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Objectives We aimed to assess the prevalence of hip involvement and its characteristics, its correlates and its impact on patients’ quality of life (QoL) in Moroccan ankylosing spondylitis (AS). Methods One-hundred-twenty patients with AS according to New York Classification criteria were consecutively recruited. To assess hip involvement were specified: presence of hip tenderness, range of passive and active motion, BASRI-Hip (≥hip involvement if ≥2) and functional impact (using the Lequesne index and the Harris hip Score) For all patients were collected: sociodemographic data; disease activity (evaluated by the Bath ankylosing spondylitis disease activity index (BASDAI)); functional disability (assessed by the Bath Ankylosing spondylitis functional index (BASFI)); spinal mobility (measured by the Bath Ankylosing Spondylitis Metrology Index (BASMI)) and radiographic damage (assessed by the Bath Ankylosing Spondylitis Radiologic Index (BASRI total score)). The erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were determined. The quality of life (QoL) was measured by the generic instrument SF-36. Results At the study inclusion, 75 patients (62.5%) had hip tenderness (70 (93.3% had bilateral hip tenderness)) with a mean pain intensity of 54.8±14.4. Sixty-eight patients (56.6%) had limited articular motion. In our data, 64 patients (53.3%) had radiographic hip involvement (59 patients (92.2%) had bilateral hip involvement) with a mean BASRI-Hip=3.1±1.2. Seven patients (5.8%) had a total articular replacement. The functional impact was high with a mean Lequesne score=13.9±6.3 and a mean Harris score=61.8±17.4 (49 patients (40.8%) have a Harris score ≥70 (indicating poor function)). Patients treated with biologic agents have best scores of Lequesne (p=0.011). Radiographic hip involvement was associated to an early age at onset (p=0.006), diagnosis delay (p=0.001), altered spinal mobility (p Conclusions Hip involvement is a major and highly prevalent issue in our AS patients that influences negatively patients’ QoL. Among our AS, there were significant associations between functional and radiographic hip scores and the impairment of spinal mobility, functional status and structural damage of AS. Taking into account the frequency and impact of hip involvement in the course of AS and considering the young age ate onset, the severity of functional impairment and the importance of diagnosis delay in Moroccan ankylosing spondylitis, as previously shown by several studies, it is necessary in our context to highlight the early recognition and management of AS especially with the advent of new treatments. Disclosure of Interest None Declared

Objectives The aim of this study was to assess the type and frequency of foot deformities in rheumatoid arthritis (RA) patients, and to evaluate the impact of these deformities on Foot Function Index (FFI) and patient functional ability. Methods We conducted a cross-sectional study in 71 Moroccan patients with a disease duration over than 2 years. Sociodemographic, clinical and biological data were collected. We examined the feet of all patients for hallux valgus (HV) and rigidus (HR), quintus varus (QV), cock-up deformity (CD), clawing toe (CT), mallet finger (MF), Blast of wind peroneal (BWP) and tibial (BWT), and we measured calcaneal valgus angle (CV). Function status of feet, capacity, and health status was evaluated by using FFI, Steinbrocker Functional Class (SFC) and the Arabic version of HAQ respectively. Structural damage was assessed by using the modified Sharp score in the feet. Results 93% of patients were female. The mean age was 48.8±12.95 years old [22-82]. The mean disease duration was 10.59±8.34 years [2–35] and the mean score of DAS 28 was 5.3±1.8 [1.6-8.2]. Rheumatoid factor (RF) was positive in 80.3% of cases. Foot deformities were observed in 57 (80.3%) patients; HV (57.7%), CT (23.9%), CD (22.5%), BWP (21.1%), BWT (15.5%), HR (9.9%), QV (7%), MF (4.2%), CV (42.3%). Flat foot was found in 59.2% of cases and cavus foot in 21.1%. The mean of FFI score was 45.75±29.67 [0 – 98], of SFC was 2.15, of HAQ was 1.43 and the Scharp modified score was 14.91±11.83. 3 deformities were associated with the increase of disease duration: HV (p=0.001), HR and QV (p=0.01); HV was also correlated to RF (p=0.01). BWT was associated to FFI (p=0.04) and Sharp score (p=0.03). we did not find any correlation between deformities and HAQ. SFC was correlated with HAQ, structural damage and activity of RA. There was significant correlation between FFI and HAQ and high disease activity (p Conclusions Feet deformities are highly frequent in our RA patients. They may affect patient functional foot, especially BWT. Disclosure of Interest None Declared

Objectives Assessment of fatigue in Moroccan patients with rheumatoid arthritis (RA) and its relationship with disease parameters. Methods 1089 Moroccan patients with rheumatoid Arthritis (RA) were included in the multicenter cross-sectional study QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis). The presence of fatigue was researched and its degree was assessed by a visual analogue scale (VAS) ranging from 0 to 100 mm. The presence and intensity of fatigue were correlated to the RA patient and disease parameters (sex, DAS 28, score of Health assessment Questionnaire (HAQ), corticosteroids intake, presence or absence of sleep disorders or psychological problems). Results The mean age of our patients was 49 ± 12.6 years with a female predominance of 80.3%. The average of disease duration was 6 (3, 12) years. The mean DAS28 was 4.9 ± 1.68. The average of HAQ was 1 (0.4, 1.6). Fatigue was present in 97.1% patients and the average of VAS fatigue was 43.2 ± 26.6 mm. A high level of fatigue was associated with female gender (44% versus 39%, p = 0.05), an important level of disease activity (r = 0.544, p Conclusions Fatigue is a major problem in our patients with RA and must be included in their routine assessment. In our sample, fatigue appears to be related to female sex, high level of disease activity and greater functional disability. Disclosure of Interest None Declared

Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Delayed onset of puberty and a growth retardation spurt are often reported in patients suffering from JIA. The basis of abnormal puberty in these patients is multifactorial. Both chronic inflammation and antiinflammatory therapy with glucocorticosteroids may deteriorate linear and pubertal growth. The aim of our study was to evaluate the linear and pubertal growth of Moroccan children and adolescent with JIA and to identify factors playing role in contributed to growth disorders and delayed puberty. Methods Thirty three subjects with juvenile idiopathic arthritis (JIA) 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 (ILAR). Information on disease activity, quality of life, sex, age, age at diagnosis, duration and medication use were collected by use of a standardized questionnaire. Patients underwent anthropometric assessment (expressed in standard deviations according to the age and of the sex according to the World Health Organization). Body mass index (BMI) was calculated from the ratio of weight/height2 (kg/m2).The pubertal status was determined according to the Tanner criteria (from 1 to 5), thus the evaluation of appearance of the secondary sexual characters was carried out by comparison at the chronological age [2-3], the children were also divided into 3 groups: pre-puberty (stage 1), puberty (stages 2-3) and post-puberty (stage 4-5). Bone mineral density (BMD) assessment by dual energy x-ray absorptiometry of the lumbar spine, and total body. Bone mineral density (in g/cm2) was expressed in Z-scores. In children, low BMD was defined as a Z-score less than -2 and osteoporosis was defined as a Z-score less than -2 with a fracture history. Results Thirty three children with JIA were included (18 male, 15 female), the median of age of the patients was11 years [6-14]. The prevalence of the underweight (IMC There was an association between the delayed puberty and the by corticosteroids (p=0,05). In addition There was no significant association between this poor puberty and the subtype of JIA (p=0.2), its duration (p=0.3) and its activity calculated by the DAS28 (p=0. 8). A significant association was found between the underweight and the low BMD (p=0.01). There was a positive correlation between the height and the BMD (r=0.48, p=0.005) in the lumbar spine and (r=0.57, p=0.001) for the total body). Conclusions Our study suggests that linera growth and puberty is retarded in Moroccan patients with JIA, and that corticosteroids may contribute to delayed puberty. Disclosure of Interest None Declared

Objectives To assess the prevalence of sexual dysfunction in married women with rheumatoid arthritis (RA) and comparing with a control group. Methods We conducted a cross-sectional study including 31 case-control patients with rheumatoid arthritis according to the ACR criteria 1987. Patients with any disease or who are taking medication that may impair sexual function were excluded. The controls were healthy volunteers matched for age and sex. Clinical and sociodemographic characteristics were collected. Sexual function was assessed by self-reported questionnaire the FSFI (index of female sexual function). This score assesses sexual function during the past 4 weeks; it is composed of six domains respectively assessing desire, arousal, lubrication, orgasm, satisfaction and pain. The FSFI total score varies between 1.2 and 36. The threshold score of FSFI ≤ 26 defines a sexual dysfunction. Results The mean age was 45 ± 9.1 with a median disease duration of 60 months (24-144). The mean DAS28 was 4.59 ± 1.81 with a median HAQ of 0.75 (0.25 to 1.22). The mean age of controls was 44.7 ± 10 years. The prevalence of sexual dysfunction in RA was 74.1%. There was a significant difference in the total FSFI score between patients 17.17 ± 10 and controls 23.05 ± 8 (p = 0.04). Areas of desire (p patients: 2.07 ± 1 versus control t: 2.9 ± 10), excitement (p: 2.4 ± 1.5 vs t: 3.6 ± 1.6) lubrication (p: 2.7 ± 2 vs t: 3.7 ± 1.8), orgasm (p: t 2 vs 2.8 ± 3.8 ± 1.6) and satisfaction (p: 3.44 ± 1.8 vs. t = 4.7), respectively, were lower in RA patients compared to controls (for all p Conclusions This study suggests that sexual dysfunction is more common among married patients with RA compared to controls. These dysfunctions were related to desire, arousal, lubrication, orgasm and satisfaction. Further studies are needed to confirm these results. Disclosure of Interest None Declared

Objectives Translate, adapt and validate in patients with rheumatoid arthritis a self-assessment questionnaire of female sexual function: (FFSI) The Female Sexual Function Index Methods It is a cross-sectional study including 31 patients with rheumatoid arthritis according to the 1987 ACR criteria in period of sexual activity. The FSFI is a self-administered questionnaire that assesses sexual function during the past 4 weeks, it is composed of six domains respectively assessing desire, arousal, lubrication, orgasm, satisfaction and pain. The FSFI total score varies between 1.2 and 36, a score ≤ 26 defines sexual dysfunction. Translation and adaptation of the FSFI in classical Arabic was performed according to international recommendations for the translation of questionnaires (translation, back translation, committee of expert). The acceptability, reliability, internal and external construct validity of the arabic version were evaluated. External construct validity was assessed by analyzing the correlation between this instrument and the quality of life of patients assessed by the SF-36 (short form health survey), anxiety and depression assessed by the HAD (hospital anxiety and depression scale) Results The average age of our patients was 45 ± 9.10 with a median disease progression of 60 months (24-144). The mean DAS28 was 4.59 ± 1.81 and the median HAQ was 0. 75 (0.25 to 1.22). Reliability was excellent, the intraclass correlation coefficient of FSFI: ICC was 0.995 (95% CI :0.98-0 .99). Reproducibility measured by Cronbach’s alpha coefficient was 0.997. we did not find significant correlation between the FSFI total score and the different areas of SF36 (physical activity r = 0.23, p = 0.22) (limitation due to the physical state r = 0, 30, p = 0.22) (limitation due to mental health r = 0.30, p = 0.1) (vitality r = 0.27, p = 0.14) (mental health r=0.06, p = 0.14); (pain r = 0.25, p = 0.17), perceived health r = 0.31, p = 0.09) except for the field (relationship with other living r = 0.740, p Conclusions The psychometric properties of the FSFI are good. This tool translated into Arabic and may be useful in the evaluation of female sexual function of both Moroccan and Arab women. Disclosure of Interest None Declared

Background The results of the international QUEST RA study showed that the high BMI was associated with a high activity of rheumatoid arthritis (RA) in women. Althoughour country is in developing, 25,2 % of the population is in overweight and 10,3% are obeses. Objectives The aim of our study was to analyze the relationship between body mass index (BMI) and the activity of rheumatoid arthritis in Moroccan population. Methods This is a multicenter cross-sectional study, conducted between December 2008 and May 2010, involving patients with rheumatoid arthritis in the QUEST-RA program of Morocco. The clinical and demographic data were collected by rheumatologists in the public and liberal sectors. The disease activity was assessed by clinical examination, ESR, CRP and DAS28. The functional impact was evaluated by the HAQ. BMI was stratified according to the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults established in 1998, as follows: underweight or = 30. Results 1129 patients were included, the mean age was 48.82 ± 12.71 years. Among our patients, 441 (42%) were overweight, 389 (37%) were normal weight, 186 (17.7%) were obese, and 35 (3.3%) in a state of underweight. The mean DAS28 was 4.93 ± 1.68. The mean score for DAS28 decreased with BMI; underweight (5.76 ± 1.41), normal (5.02 ± 1.75) in overweight (4.89 ± 1.58) and obesity (4.82 ± 1.58) in women, whereas the opposite trend was observed in men. The analysis of variance (ANOVA) did not detect a statistically significant relationship between the different categories of BMI and DAS28; underweight (ANOVA: p = 0.13), normal (p = 0.48), overweight (p = 0.29), obesity (p = 0.24). Conclusions The body mass index with its differents categories does not seem to be related to disease activity assessed by the DAS28 in Moroccan patients with RA, contrary to whatwas found onthe international QUEST-RA study. Disclosure of Interest None Declared

Objectives To investigate the discrepancy between physician’s and parent’s global assessments of disease status and the factors explaining discordance in patients with juvenile idiopathic arthritis (JIA). Methods A cross-sectional study was conducted on 47 children with JIA. The diagnosis of JIA was made according to the criteria of the International League of Association of Rheumatology (ILAR). Parent’s evaluation was based on an overall assessment of the disease by the mother. A discordance score was calculated by subtracting the physician’s global assessment from that of the parent’s, leading to the definition of three patient groups: (1) no discordance, when physician’s and parent’s assessments were within 1 cm of each other; (2) negative discordance, when parent’s assessment was underrated relative to the physician; and (3) positive discordance, when parent’s assessment was over-rated relative to the physician. Results Forty-seven patients were included (28 male, 19 female); mean age was11.59 ± 3.35 years. The mean disease duration of JIA was 4 [2-6] years, with a predominance of oligoarticular 12 cases (25.5%). Concerning the mothers, 43 (91.5%) were housewives, with a mean age of 38.5 ± 8.5 years. No discordance was found in 23 (48.9%) patients. Negative discordance was found in 4 patients (8.5%). Positive discordance was found in 20 patients (42.6%). The positive discrepancy was statistically significant in patients who have increased articular index (p = 0.033), and patient VAS pain (0.008). Conclusions Parents and physicians often perceive the health status of children with JIA differently, with the most negative perception among parents, suggesting that parent’s evaluation should be taken into account when defining the clinical activity of the disease. Disclosure of Interest None Declared

Objectives The objective of our study was to search the ultrasonography afflictions metacarpophalangeal and metatarsophalangeal joints notably ultrasonography synovitis, the intra articular liquid accumulations, the cartilaginous vascularisation, bone erosion and to compare them with the clinical aspects (pain, swolling, limitations of mobility). Methods It was a transversal study from January 2012 to August 2012 comprising the cases of JIA ( children followed on rheumatology consultation or those hospitalised at Hospital El Ayachi CHU Rabat – Sale and the Hospital of child’s CHU Ibn Sina Morocco ) corresponding to the criteria of ILAR 2001. Consent was obtained from the children and/or their parents. All the patients were clinically examined by two seniors rheumatologists, to look for pain, synovitis, articular limitations. Linear sound echography ( 14 MHz ) with doppler power, was used. Bilateral echography of the MCP ( 2 a 5 ) and of all the MTP done on blind clinical data, less than 72h after clinical evaluation with longitudinal, transverse exploration by the dorsal route. Ultrasound examination was performed by a senior sonagrapher rheumatologist. The OMERACT criteria were utilised for evaluating the ultrasonograhy synovitis ; the other ultrasonography signs looked for were : intra-articular liquid collection, cartilaginous vascularization, bone erosion. The software Excel and Epi info were employed ; ( chi 2 ) was used as test statistic, with α fixed at 5 %. Results 34 cases of JIA were included, or a total of 612 joints. Mean age was 10,80 ±3,29. Sex ratio was 0,90 ( 18 girls for 16 boys ). The study found 11 cases ( 32,40% ) of systemic arthritis, 8 (23,50% ) poly- articular seronegative, 2 ( 5,90 % ) poly articular seropositive, 8 ( 23,50%) oligo articular, 5 (14,70 % ) enthesitic forms. Pathological clinical examination for 33 ( 5,4 % ) articulations, with a total number of painful articulations at 31 ( 94% ) ; synovitic articulations at 4 ( 12 % ) ; limited articulations at 2 ( 6% ). Number of joints ultrasound abnormalities at 184 ( 30% ) ; total number of ultrasonography synovitis at 110 ( 18 %) ; total number bone erosions 17 ( 3 % ). Clinical examination normal was statistically significantly associated with ultrasound abnormalities in 159 (27 %), with the most frequent localization at MTP joints in 86 ( 54% ) mainly MTP1 40 ( 25% ) p Conclusions Our study detected subclinical synovitis ; this study suggest that ultrasound is a joint supplement clinical examination and should be performed in a systematic way to evaluate the activity of the disease. Disclosure of Interest None Declared

Objectives To evaluatethe prevalence of metabolic syndrome in patients with rheumatoid arthritis and analyze the factors that are associated with its presence. Methods QUEST-RA Moroccan inspired by Finland QUEST-RA (Quantitative monitoring of standard patients with rheumatoid arthritis) is a multinational cross-sectional study, including patients with rheumatoid arthritis, according the criteria for diagnosis of ACR 1987, and collected in several Moroccan centers combining the public and private sector over a period of two years (from January 2008 to December 2010). A questionnaire containing sociodemographic, clinical and paraclinical parameters was completed by all patients. The definition of theWorld Health Organization (WHO 1998) was used to identify the metabolic syndrome. Metabolic syndrome is defined as the presence of at least two of the four following factors (obesity (BMI> 30 kg/m2), diabetes, hypertension, dyslipidemia). Results 1129exploitable files were analyzed. The mean age of patients was 48.8 ± 12.7 years with female predominance 87.3%. The median disease duration was 6 years (3, 12), the mean DAS28 was 4.94 ± 1.68, with a median HAQ of1 (0.37, 1.62). The prevalence of hypertension, diabetes, hyperlipidemia, and obesity was respectively 13.7%, 8.3%, 4.4%, 17.6%. The prevalence of metabolic syndrome according to the WHO definition was 8.1%. In univariate analysis, the presence of metabolic syndrome was associated with a higher age of patients (p Conclusions This study suggeststhat there is no increased frequency of metabolic syndrome in rheumatoid arthritis in Morocco compared to literature data. The presence of metabolic syndrome was associated with age and disease duration of the disease unrelated to the activity or severity of the disease. Comparison with a control group and larger multiethnic studies are necessary. Disclosure of Interest None Declared

Background Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. Objectives to Assess the impact of rheumatoid arthritis on physical activity. Methods The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) is a cross-sectional study that includes a self-report questionnaire and clinical assessment of non selected consecutive outpatients with RA who are receiving usual clinical care. Frequency of physical exercise (>or=30 minutes with at least some shortness of breath, sweating) is queried with 4 response options: >or=3 times weekly, 1-2 times weekly, 1-2 times monthly, and no exercise. Results The total of 1129 patients were enrolled: 87,3% were women, the mean age was 48 years, and the mean disease duration was 6 years. Only 2,8% of all patients reported physical exercise>or=3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80. Physical inactivity was associated with disease duration, higher levels of disease activity, pain, morning stiffness and fatigue. Conclusions This study provided the evidence that the physical inactivity rates remain high among people with RA during this millennium. The rheumatologist should motivate patients to increase physical activity levels. Disclosure of Interest None Declared

Objectives To describe in children with haemophilic arthropathy, their perceptions about their scholarship situation. Methods Twenty five children (all boys, age of 11.6±3.7 years, mean disease duration of 10.8±3.4years, haemophilia severe (28%) and moderate (72%)) suffering from Haemophilia with hemophilic arthropathy (affecting at least one joint) were consecutively recruited in this study. Children were asked about their scholarship and their perceptions about their entourage at school. Results All patients were at school. Scholarship was interrupted in one child because of the hemophilic arthropathy. 92% of parents have informed the class teacher about their child disease. Schoolmates were aware of risk of bleeding in hemophilic patients in 76% of cases. Children expressed many difficulties in their daily living at school. Relation with their schoolmates was negatively affected: verbal violence and discrimination reaction from colleagues and integration difficulties at classroom in respectively 52%, 12% and 32% of cases. Difficulties at walking to school, because of the lower limb arthropathy, were reported by 48% of patients. Three patients were also very embarrassed by difficulties at writing, due the involvement of wrist and or elbow. Absenteeism was reported in all patients and was exceeding one month per year in 56% of cases. Absenteeism was mostly caused by bleeding into joints. Only 3 children have received courses during their hospitalizations. Conclusions This study suggests a high negative impact of hemophilic arthropathy on children scholarship. Even if with such chronic disabling diseases, children must be benefit of their legitimate right of scholarship. This negliged aspect of haemophilia consequences should be more clarified in our country by a larger study. This can be a first step to make a national program to assist hemophilic children throughout their scholarship. Disclosure of Interest None Declared

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disorder of childhood. Beside other complication, it can lead to bone metabolism disturbance and osteoporosis. This bone loss is associated with several factors including low vitamin D. The aim of this study was to determine the prevalence of low bone mineral density (BMD) and hypovitaminosis D in Moroccan patients with juvenile idiopathic arthritis Methods In this cross-sectional study, Thirty three children with JIA, according to the classification criteria of International League of Associations for Rheumatology (ILAR), were included. The evaluation concerned a Patients underwent anthropometric assessment and clinical evaluation. Serum 25-hydroxyvitamin D2 et D3, other bone markers and BMD were measured. Bone mineral density (in g/cm 2 ) was expressed in Z-scores, the number of standard deviation above or below the mean value of an age- and sex-matched reference population. In children, low BMD was defined as a Z-score less than -2 and osteoporosis was defined as a Z-score less than -2 with a fracture history. Hypovitaminosis D was defined as serum 25-hydroxyvitamin D Results The median of age of the patients was 11 years [6-14]. Bone mineral density in lumbar spine showed a statistically significant correlation with weight (β=0.613, IC at 95% [0.005-0.013], p=0.001) and age (β=0.5, IC at 95% [0.01-0.044], p=0.003) and the BMD in total body showed a statistically significant correlation only with weight (β=0.33, IC at 95% [0-0.008], p=0.05). There was a positive correlation between 1,25 dihydroxyvitamin D and disease activity (r = -0.52, p=0.03). No relationship was found between vitamin d and BMD and others bone markers. Conclusions Our study suggests that osteopenia was a frequent complication of JIA and it is associated to a low age and low body mass index (BMI). Its also shows that Vitamin D deficiency is highly prevalent among pediatric patients with JIA and it was associated with important activity of the disease. Disclosure of Interest None Declared

Background Counter to the course of physical function and structural damage, few studies have addressed psychological health status as the primary outcomes in rheumatoid arthritis (RA) researches. Depression and its predictors among RA patients appear to be unrecognized or under-treated. In African and Arabic region, there are limited data outlining depression in RA. Objectives We aimed to determine the prevalence of depression in Moroccan patients with RA and to evaluate the disease-related parameters influencing it. Methods 250 consecutive patients with RA were recruited. Patients with previous psychological disorders and significant comorbidities were excluded. The Patient Health Questionnaire depression scale (PHQ-9) was used to measure depressive symptoms. For all patients were collected: socio-demographic characteristics; disease duration; joint pain intensity (visual analogue scale); disease activity (measured clinically using physical examination, biologically and by the disease activity scores (DAS28)); structural damage (by radiographs scored using the Sharp’s method as modified by Van der Heijde); functional disability (by the Health Assessment Questionnaire (HAQ)); extra-articular manifestations; immunological status and treatments. Fatigue was assessed on a 0-100 visual analogue scale (VAS fatigue) and the Arabic version of the generic instrument SF-36 was applied to assess quality of life (QoL). Results There was high prevalence of depressive syndrome among or RA patients: 164 (65.6%) patients have major depressive syndrome and 64 (25.6%) have minor depressive syndrome with a mean total score of PHQ-9 =17.3±8.1indicating a moderate-severe depression. Severe depressive syndrome and higher scores of PHQ-9 were associated with female gender, disease duration, pain intensity, clinical and biological disease activity (DAS28, ESR and CRP), functional disability, structural damage, high levels of RF and ACPAs, higher VAS fatigue scores and impaired physical and mental domains of QoL (for all p≤0.01). Also, patients with decreased levels of education and low socioeconomic status had significantly higher scores of depression (for all p Conclusions Depression is a major issue among our RA which influenced negatively different aspects of QoL. In our data, depression was associated with low socioeconomic and educational status, pain intensity, disease activity, fatigue, functional disability, ACPAs and structural damage. Depression must be recognized and included in the assessment and management of our patients. The advent of new treatments may improve depressive symptoms through their action on inflammation, pain, fatigue and physical disability. Disclosure of Interest None Declared

Objectives to investigate the prevalence of ultrasound (US) abnormalities in shoulders of patients with ankylosing spondylitis (AS), and to determine predictive factors of ultrasound shoulder enthesitis. Methods 38 AS patients were included with 38 age and sex-matched healthy controls. All patients fulfilled the modified New York criteria for ankylosing spondylitis. Clinical and demographical data were recorded. US examination of bilateral shoulders was performed by a musculoskeletal sonographer according to a defined protocol that included imaging of the insertions of supraspinatus, subscapularis and infraspinatus tendons, rotator cuff tendons, subacromial-subdeltoid bursa, acromioclavicular joint, and glenohumeral joint. Results the mean age of patients and controls was 36 years, each group of patients and controls comprised 22 men (57.9%) and 16 women (42.1%). Disease duration was 9.6±7.2 years. Among 38 AS patients, 21 had coxitis (55%) and 19 had previous or current shoulder pain (50%). AS shoulders presented significantly more ultrasound enthesitis than controls shoulders (43 shoulders (56.6%) versus 8 shoulders (10.5%) respectively). Involvement of rotator cuff tendons was significantly higher in AS patients compared with control subjects (16/38 (42.1%) versus 6 (15.2%) respectively). However, involvement of glenohumeral and acromioclavicular joints was infrequent in both groups. In AS patients, we found that the presence of coxitis was the only significant predictive factors of shoulder enthesitis (Odds Ratio (OR) =9.4; Confidence interval (CI)95% (1.10; 81.9), p=0.04) Conclusions Ultrasound abnormalities of shoulders are common in patients with ankylosing spondylitis, and the most frequent abnormality was enthesitis, which was associated with the presence of coxitis. Disclosure of Interest None Declared

Objectives To determine what sleep abnormalities may exist in children with juvenile rheumatoid arthritis (JRA), and their relationship to pain, dysfunction, and disease activity Methods Case control study including 47 patients diagnosed with JIA. The diagnosis of JIA was made according to the criteria of the International League of Association of Rheumatology (ILAR), and 47 healthy children, age and sex matched. Sleep was assessed by questionnaire CSHQ (children’s sleep habits questionnaire). All parents have filled the 45 items of the CSHQ, grouped into eight subscales: (1) bedtime resistance, (2) sleep onset delay, (3) sleep duration, (4) sleep anxiety, (5) sleep-disordered breathing, (6) night Wakings, (7) parasomnias, (8) morning wakening/daytime sleepiness. The disease activity was assessed by the number of painful joints, swelling, erythrocyte sedimentation rate, and c-protein reactive. Functional assessment was based on the value of CHAQ Arabic validated. Pain was assessed by visual analog scale pain (VAS). Results Forty-seven patients were included with 28 male (59.6%), mean age was 11.59 ± 3.35 years, with predominance of oligoarticular 12 (25.5%). Children with JIA had a total score of CSHQ significantly higher than the control cases (p = 0.001), significant differences were also found in the subscale sleep onset delay, night wakings, sleep disordered breathing and parasomnias, with a p-value respectively (0.024, 0.004, 0.004, 0.001). Significant association was found between the CSHQ total score and VAS activity physician (p = 0.016). Sleep onset delay was associated with VAS patient pain (p= 0,05), as nocturnal awakenings and VAS patient pain (p = 0.016). Finally, parasomnias and painful joints (p = 0.002); physician’s VAS activity (p = 0.015) and patient pain VAS (p = 0.03) were also correlated. Conclusions This study suggests that sleep abnormalities are common in children with JIA. Strategies to improve sleep and reduce fatigue should be studied as a possible tool of improving the quality of life of children with rheumatic disease. Disclosure of Interest None Declared

Background The introduction of biological therapies has significantly improved the treatment of chronic rheumatic diseases. In our routine clinical management of patients, varying ideas and fears are expressed by patients concerning the risks associated to the use of these agents. Objectives We aimed to evaluate what patients think about these treatments and what are they afraid of. Methods Sixty-two patients (45 rheumatoid arthritis and 17 ankylosing spondylitis), in whom a biologic agent has been recently indicated, were consecutively included at El Ayachi Hospital-University Hospital of Rabat-sale, Morocco. For all patients, we specified the indication for which the biologic agent was prescribed. All patients have given informed consent to answer a self-questionnaire: Have you been well informed about the treatment by your rheumatologist? Have you done research on the internet or consulted the media? Have you requested any information from your physician, family, friends or other patients who have received biologics? What do you expect from this treatment in terms of efficacy? What side effects you fear most? All patients were assessed at baseline before the introduction of the biologic agent. Results In our data, 41 patients (66.1%) received CD20 antagonist, 17 (27.4%) received TNF blockers and 4 (6.4%) received IL6 antagonist. Among our patients, 33 (53.2%) have already heard about biologic agents from the media or from their physician; 39 (62.9%) were satisfied with the information given by their rheumatologist; 35 (56.4%) have been given adequate time to discuss and ask their rheumatologist; 20 (32.2%) have done research on the internet after the biologic agent was indicated; 5 patients (8.1%) have consulted another physician before receiving treatment; 2 patients (3.2%) have asked an allied health professional and 4 patients (6.4%) have asked other patients already treated with biologic agents. Forty-eight patients (77.4%) were convicted with the efficacy of the treatment and expected total remission. Six patients expected the improvement of their pain and 2 patients didn’t know what they did really expect. Six patients (all women) (9.6%) were afraid of becoming blind; and 9 patients (14.5%) were afraid of having a heart attack; 6 patients (9.6%) were afraid of death; 2 patients (3.2%) were afraid of paralysis and 1 male patient was afraid of becoming sterile. Conclusions It seems that there are many beliefs and fears about biologic agents in our patients. Only 2/3 of our patients were well informed by their physician and approximately 1/3 of patients looked for information from other sources (Internet, media and entourage). An objective and targeted information about biologics should be given to patients. Besides the role of rheumatologist, the role of media and society should be highlighted in patients’ information in order to clarify adverse events to alleviate fear of the unknown. Disclosure of Interest None Declared

Objectives We aimed to assess differences between juvenile-onset ankylosing spondylitis (JOAS) and adult-onset ankylosing spondylitis (AOAS) in terms of activity, severity and quality of life (QoL) in Moroccan patients. Methods In this cross-sectional study, 120 patients with ankylosing spondylitis according to the modified New York classification criteria were consecutively recruited. JOAS was defined as an age at onset ≤16 years-old and AOAS >16 years-old. Assessment criteria included: sociodemographic data, educational level, diagnosis delay, peripheral and axial pain (on a visual analogue scale), disease activity (Bath Ankylosing Spondylitis Disease Activity index), functional impairment (Bath Ankylosing Spondylitis Functional Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index); structural damage (Bath Ankylosing Spondylitis Radiologic Index) and treatment details. The Maastricht Ankylosing Spondylitis Enthesis Score (MASES) was applied to assess severity of enthesitis. Laboratory tests included the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP). The generic instrument SF-36 was used to assess QoL. Comparisons were examined using a T test for continuous variables and Chi-square test for categorical variables. Logistic regression models were used to assess associations between JOAS and disease parameters. Results In our data, 37 patients (30.8%) had JOAS and 83 (69.1%) had AOAS. There were no differences between the two groups according to gender, socioeconomic status, diagnosis delay, treatments, structural damage (BASRI) or scores of spinal mobility. However, patients with JOAS had more severe peripheral pain intensity, higher clinical and biological disease activity (BASDAI and CRP), severe enthesitis scores; impaired functional ability and more prevalent hip involvement (for all p≤0.001). Moreover, patients with JOAS had lower educational level (p=0.014) and significantly lower scores of physical domains of QoL (for all p≤0.01). In logistic regression, JOAS was associated with severe peripheral pain [OR =1.391-CI (95%) 0.514-0.983], higher enthesitis scores [OR =1.522-CI (95%) 1.074-1.864] and severe functional disability [OR =1.517-CI (95%) 1.108-1.754]. Conclusions In our study, we state that our AS patients presented differently according to the age at onset. Patients with JOAS had altered aspects of QoL with more peripheral and entheseal involvement, high disease activity an altered functional ability. An early diagnosis and treatment of AS, particularly JOAS seem to be important in order to improve patients’ living and quality of life. Disclosure of Interest None Declared

Background Shoulder pain is a common symptom in patients with rheumatoid arthritis (RA). Diverse anatomic structures of shoulder could be involved in RA with considerable functional limitations. However, little attention was paid to the diagnosis and the management of shoulder involvement in the routine clinical assessment of RA patients. Objectives We aimed to assess clinical and radiological abnormalities of shoulder in Moroccan patients with RA and their association with disease activity and severity. Methods 250 consecutive patients with RA attending the Department of Rheumatology of the University Hospital of Rabat-Sale were included. Sociodemographic data, age at onset, disease duration, disease activity (DAS 28), functional disability (HAQ) and structural damage (Sharp’s method) were specified. Immunological status and treatment details were assessed. History of shoulder pain (at the onset of RA or during the course of disease), shoulder pain intensity (on a VAS), area of pain, previous diagnosis, previous radiological investigations or anterior treatments were collected. Physical examination was done by the same rheumatologist: involved site, range of passive and active motion and tests for shoulder impingement and rotator cuff tendons lesions. Recent (≤6 last months) radiographs of shoulder (evaluated by the Larsen erosion score); and ultrasonographic examination (US) for the glenohumeral joint and periarticular tissues were assessed. Results 106 (42.4%) of patients had a history of shoulder pain at the onset of disease and 141 (56.4%) reported shoulder pain during the course of RA. 55 (22%) patients had previous intra-articular treatment with corticosteroids, 14 (7.2%) have benefited from functional rehabilitation and no patient had arthroplasty. At the study inclusion, 193 patients (77.2%) had shoulder pain with a mean pain intensity of 57.3±19.7 and a mean duration of 2.8±0.9 years. Physical examination data were as follow: the most tender sites: glenohumeral joint (87.5%) and subacromial space (21.7%); the most limited motions: abduction (92%) and antepulsion (66.2%); impingement tests (Neer) (43%); maneuvers of tendon lesions: Jobe’s test (34.7%). Comparing patients with and without shoulder pain, there were no differences in terms of gender, disease duration, disease activity or treatments. However, patients with painful shoulder had worst functional ability (p=0.013) and high levels of rheumatoid factor (p=0.007). Recent radiographs of shoulders were realized in 72 patients (28.8%) all with painful shoulder. Larsen’s scores were: 17 patients (23.6%) grade 0; 7 (9.7%) grade 5 and 48 (66.6%) ranged between grade 1 and 4. Forty-nine (19.6%) patients had a recent shoulder US. The most frequent lesions in US were: synovitis of the glenohumeral joint (73.4%), thickening of the long head of biceps (46.9%) and the supraspinatus (22.4%), and humeral head irregularity (18.3%). Conclusions In this study, our RA patients had frequent painful shoulder with articular and periarticular involvement. Shoulder involvement did occur even in early stages of RA and was associated with low functional ability. Radiographic and US exploration were realized in a small number of patients. The early and correct recognition and treatment of RA and shoulder involvement especially with the advent of imaging techniques may improve patients function. Disclosure of Interest None Declared

Objectives To assess the prevalence of depression in Moroccan patients with ankylosing spondylitis (AS); and its relationships with disease-related parameters of activity, severity and quality of life (QoL). Methods 110 patients with AS (67 men and 43 women) according to the modified New York Classification criteria were consecutively included in this cross-sectional study. Patients with previous psychological diseases or antidepressant treatment were excluded. To assess depression, the Patient Health Questionnaire depression scale (PHQ-9) was applied. The evaluation included: sociodemographic data, age at onset, peripheral and axial pain (on visual analogue scale (VAS)), treatments (doses and duration), disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functional disability (Bath Ankylosing Spondylitis Functional Index), spinal mobility (Bath Ankylosing Spondylitis Metrology Index (BASMI)), radiographic damage (Bath Ankylosing Spondylitis Radiologic Index (BASRI)), hip involvement (BASRI-Hip), enthesitis (Maastricht Ankylosing Spondylitis Enthesis Score (MASES)), fatigue (on a 0-100 VAS) and QoL (SF-36 generic instrument). Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were determined as biologic signs of inflammation. Comparisons were assessed by the ANOVAs analysis of variance and correlations were evaluated with the Pearson correlation coefficient completed with regression models analysis. Results In our data, 51 (46.3%) patients have major depressive syndrome, 36 (32.7%) have minor depressive syndrome and 23 (20.9%) have no depressive syndrome. The mean total score of PHQ-9 was 20.03±11.05 indicating severe depressive symptoms. Severe depression was associated with disease duration, diagnosis delay, axial pain intensity, number of tender and swollen peripheral joints, high clinical and biological disease activity (BASDAI, ESR and CRP), severe enthesitis, limited spinal mobility, functional disability, fatigue scores and the presence of hip involvement (for all p≤0.01). There were significant association between high scores of depression and the deterioration of physical as well as mental domains of QoL (for all p Conclusions In our data, we state the high prevalence of depressive syndrome among our AS which influenced negatively the patients’ QoL. Diagnosis delay, functional impairment, disease activity, enthesitis and the involvement of the hip were the main factors associated with high depression scores. Evaluating and recognizing relationships between depression and disease parameters should be highlighted in order to improve patients’ management and living. Disclosure of Interest None Declared

Objectives Haemophilia is traditionally considered to be a disease with a major impact on all aspects of quality of life (QoL). Our purpose is to explore quality of life in haemophilic children with chronic arthropathy and to search eventual factors related to deterioration of quality of life. Methods Twenty five children (all boys, age of 11.6±3.7 years, mean disease duration of 10.8±3.4years, haemophilia severe (28%) and moderate (72%)) suffering from Haemophilia with hemophilic arthropathy (affecting at least one joint) were consecutively recruited in this study. Children were asked to complete The Moroccan version of EuroQol questionnaire. We initially calculated patients’ median scores for both of the EQ-5D and the different domains of the EuroQoL. Results The median of the EuroQol visual analog scale was 0.5 (0.2, 0.9). EQ-5D subscale scores were, with upgrading percentage of no difficulties answers as following: mobility, self-care and usual activities, anxiety/ depression and pain discomfort (table 1). No association was found between QoL and haemophilic arthropathy features. Conclusions Our data shows a poor quality of life in children with hemophilic arthropathy. Those children with specific needs should receive more interest from society in order to improve their quality of life. Larger studies are also required in order to search factors of hemophilic arthropathy related to a disturbed QoL. Disclosure of Interest None Declared

The aim of this study was to assess the vitamin D status in patients with ankylosing spondylitis (AS), and to investigate the relation between vitamin D levels, bone mineral density (BMD) and disease activity in men with ankylosing spondylitis. Seventy patients with AS and 140 healthy individuals were included in the study. BMD of femur and lumbar spine was measured by DXA. Serum 25OH vitamin D, parathormone, serum calcium, C-reactive protein levels of all participants were also measured. The disease activity was evalu ated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and functional status by Bath Ankylosing Spondylitis Functional Index (BASFI). The mean 25(OH)D level was 17.5+9.7 ng/mL in AS patients and 21.9+7.7 ng/mL in controls (P

Patients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of infections [1, 2]. The exact causes of this increased risk are unknown, but may be related to immunologic disturbances associated with the disease or to the immunosuppressive effects of agents used in its treatment [3, 4]. Recently, the question of whether patients with RA are at increased risk of developing tuberculosis compared with the general population has gained interest in light of reports of serious cases in patients receiving biologic therapies for the disease [5, 6]. Mycobacterium infection is an important cause of morbidity and mortality in patients with RA, especially in prevalent areas [7, 8]. Tuberculosis infection in RA has been reported with an incidence rate of 2.3/1000 patient years, which is higher than in the general population [7]. According to a national study, the prevalence of active tuberculosis in Morocco is estimated to be 160–180/100,000 patients. The aim of this report was to assess the prevalence and the clinical features of tuberculosis infection in RA patients living in Morocco.

Both genetic and environmental factors probably influence the severity of spondyloarthropathies. Hip involvement, which may be used as a marker of disease severity, is more frequent in spondyloarthropathies developed in North Africa. The objective of this study was to determine the predisposing factors of hip involvement in spondyloarthropathy in North Africa. Patients fulfilled the Amor or European Spondyloarthropathy Study Group (ESSG) criteria of spondyloarthropathy. The study was retrospective, cross-sectional, multicentre and carried out in North Africa. The data collected were demographic data, socio-cultural factors and clinical presentation at onset. The risk of hip involvement with regard to disease duration was estimated using Kaplan-Meier's method. The predictive value of each variable with regard to time to hip involvement was evaluated using a uni- and then a multivariate Cox proportional hazard model. Five hundred and eighteen patients were included. The risk of hip involvement was estimated at 39 ± 3% after 10 yr disease duration. The factors picked up by the multivariate analysis were : diagnostic delay less than 7 yr, age at onset below 24 yr and a combination of 'lower social class' and 'no refrigerator at home'. This study confirms the high prevalence of hip involvement during the course of spondyloarthropathy in North Africa and suggests a role of environmental factors in its appearance.

Background The Bath Ankylosing Spondylitis Functional Index (BASFI) has been commonly used in rheumatology to quantify functional disability in patients with Ankylosing Spondylitis (AS). Our aim was to evaluate the discriminating power of BASFI and determine the best cutoff score of this index in the general population compared with AS patients. Methods A cross-sectional study that included 200 patients suffering from AS and 223 subjects from the general population matched for age and sex was carried-out. The discriminating power of the BASFI by strata of age was evaluated by the area under the Receiver Operating Characteristic curve and the best cutoff was determined by the Youden index. Results The mean age of the general population was 39 ± 12 years. 76.7% of them were male. The median BASFI of the healthy subjects and patients was 0.2 and 4.5 (P < 0.001) respectively. The best cutoff of BASFI was 1.5 with a sensitivity of 86% and a specificity of 90%. In the age group of 18-29 years, the best cutoff of the BASFI was 0.9 with a sensitivity of 93% and a specificity of 94%. In the age group of 30-50 years, the best cutoff of the BASFI was 1.5 with a sensitivity of 84% and a specificity of 88%. For those over 50 years of age, the best cutoff of the BASFI was 2.5 with a sensitivity of 84% and a specificity of 97%. Conclusions This study suggests that the discriminating power of BASFI is considered good at any age. The best cutoff of this index increased as age increases as functional disability is associated in part with lifestyle choices and increases with age. The cutoff values of the BASFI that we have presented could be used as a reference benchmark for both clinical practice and research.

‘‘HLA polymorphism and early rheumatoid arthritis in the Moroccan population’’ [Joint Bone Spine 2008; 75: 554e558] Ouafa Atouf *, Karima Benbouazza , Chehrazade Brick , Fatiha Bzami , Naima Bennani , Bouchra Amine , Najia Hajjaj-Hassouni , Malika Essakali a a Service de transfusion sanguine et d’hemovigilance, Unite d’Immunologie, CHU Ibn Sina, Rabat, Moroco b Service de Rhumatologie, Hopital El Ayachi, CHU Ibn Sina, Rabat, Morocco

s / Revue du Rhumatisme 74 (2007) 976–1037 1006 l’acquisition du PMO. Ce travail represente la premiere etude portant sur l’âge de survenue du PMO en fonction de l’activite physique. Materiels et Methodes. – 70 filles et 90 garcons (1728 ans) ont ete repartis en 4 groupes : femmes sportives (n = 40) et temoins (n = 30), hommes sportifs (n = 60) et temoins (n = 30). Les sportifs pratiquaient des sports en charge (judo, sports collectifs ou musculation) avec une pratique moyenne de 9,6±3,5 heures par semaine pour les femmes et de 10,4±3,7 heures pour les hommes. Ces sujets ont ete engages dans une etude prospective avec un suivi de 2 ans. Nous disposons des resultats intermediaires a un an. Les mesures de DMO ont ete effectuees par DXA (Delphi, Hologic®) pour le corps entier, (avec mesures derivees des membres superieurs et inferieurs), le rachis lombaire et le femur non dominant. L’âge du PMO a ete calcule a partir de l’equation de la courbe polynomiale du second degre representant la DMO en fonction de l’âge (y = ax+bx+c) selon la formule : PMO = -b/2a. Resultats. – Les sportifs presentaient des valeurs de DMO superieures aux temoins pour les deux sexes et a tous les sites osseux (p

Background To determine radiological features of arthropathy in systemic sclerosis patients with polyarthritis. Results Forty one women and 5 men were included in this study. The mean age was 41 + 14,2 years, the mean duration of disease was 10,5+ 6,5 years. Thirty seven patients (80%) had radiological abnormalities including joint space narrowing (37%) and erosions (43%). At presentation, the prevalence of radiological foot abnormalities was lower than that of hands (26% vs 79%, p < 0,001). There was no significant difference between patients with (n = 24) and without erosive arthropathy (Joint space narrowing and/or erosion) (n = 22) in terms of cutaneous subtype, organ involvement, calcinosis presence of rheumatoid factor, ANA, Anti-topoisomerase antibodies. Conclusion This study showed an high frequency of erosive arthropathy in our morroccan SSc patients with clinical synovitis.