite rhumatoide (PR) precoce traites par des medicaments antirhumatismaux modifiant l’evolution de la maladie (DMARDs) conventionnels et d’identifier des facteurs predictifs possibles de remission. Methodes Les patients atteints de PR precoce ( Resultats Cinquante et un patients (88,2 % femmes, âge moyen de 46,9 [24–72] ans, avec une duree moyenne d’evolution de la maladie de 24 [6–48] semaines) ont ete inclus dans l’etude. Le delai avant consultation specialisee etait de 140 (7–420) jours. Le facteur rhumatoide (FR), les anticorps anti-CCP, les alleles l’HLA-DRB1*01 et DRB1*04 etaient presents respectivement chez 62,5 ; 56,6 ; 11,8 et 45,1 % des patients. A 24 mois, 77,2 % des patients recevaient une dose mediane de 5 (0–8) mg/jour de prednisone et 65,2 % prenaient du methotrexate (MTX). Le DMARD a ete arrete chez 13,6 % des patients en raison de difficultes socioeconomiques. A 24 mois, nous avons observe une amelioration significative de la raideur matinale, du score de douleur, du nombre de synovites, de la VS, de la CRP, des scores DAS 28 et HAQ. La remission a deux ans a ete observee chez 34,8 % des patients et etait correlee significativement au sexe masculin ( p = 0,02) et a un delai court pour beneficier d’une consultation specialisee ( p = 0,03) en analyse univariee mais pas multivariee. Conclusion Dans cette cohorte de patients atteints de PR precoce et traites par DMARDs conventionnels, notamment par le MTX en monotherapie, la remission a deux ans de suivi a ete obtenue chez un tiers des patients. Aucun facteur predictif de remission n’a ete retrouve. Ces resultats demandent a etre verifies par d’autres etudes.

Resume Objectif Notre objectif etait d’estimer la prevalence du surpoids parmi les enfants et adolescents marocains atteints d’arthrite juvenile idiopathique (AIJ). Methodes Cinquante-huit patients atteints d’AIJ selon les criteres de l’International League of Association of Rheumatology (ILAR) ont ete inclus consecutivement dans cette etude. L’âge median des patients etait de 11 ± 3,3 ans (ecart 2–16). Le surpoids et l’obesite etaient definis par l’index de masse corporelle (apparie selon l’âge et le sexe et en reference aux courbes francaises). Les donnees suivantes etaient colligees : âge, sexe, âge de debut, duree de la maladie, sous-types d’AIJ, incapacite fonctionnelle (determinee selon la version marocaine du Childhood Health Assessment [CHAQ]), activite de la maladie (evaluee avec une echelle visuelle analogique [EVA] de 0–10), nombre d’articulations douloureuses et gonflees, vitesse de sedimentation ainsi que le traitement medical et le statut socioeconomique des patients. Resultats Vingt-quatre patients (41,4 %) etaient en surpoids, 13 (22,4 %) etaient obeses et 21 (36,2 %) avaient un poids normal. Les patients avec un poids normal, obeses et en surpoids representaient successivement 16,7 %, 33,3 % et 50 % des formes systemiques, 33,3 %, 8,3 % et 58,3 % des formes seronegatives polyarticulaires, 40 %, 40 % et 20 % des formes polyarticulaires seropositives, 36,4 %, 27,3 % et 36,4 % des formes persistantes oligoarticulaires, 75 %, 25 % et 0 % des formes extensives oligoarticulaires et 57,1 %, 0 % et 42,9 % des formes avec arthrites et enthesites. Dans notre etude, il n’y avait pas de rhumatisme psoriasique. Le surpoids et l’obesite etaient plus frequemment observes chez les patients plus âges (p = 0,01), avec une atteinte fonctionnelle significative (p = 0,04) et une maladie active (EVA augmentee) (p = 0,005). Il n’y avait pas de relation avec le sous-type d’AIJ ni avec le traitement par glucocorticoides (p = 0,451). Conclusion Environ plus de 60 % de nos patients etaient au moins en surpoids. Une atteinte fonctionnelle severe et une maladie active sont les parametres les plus correles au surpoids. Une meilleure prise en charge de l’activite de la maladie et de la capacite fonctionnelle pourrait etre interessante pour empecher le surpoids chez l’enfant atteint d’AIJ. Plus d’etudes avec un plus grand nombre de patients semblent etre necessaires pour confirmer nos resultats.

Primary objectives To describe the symptoms of chronic post-concussion syndrome (PCS) and to investigate the relationship between the persistence of these symptoms and different aspects of social life (return to work, quality of life, sport and leisure activities and family relationships) in Moroccan patients with mild traumatic brain injury (MTBI), one year after the trauma. Methods Forty-two adult patients who sustained MTBI were reviewed one year after trauma. We investigated the persistence of PCS by using the “Problem Checklist” questionnaire. We also assessed their quality of life using a visual analogue scale, and noted the changes in employment status, social activities and family relationships. Then, we examined whether there were significant relationships between these different data. Results More than half of the patients (n = 23, 54.8%) were found with persistent post-concussion symptoms at one year post-injury. Chronic PCS was significantly more common in married persons (p = 0.008) and significantly related to both non return to work (p ≤ 0.01), and QoL deterioration (p ≤ 0.001). Conclusion In this study, a large proportion of persons who sustained a MTBI experienced persistent symptoms up to one year after trauma. MTBI might have significant and lasting impact on the quality of life, which is to be verified by further studies.

The BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) is the most widely used instrument for the assessment of disease activity in ankylosing spondylitis (AS). Objective. The aims to investigate whether the alternative BASDAI, here termed as the miniBASDAI [(Question (Q) 1 fatigue + Q2 spinal pain) + mean of (Q5 strength morning stiffness + Q6 duration morning stiffness)] / 3], measures disease activity more accurately in the subgroup of AS patients without peripheral manifestations. One hundred and ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Clinical and biological parameters were evaluated. The disease activity was evaluated by the BASDAI. We calculated the miniBASDAI by omitting both the peripheral joints and the enthesitis questions: questions 3 and 4. Patients were dichotomized into a "P+" group if peripheral manifestations were present (at least arthritis or enthesitis) and a "P-" group, the subgroup without peripheral involvement (with either arthritis or enthesitis). Correlation of the BASDAI and miniBASDAI with other disease parameters were examined with the Spearman's rank correlation analysis. One hundred and ten patients were recruited. The percentage of patients with pure axial disease manifestation without peripheral involvement "P - group" was 42.7%. We found a similarly good correlation of the miniBASDAI with patient global, physician on disease activity, BASFI, ESR and CRP if compared to the correlation of the original BASDAI with these disease parameters, also in the group without peripheral involvement. Our study suggests that the BASDAI remains valid in assessing disease activity in AS patients with and without peripheral manifestations.

We aimed to evaluate the immunological status and its relationships with disease-related parameters of activity, severity and quality of life in Moroccan patients with rheumatoid arthritis (RA). Two hundred forty-five consecutive patients with RA were recruited. The following data were collected: demographic characteristics, disease duration (years), disease activity (evaluated by the disease activity score, DAS28), structural damage (evaluated by Sharp's method as modified by van der Heijde), functional disability (assessed by using the Moroccan version of the Health Assessment Questionnaire, HAQ) and quality of life (by using the Arabic version of the Medical Outcomes Study Short Form 36 Health Survey: the SF-36). Immunological status (rheumatoid factor rate, RF) and antibodies against citrullinated peptides rate (ACPAs) by the Elisa method were examined. ACPAs were detected in 75.1% of patients with a mean rate of 79.2 ± 43.8 UI. RF was detected in 80.8% of patients with a mean rate of 80.1 ± 50.6 UI. Patients with positive RF and ACPAs had higher disease activity, impaired functional ability, severe structural damage, more ocular symptoms and altered aspects of quality of life. In univariate analysis, higher levels of ACPAs were significantly correlated with the age at onset (r = 0.307), disease duration (r = 0.520), disease activity (DAS28) (r = 0.531), Sharp score (r = 0.431), and with the deterioration of all domains of SF-36 (for all p ≤ 0.01). RF levels were correlated with disease duration (r = 0.517), disease activity (r = 0.470), functional disability (r = 0.521), and the alteration of physical domains of SF-36 (for all p ≤ 0.01). In multivariate analysis, the main factors associated to ACPAs and RF levels were functional disability, structural damage and impaired QoL. Furthermore, using the SF-36 scores as dependent variables, the impairment of physical domains and the domain of vitality were significantly associated with ACPA levels while the decrease of the domain of physical function was associated with the level of RF. Our study suggests that the presence and the levels of ACPAs and RF in our RA patients are associated with more active disease, more severe joint damage, worst functional disability and altered aspects of quality of life.

We report a rare case of multifocal septic arthritis associated to spondylodiscitis and endocarditis caused by group A beta-hemolytic streptococcus (GABHS) in an immunocompetent adult, and we discuss diagnosis and therapeutic difficulties, while insisting into the rational use of corticosteroids that seems to be the only risk factor in our patient.

Our aim was to evaluate fatigue and quality of life (QoL) in Moroccan patients with primary Sjögren's syndrome (PSS) and determine their correlates with disease-related parameters. Fifty-seven consecutive patients with PSS according to the American-European Consensus group (AEGG) criteria were included. Demographic, clinical, biological and immunological characteristics for all patients were collected. Xerostomia was demonstrated by histological grading of lower lip glandular biopsy. A Schirmer test was performed to measure lachrymal flow. Oral, ocular, skin, vaginal and tracheal dryness were evaluated by using a visual analogue scale (VAS). Fatigue was assessed by the Multidimensional assessment of fatigue (MAF) and the QoL by using the generic instrument: SF-36. 90% of our patients were women. The mean age of patients was 53.73 ± 7.69 years, and the mean disease duration was 5.38 ± 4.11 years. The mean oral dryness was 68.38 ± 20.29, and the mean ocular dryness was 51.91 ± 14.03. The mean total score of the MAF was 26.73 ± 8.33, and 87.5% of our patients experienced severe fatigue. Also, physical and mental domains of QoL were altered in a significant way, and the severity of fatigue had a negative impact on SF-36 scores. MAF and SF-36 scores were correlated with the delay of diagnosis, the intensity of xerostomia and the activity of joint involvement. A low socioeconomic and educational level had a negative impact on fatigue scores and QoL. Histological grading of lower lip glandular biopsy, immunological status and the severity of systemic involvement had no correlations with fatigue scores or the alteration of QoL. Patients receiving antidepressant have lesser fatigue and those receiving Methotrexate have better SF-36 scores. In our data, there was a high prevalence of fatigue in Moroccan patients with PSS associated with altered QoL. Severe fatigue and reduced QoL seem to be related to the severity of joint involvement, xerostomia and both educational and socioeconomic levels. Also, treatment with methotrexate and antidepressant seems to improve patients' living and QoL. An appropriate therapeutic intervention for depression and articular manifestations in PSS should be applied to improve patients' living.

Septic arthritis remains an important and serious disease of the young because of its high potential to cause permanent sequelae. The hip is the most commonly involved joint in infants and in the young (35%). Most often, patients have a single joint involved. We report here a rare case of septic arthritis reaching both hips, shown by a severe septicemic shock and complicated unusually by a psoas abcess and osteitis in an immunocompetent adolescent.

To determine the prevalence and predictors factors of depression in Moroccan patients with systemic sclerosis (SSc), we conducted a cross-sectional study of 59 Moroccan patients with systemic sclerosis. Patients were assessed by using the Patient Health Questionnaire depression scale "PHQ-9" and through extensive clinical histories and medical examinations. The Arabic version of HAQ and SF-36 was used to assess functional disability and health status, respectively. Forty-six patients (77.4%) presented symptoms of depression. Thirty six (61%) have a major depressive syndrome and 10 (16.4%) have a minor depressive syndrome. The PHQ-9 score was significantly higher in the patient with prolonged disease duration, severe joint pain, higher disease severity, and important acute-phase reactants. Also, depression had a negative impact on physical and mental scores. Systemic scleroderma is associated with a high prevalence of depression. Screening for depression among patients with SSc is recommended and it should be assessed for routinely.

This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint pain. The erythrocyte sedimentation rate and C-reactive protein were measured. To assess psychological status, the hospital anxiety and depression scale (HADS) was used. Sleep disturbance was assessed by the fourth item of Hamilton anxiety scale. One hundred and ten patients were included, of average age 38.0 years ± 12.6. In our data, 66.4% experienced severe fatigue (BASDAI fatigue ≥ 5). The mean total score of MAF was 26 ± 12.77. The disease-specific variables contributed significantly with both BASDAI fatigue and MAF as dependent variables, accounting for 71.3 and 65.6% of the variance, respectively. The contribution of the depression, anxiety, and sleep disturbance were 24.9, 18.4 and 15.4%, respectively. This study state the importance of fatigue in AS patients. Even though disease activity was the most powerful predictor of fatigue, the effects of psychogenic factors and sleep disturbance, should be taken into consideration in the management of AS.

The last few years have witnessed considerable progress in the diagnosis and treatment of spondyloarthritis (SpA). Tools are now available for establishing the diagnosis at an early stage, when appropriate treatment may be able to control the inflammatory process, limit the functional impairments, and improve quality of life. Late-onset SpA after the age of 50 years is uncommon. All the spondyloarthritis subgroups are represented in the elderly. Thus, late onset spondyloarthritis is underdiagnosed in favour of other inflammatory disorders that are more frequently observed in the elderly because the clinical or radiological presentations of late-onset spondyloarthritis are modified in the elderly. They deserve further attention because age population is increasing and new criteria for axial SpA including sacroiliitis detected by MRI may help the clinician with diagnosis. Specific studies evaluating the benefit/risk ratio of TNFα-blocking agents in late onset SpA patients are required.

Vertebral fractures are the hallmark of osteoporosis, responsible for increased back pain, impairment of mobility and functional limitations. These factors have an impact on patients’ health-related quality of life (QOL). The aim of this study was to evaluate the prevalence of vertebral fractures in Moroccan postmenopausal women and to assess their QOL, using an Arabic validated version of QUALEFFO. The study recruited 347 postmenopausal women in obvious good health. We excluded women who had used a drug or who had chronic diseases affecting bone metabolism. All patients had density measurements and spinal radiography. Each vertebral body (T4–L5) was graded using the semiquantitative method of Genant. The mean age was 60 years. Forty-six percent of patients had at least one vertebral fracture. The prevalence ranged from 31% in patients 50–55 years to 69% in patients 65 years and older. Patients with vertebral fractures were older (61.6 ± 8 vs 57 ± 7 years, P < 0.001), had more frequent history of nonvertebral fractures, and had spine and hip BMD values significantly lower (P < 0.001) than patients without vertebral fractures. In multivariate analysis, older age and a history of nonvertebral fractures were the two independent clinical factors of vertebral fractures. The number of fractures was a determinant of a low QOL, as indicated by an increased score in physical function, social function, mental function, and general health [for all (P < 0.05)]. Patients with higher grades of vertebral deformities, i.e., more severe fractures, had low QOL in these four domains. Patient with thoracolumbar fractures had a worse general health than patients with thoracic or lumbar fractures. We found a high prevalence of vertebral fractures probably explained by socioeconomic factors in Morocco. QOL, assessed by an osteoporosis-specific instrument, is decreased in postmenopausal women as a function of both the number and the severity of the vertebral fractures. Treating women with prevalent fractures may avoid a further decrease in their quality of life.

Objective To conduct a systematic review to identify and describe the scope and nature of the research evidence on the effectiveness of interventions to improve health care quality or reduce disparities in the care of disadvantaged populations with osteoarthritis (OA) as an example of a common chronic disease. Methods We searched electronic databases from 1950 through February 2010 and grey literature for relevant articles using any study design. Studies with interventions designed explicitly to improve health care quality or reduce disparities in the care of disadvantaged adult populations with OA and including an evaluation were eligible. We used the PROGRESS-Plus framework to identify disadvantaged population subgroups. Results Of 4,701 citations identified, 10 met the inclusion criteria. Eight were community based and 6 targeted race/ethnicity/culture. All 10 studies evaluated interventions aimed at people with OA; 2 studies also targeted the health care system. No studies targeted health care providers. Nine of 10 studies evaluated arthritis self-management interventions; all showed some benefit. Only 1 study compared the difference in effect between the PROGRESS-Plus disadvantaged population and the relevant comparator group. Conclusion There are few studies evaluating the effectiveness of interventions to improve health care quality in disadvantaged populations with OA. Further research is needed to evaluate interventions aimed at health care providers and the health care system, as well as other patient-level interventions. Gap intervention research is also needed to evaluate whether interventions are effective in reducing documented health care inequities.

In this study, we evaluated the relationship between enthesitis and clinical, laboratory and quality-of-life parameters in ankylosing spondylitis (AS) in Moroccan patients. Seventy-six patients were included in this cross-sectional study according to the modified New York criteria for AS. All patients had enthesitis involvement. Clinical and biological parameters were evaluated. Enthesitis were assessed by two indices: Mander Enthesis Index (MEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). Disease activity was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impact was assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). The quality of life was measured by the Short form-36 (SF-36). Severity of enthesitis was significantly correlated with disease activity, functional disability and degradation of quality of life. There was no relation between enthesitis indices and disease duration or laboratory parameters. The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indices could be used to evaluate disease activity in patients with AS.

We aimed to evaluate diagnosis delay and its impact on disease in terms of activity, functional disability, and radiographic damage in Moroccan patients with ankylosing spondylitis (AS). We recruited 100 Moroccan patients who fulfilled New York Classification criteria for AS. Diagnosis delay was defined as the interval between the first symptom of AS and the moment of a correct diagnosis. Disease activity was evaluated by the bath ankylosing spondylitis disease activity index (BASDAI), functional status by the bath ankylosing spondylitis functional index (BASFI), and radiographic damage by the bath ankylosing spondylitis radiologic index (BASRI). Measurements of spinal mobility were assessed. The average age at disease onset was 28.56 ± 10.9 years. Of the patients, 16% had juvenile-onset AS. Disease duration was 9.5 ± 6.8 years, and the average of diagnosis delay was 4.12 ± 3.99 years. There were no differences in diagnosis delay according to the age at onset, educational level, or the presence of extra-articular involvement. Our patients had altered functional ability. Patients with late diagnosis (>5 years) had statistically significant higher structural damage (BASRI) and severe limited spinal mobility. There was no correlation between diagnosis delay and the activity of disease. Few studies focused on diagnostic delay and its impact in patients with AS. It is necessary in our context to establish an early diagnosis taking into account the high frequency of severe functional disability in Moroccan AS.

The objectives of this study are (1) to evaluate whether the prevalence of osteoporosis and peripheral fractures might be influenced by the educational level and (2) to develop a simple algorithm using a tree-based approach with education level and other easily collected clinical data that allow clinicians to classify women into varying levels of osteoporosis risk. A total number of 356 women with a mean age of 58.9±7.7 years were included in this study. Patients were separated into four groups according to school educational level; group 1, no education (n=98 patients); group 2, elementary level (n=57 patients); group 3, secondary level (n=138 patients) and group 4, university level (n=66 patients). We observed dose-response linear relations between educational level and mean bone mineral density (BMD). The mean BMDs of education group 1 (10.39% (lumbar spine), 10.8% (trochanter), 16.8% (wrist), and 8.8% (femoral neck)) were lower compared with those of group IV (p0.05). Twelve percent of patient had peripheral fractures. The prevalence of peripheral fractures increased with lowered educational levels. Logistic regression analysis revealed a significant independent increase in the risk of peripheral fracture in patients with no formal education (odds ratio, 5.68; 95% , 1.16-27.64) after adjustment for age, BMI and spine BMD. Using the classification tree, four predictors were identified as the most important determinant for osteoporosis risk: the level of education, physical activity, age62 years and BMI30 kg/m2. This algorithm correctly classified 74% of the women with osteoporosis. Based on the area under the receiver-operator characteristic curves, the accuracy of the Classification and Regression Tree (CART) model was 0.79. Our findings suggested that a lower level of education was associated with significantly lower BMDs at the lumbar spine and the hip sites, and with higher prevalence of osteoporosis at these sites in a dose-response manner, even after controlling for the strong confounders. On the other hand, our CART algorithm based on four clinical variables may help to estimate the risk of osteoporosis in a health care system with limited resources.

The objective of this study was to assess the effects of an educational program on the course of rheumatoid arthritis (RA) after 3 years.From December 2002 to December 2003, 39 RA patients participated in a 3-day education program delivered to groups of four or five patients. Effects of the program were evaluated after 3 years in 33 patients, comparatively to baseline, based on the following variables: knowledge of RA (self-questionnaire), disease activity (DAS 28), functional impairment (health assessment questionnaire [HAQ]) and quality of life (arthritis impact measurement scale 2 [AIMS2], short-form). We also compared patient knowledge in the educational program participants and in 38 controls with RA. Direct questions were used to evaluate the program after 3 years.Patient knowledge 3 years after the education program was significantly improved compared to baseline (P0.0001) and was significantly better than in the controls (P0.0001). Disease activity was significantly lower in the education group after 3 years than at baseline (DAS28, 3.1 vs. 3.8, P0.005). Neither the HAQ nor the AIMS2 scores changed significantly after 3 years compared to baseline. The replies to the direct questions indicated a very high level of overall satisfaction with the educational program.An educational program tailored to patient needs can produce lasting improvements in knowledge of the disease and may help to control the activity of RA. These results warrant the development of education programs for patients with chronic inflammatory joint disease.

Resume Introduction L’objectif de cette etude etait d’analyser, a trois ans, l’influence d’un programme educatif sur l’evolution de la polyarthrite rhumatoide (PR). Patients et methode De decembre 2002 a decembre 2003, 39 PR ont participe a un programme educatif realise pendant trois jours, par groupe de quatre ou cinq patients. Ce programme a ete evalue avant les journees d’education (j0), et trois ans plus tard (A3) chez 33 PR. Pour chaque patient, nous avons compare, entre j0 et A3, l’evolution des connaissances sur la maladie (autoquestionnaire), l’activite de la maladie (DAS 28), la capacite fonctionnelle (HAQ), et la qualite de vie (EMIR court). Les reponses des PR eduquees a l’autoquestionnaire de connaissance ont egalement ete comparees a celles de 38 PR temoins. Une evaluation du programme par des questions directes a ete realisee a trois ans. Resultats L’evaluation des 33 PR eduquees a trois ans a mis en evidence une augmentation significative des connaissances, par rapport a j0 (p Conclusion Ces resultats montrent que la realisation d’un programme educatif adapte aux besoins des patients peut conduire a une acquisition durable des connaissances sur la maladie et etre utile dans le controle de l’activite de la polyarthrite. Ce travail justifie le developpement des programmes d’education patients dans les rhumatismes inflammatoires chroniques.

The objective of this study is to develop and validate a Moroccan version of the childhood health assessment questionnaire (CHAQ), a disability measure for children suffering from juvenile idiopathic arthritis. The CHAQ has been validated in a cross-sectional study in 60 JIA, classified into systemic (33%), polyarticular (38%), extended oligoarticular (6.4%), and persistent oligoarticular (21.6%) subtypes. The CHAQ was tested for reliability and construct validity by correlating the yield of the questionnaire with other disease activity parameters. Disability index was significantly different among the four JIA subtypes. CHAQ proved to be valid in clinically discriminating between healthy subjects and patients with different patterns of JIA. The convergent validity was demonstrated by strong correlations of the disability score with the JIA score set of variables. In conclusion, the Moroccan version of the CHAQ has good psychometric properties. This validated version of the Moroccan CHAQ should help to individual follow-up of children suffering from JIA.

The aim of this study was to evaluate the relationship between historical height loss (HHL) and prevalent vertebral fractures (VF) in postmenopausal Moroccan women and to estimate its accuracy as a clinical test for detecting VF. Two hundred eighty-eight postmenopausal women were studied. All subjects had bone density measurements and spinal radiographs. Vertebral bodies (T4-L4) were graded using the semi-quantitative method of Genant. HHL was calculated as the difference between a patient's tallest recalled height and the current measured height. The mean age was 58.4 +/- 7.8 years. Thirty-one percent of patients were osteoporotic, and 46.5% had VF. Patients with VF had lost more height than those without VF (median, 2.0 cm (0.26-3.3) vs 0.96 cm (0.33-2.4), p0.05). In univariate analysis, HHL was positively correlated to both number and grade of prevalent VF (p0.05). The area under the receiver operating characteristics curve for the ability of HHL to detect VF was 0.60 (95% confidence interval (CI), 0.52, 0.69). Our HHL threshold for detecting VF was1.5 cm, its sensitivity was 58%, and its specificity was 61%. The positive predictive value was 53%, and the negative predictive value was 65%. With HHL1.5 cm, positive likelihood ratio was 1.49 with 95% CI, 1.07, 2.06. Our results demonstrate significant positive associations between HHL, VF, number of VF, and grade of VF. However, this relationship is not clinically pertinent. Consequently, HHL cannot be used as a reliable clinical test for detecting VF in postmenopausal Moroccan women.

We undertook this study to determine the prevalence of hypovitaminosis D, its determinants, and its relationships to physical performance, serum parathyroid hormone (PTH) concentration, bone mineral density, and biochemical markers of bone turnover in healthy, ambulatory, pre- and postmenopausal women.The group studied included 415 women aged 24 to 77 years. Between July and September, we assessed calcium intake and measured serum calcium, phosphorus, albumin, alkaline phosphate, 25-hydroxyvitamin D (25(OH)D), PTH, osteocalcin, and C-terminal cross-linking telopeptide of Type I collagen. We also measured bone mineral density (BMD) by dual-energy radiograph absorptiometry in the spine and total femur. Three tests were used to assess physical performance: timed get-up-and-go test, 5-times-sit-to-stand test, and 2.4 m speed walk.The prevalence of vitamin D insufficiency (30 ng/mL) was 91%. In multiple logistic regression, the main determinants of hypovitaminosis D were age55 years (OR 2.14 [95% IC, 1.1-4.1; P = 0.026)], wearing a veil [OR 2 (95% IC, 1.1-4; P = 0.04)], time spent outdoors less than 30 min/d [OR 2.8 (95% IC: 1.4-5.7; P = 0.003)], and daily calcium intake less than 700 mg [OR 2.39 (95% IC, 1.2-4.7; P0.01)]. A significant inverse correlation between 25 OH and osteocalcin (r = -0,18, P0001), 25 OH, and Type I collagen (r = -0,15, P = 0003) were observed. By Locally Weighted Regression and Scatterplot Smoothing technique, there was an increase in PTH level when S-25(OH)D was below 30 ng/mL. After adjustment for age, both spine BMD and total femoral BMD failed to show any significant correlation with serum 25(OH)D and PTH. There was no correlation between any physical performance tests and 25(OH)D levels.Our study showed that during the summer season, vitamin D insufficiency is very common in healthy adult Moroccan women. Lack of sun exposure and veiled clothing style were the most important factors that influenced hypovitaminosis D. Patients with hypovitaminosis D had a high bone turnover, whereas there was no effect on BMD and physical performance. Further research is needed to evaluate the clinical impact of the above findings.

We report two cases of primary Non-Hodgkin's Lymphoma in the spine leading to radicular compression secondary to infiltration of lumbar body vertebras. The two patients were free of either nodular or other extra-nodular disease. Treatment consisted of chemotherapy alone, one patient have had a cauda equina syndrome and surgical decompression was performed in emergency. The patients were in remission for 20 months after diagnosis. A review is given for the incidence of primary vertebral localization of lymphoma, its diagnosis, treatment and prognosis.

Ankylosing spondylitis (AS) is characterised by a geographic differences in terms of prevalence and clinical expression of the disease. The aim of our study was to describe the actual features of AS in Morocco and we wanted to examine a large population of patients for evidence of phenotypic clustering that could suggest the presence of distinct clinical entities. We investigated 117 patients with a diagnosis of primary AS according to the modified New York criteria. All patients were evaluated according to a standardised data collection form, including demographic variables and disease history with clinical and radiological features. To analyse our data and try to individualise clinical subsets, we applied a two-step cluster analysis using log-likelihood distance measures. Patient's mean age at onset was 25.51 +/- 10.8 year. The mean BASDAI and BASFI score was 33.5 +/- 20.3 and 38.9 +/- 27.5, respectively. Radiographic damage was present in 99.1% of the subjects and radiographic hip involvement in 47.3%. Only 52.6% of patients had been treated with disease modifying antirheumatic drugs. Cluster analysis detected two distinct populations within the data set. Statistically significant differences were found between the two groups particularly concerning activity of the disease, age at onset and the hygienic conditions. Our study revealed that the Moroccan AS was active and severe and suggested that the age at onset and the precarious hygienic level has the greatest capacity to predict activity and severity of the disease.

Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus. Motor involvement in acute herpes zoster is rare. We report a case of sciatica L5 due to herpes zoster infection with motor loss. Typical skin lesions occurred one week before the sciatica. Radiological finding did not explain the paresis. The diagnosis of zoster sciatica with motor involvement was suspected. Serological tests and cerebrospinal fluid examination established the diagnosis. The antiviral and physical treatment was conducted in order to improve functional outcome.

Resume Objectifs La polyarthrite rhumatoide (PR) est une maladie auto-immune d’origine multifactorielle qui pose un probleme socioeconomique important au Maroc. L’association de cette maladie avec les genes HLA a ete etudiee dans differents groupes ethniques. Notre etude s’est interessee, pour la premiere fois au Maroc, a evaluer la distribution et l’implication des genes HLA classe I et II chez des patients presentant une PR precoce. Methodes Quarante-neuf patients atteints de PR precoce ont ete compares a des temoins sains apparies par âge, sexe et origine ethnique. Parmi ces patients, 34 etaient seropositifs (presence du facteur rhumatoide). Le typage HLA des patients et des temoins a ete realise par microlymphocytotoxicite pour la classe I (A et B) et en biologie moleculaire (PCR-SSP) pour la classe II (DR et DQ). Resultats Nous avons observe, chez les patients seropositifs, une augmentation significative de la frequence de l’antigene A24 (p = 0,03) et des alleles DRB1*04 (p = 0,004) et DQB*03 (p = 0,03) et une diminution significative de l’allele DRB1*07 (p = 0,03). La frequence des alleles DRB1*01, DRB1*10 et DRB1*14 etait comparable chez les patients et les temoins. La frequence des haplotypes DR4-DQ2 et DR4-DQ4 etait augmentee, alors que celle des haplotypes DR7-DQ2 et DR13-DQ6 etait diminuee chez les patients. Conclusions Notre etude montre que l’allele DRB1*04 predispose a la PR alors que l’allele DRB1*07 semble protecteur chez les patients marocains. Nos resultats suggerent egalement le role de certains haplotypes DR-DQ dans la predisposition ou la protection vis-a-vis de la maladie.

This study aimed to investigate the proxy-reported Health related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA). It was hypothesized that HRQOL would decrease with worsening disease and disability. Data were available in cross-sectional study on children and adolescents with JIA according to the ILAR criteria. Patient demographics, type of JIA, clinical determinants and laboratory parameters relating to JIA were obtained for each patient. Functional disability was assessed using the parent's or children's version of the child health assessment questionnaire (CHAQ). The HRQOL was evaluated using the juvenile arthritis quality of life questionnaire (JAQQ). These questionnaires were previously translated and validated in Moroccan children. A total of 80 participants were enrolled with mean age of 11 [6-17 years], and female predominance (59%). Many patients (42.5%) had oligoarticular subtype; 31.3% polyarticular subtypes and 26.2% systemic form. The mean global score of JAQQ was 2.6 +/- 1.3 (1-6). Patients with persistant oligoarticular had better gross motor function (P < 0.0001), better fine motor function (P < 0.0001), less psychosocial impact (P = 0.001), and less symptoms (P = 0.001) in comparison with polyarticular and systemic subtypes. The HRQOL assessed by the JAQQ was worse in adolescent patients in comparison with children except for symptoms (P = 0.15). The gender (P = 0.95), age at onset of JIA (P = 0.81), and evolution duration (P = 0.34) were not correlated with global score of JAQQ. The diagnosis delay was significantly associated with decrease of HRQOL (P = 0.001). The decrease of HRQOL was correlated with disease activity [pain (VAS), painful and swollen joints, erythrocyte sedimentation rate (for P < 0.0001)], with disability index (CHAQ) (P = 0.001) and presence of hip involvement (P = 0.01). This study suggests that JIA can have a significant adverse effect on the HRQOL of moroccan patients, particularly adolescents with polyarticular and systemic subtypes. Disease duration, disability score (CHAQ) and pain were the strongest determinants of poorer HRQOL.

Resume Introduction Le lipome est une tumeur benigne frequente des tissus mous, mais sa localisation intra-articulaire est exceptionnelle. Nous en rapportons un cas survenant sur un genou rhumatoide. Observation Une patiente de 50 ans avait depuis 17 ans une polyarthrite rhumatoide seronegative, deformante, mal suivie. Elle etait traitee par une corticotherapie a faible dose (7,5 mg/j). L’evolution s’est faite par poussees-remissions. Depuis 2 ans, elle avait une arthrite du genou gauche. Un bilan infectieux realise devant la crainte d’une greffe septique etait negatif. La ponction articulaire du genou retirait un liquide inflammatoire sterile. La radiographie standard des genoux etait normale. En raison des conditions sociales et economiques de la patiente, l’imagerie par resonance magnetique et la tomodensitometrie des genoux n’ont pu etre obtenues. La decision d’une biopsie synoviale medicale etait alors prise. Elle montrait une synovite chronique non specifique. Des infiltrations cortisoniques etaient pratiquees sans resultat. L’analyse histologique etant aussi peu contributive au cours d’une 2e biopsie medicale, une biopsie chirurgicale etait realisee. Elle permettait l’exerese totale d’une masse graisseuse encapsulee, entouree par la synoviale. L’etude histologique a conclu a un lipome intra-articulaire vrai. Le recul est de 2 mois. Discussion Le lipome intra-articulaire vrai est extremement rare et affecte le plus souvent le genou. Il survient habituellement de novo. Sa survenue chez notre patiente sur un terrain d’arthrite a fait discuter le diagnostic de lipome arborescent. L’IRM est performante pour faire les diagnostics positif et differentiel. La confirmation reste cependant histologique, ce qui est le cas chez notre patiente. Elle montre une tumeur adipeuse encapsulee, entouree par la synoviale, alors que le lipome arborescent est une proliferation villeuse et infiltrante de la synoviale par des adipocytes. Le traitement est chirurgical ou arthroscopique.

Idiopathic avascular necrosis (AVN) of the capitate bone is an important, although rare, cause of spontaneous onset of wrist pain. Most cases involve direct or indirect trauma. Only a few reports of idiopathic avascular necrosis have been published. We present a case report of a 32-year-old woman who presented with a chief complaint of a left wrist pain, swelling and loss of all ranges of motions for approximately 1 year. She had no history of prior wrist trauma or steroid use. Laboratory testing for systemic disease or infection were negative. Diagnosis of avascular necrosis of the capitate has been made via plain film radiology, isotope bone scanning, and computed tomography scan. No etiologic factor could be identified. Surgical treatment was recommended, given drilling and autogenous bone grafting. Histological analysis showed necrotic bone. The physical therapy was implemented to restore function. Two months postoperatively, she was almost pain free.

The aim of this study is to assess the reliability and validity of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) in Moroccan patients with knee osteoarthritis. The WOMAC was translated and back translated to and from dialectal Arabic, pre-tested and reviewed by a committee following the Guillemin criteria. The Moroccan version of the WOMAC was administered twice during a 24-48 h interval to 71 Moroccan patients with symptomatic knee osteoarthritis, fulfilling the revised criteria of the American College of Rheumatology. The test-retest reliability was assessed using intra-class correlation coefficient, and the Bland and Altman method. Internal consistency was assessed by Cronbach's alpha coefficient. Construct validity was tested by correlating the WOMAC subscales with visual analogic scale (VAS) of pain, VAS of handicap, maximum distance walked and clinical characteristics. The Moroccan version of the WOMAC showed good reliability, with ICC values of the three dimensions: pain, stiffness and physical function being 0.80, 0.77 and 0.89, respectively. Bland and Altman analysis showed that means of differences did not differ significantly from 0 and that no systematic trend was observed. Internal consistency with Cronbach's alpha for pain was found to be 0.76, and its equivalents for stiffness and physical function subscales were evaluated at 0.76, 0.90, respectively. Construct validity showed statistically significant correlation with all WOMAC subscales and VAS of pain (rho=0.38, 0.42, 0.63 respectively, P

Summary Aim The aim of this study was to assess the prevalence and severity of lumbar lesions on radiography of patients with rheumatoid arthritis (RA) and of population controls and to study the correlation between lumbar lesions and RA severity. Methods RA patients who met the revised American College of Rheumatology criteria were matched with population controls for age, sex, and the presence (or absence) of low back pain. Thoracolumbar radiographs were read by two observers looking for vertebral fractures, disc space narrowing, endplate erosion, facet joint involvement, and osteophytosis. A severity score was assigned to each lesion. Results This study included 60 RA patients and 60 controls, matched for sex (54 women and 6 men in each group) and age (mean age was 47.8 ± 14 years in the RA group and 48.4 ± 14 years in the control group). Prevalence of lumbar lesions was 83% in RA patients and 85% in the control subjects (p=0.8). Vertebral fractures were significantly more frequent in RA patients (p = 0.042). In the RA group, disc space narrowing and the severity of endplate erosion were both correlated with higher Larsen grades (p = 0.02 and 0.007 respectively), and the severity of endplate erosion was correlated with coxitis (p = 0.03). Discussion In our study, radiological lumbar lesions, except for vertebral fractures, were no more common among RA patients than among population controls. Endplate erosion and vertebral disc destruction were correlated with RA severity scores.

Resume La dysplasie progressive pseudorhumatoide est une dysplasie squelettique hereditaire autosomique recessive. Elle est caracterisee par des modifications radiologiques du rachis similaires a la dysplasie spondyloepiphysaire tardive avec un tableau clinique mais, non radiologique, evocateur d'une arthrite juvenile idiopathique. Nous presentons trois cas d'une meme famille ayant une dysplasie progressive pseudorhumatoide. Observations Une enfant, âgee de quatre ans, est suivie depuis trois ans pour une arthrite juvenile idiopathique dans sa forme polyarticulaire seronegative, evoluant par poussee remission, sans reponse aux traitements antiinflammatoires. A son admission, elle presentait des arthralgies inflammatoires avec tumefactions, limitations et deformations articulaires touchant les mains, les poignets, les chevilles et les genoux. Les hanches etaient libres. La vitesse de sedimentation et la proteine C reactive etaient normales. La ponction articulaire du genou montrait un liquide mecanique. Les radiographies standards des mains et des avants pieds ne montraient pas de destruction articulaire. La radiographie du bassin montrait une dysplasie des hanches. Le diagnostic d'arthrite juvenile idiopathique a ete reconsidere. L'enquete familiale a trouve deux cas similaires : le frere aine, âge de 14 ans, presentait un tableau similaire avec absence de syndrome inflammatoire et une dysplasie des hanches et des epiphyses metacarpophalangiennes ; l'oncle paternel presentait une raideur rachidienne avec cyphose dorsale et limitation des hanches. Les radiographies montraient des sacro-iliaques normales et une dysplasie des hanches. Le diagnostic retenu etait celui d'une dysplasie progressive pseudorhumatoide avec polyarthropathie. Discussion La dysplasie progressive pseudorhumatoide est une maladie genetique autosomique recessive avec une anomalie de l'homeostasie du cartilage. Elle constitue un diagnostic differentiel de l'arthrite juvenile idiopathique.