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Introduction: The purpose of our study is to compare between physical activity (PA) in postmenopausal women with osteoporotic vertebral fractures and healthy women and to evaluate the relationship between PA and clinical and paraclinical parameters related to osteoporotic fracture. Methods: A case-control cross- sectional study, which included 128 postmenopausal women with densitometric osteoporosis as defined by Worlds Health Organization, with at least one radiological vertebral fracture. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) short version with three items: vigorous, moderate activity and walking. Bone mineral density (BMD) and X-rays were performed in all patients. The controls were healthy women included in a randomized order in the general population, they were matched for age. Results: 128 patients with a mean age of 61.01± 8.40 years were included. 100 controls were included with a mean age of 60.61 ± 8.25 years. The patients had a median age of menopausal of 48.90 years [48-50], were osteoporotic in 49.2% and had osteopenia in 34.9%. 84 patients had a current back pain, and an average of three vertebral fracture with a median Genant score of 3.02[1-23]. There was no significant difference between the subjects of our study for total PA. However, vigorous-intensity activity and walking were significantly different between the two groups (p

Type 2 diabetes mellitus (T2DM) and osteoporosis are chronic diseases with increasing prevalence. The aim of this study was to determine the prevalence of osteoporosis and osteoporotic fracture in women with T2DM and to identify predictive factors of fracture occurrence. The prevalence of osteoporosis and fractures in postmenopausal women with T2DM was 23.1% and 16.9%, respectively. 46.2% of T2DM patients had normal bone mineral density (BMD) (P

The objective of our study was to evaluate the aseptic technique used in interventional rheumatology by Moroccan and Tunisian rheumatologists. We performed an online survey among rheumatologists from Morocco and Tunisia. The questionnaire included 15 questions with single and multiple-choice answers and three open sections for freetext comments. An online survey was prepared and sent to 380 rheumatologists. One hundred and four rheumatologists (27.36%) replied to the survey. More than half of the participants (56.7%) were from Tunisia and 43.3% were from Morocco. Interventional procedures on superficial joints were performed by all participants. Ultrasonography was used by 41.3% of respondents to guide interventional procedures. Regarding the aseptic precautions taken to avoid infection, the majority of participants used povidone iodine to clean the skin and only 8.7% wore a mask. Hand washing alone without gloves wearing was done by 19.2% of participants. 2.9% of participants reported a history of iatrogenic septic arthritis and the duration of practice was the only factor associated with its occurrence (P=0.007). Our study showed that aseptic technique used during interventional rheumatologic procedures is heterogeneous. However, the majority of participants were aware of its necessity to avoid iatrogenic septic arthritis.

Before the initiation of biotherapy in the treatment of rheumatic diseases, it is highly recommended for the patients to be screened for latent tuberculosis infection (LTBI). The objective of this study is to identify the prevalence of LTBI among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) before the initiation of biologic therapy in the Moroccan biotherapy registry (RBSMR). A cross sectional study was conducted using the baseline data of the Moroccan biotherapy registry. Tuberculin skin test or IGRA test or both tests were done before starting anti-TNF treatment for screening LTBI. The comparisons between positive and negative LTBI patients according to rheumatic disease were examined using categorical comparisons. 259 patients were included in this study.94 patients had RA and 165 had SpA. The mean age of the RA patients was 50.49 ± 11.82 years with a majority of females (84%). The mean age for the SpA patients was 36 ± 13.7 years with a majority of males (67.3%). The prevalence of LTBI in the RBSMR was 21.6%. This prevalence was at 24.8% in SpA patients, while it was at 15.9% for RA patients. After the comparison between positive and negative LTBI patients according to rheumatic disease, no demographic, clinical, or therapeutic characteristics were statistically associated with LTBI. This study found that in an endemic TB country like Morocco, a high prevalence of patients with SpA and RA had LTBI, and that RA patients had a lower prevalence than SpA patients.

Background: The aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment.Methods: Cross-sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized.Results: A total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti-TNF in 3rd position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type.Conclusion: Our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono-therapy in RA patients. Further studies are needed to confirm these results.

Purpose of Review The aim of this paper is to provide an overview about reactive arthritis, with an update regarding pathophysiology and therapeutic approach of the disease, outlining the clinical features and diagnostic approach, based on recent literature review. Recent Findings Reactive arthritis is considered to be part of the spectrum of the spondyloarthritis. Its epidemiology is changing worldwide due to several reasons, among them are as follows: different diagnosis approach and clinical presentations, different grades of infection, microbiome changes, etc. The understanding of pathophysiological models is challenging, but recent studies contribute to elucidate the major factors involved in the development of the disease. The management of ReA depends on the triggering agent and the phase of disease, whether it is acute or chronic. Summary The association between the microbiome changes and spondyloarthropathies (ReA) is becoming increasingly evident. The results regarding the biologic treatment on refectory ReA are promising.

Background Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents. Case presentation Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye. Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms. Conclusions Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.

The aim of this study was to determine the therapeutic maintenance level of methotrexate for rheumatoid arthritis patients enrolled in the Moroccan biotherapy registry and to identify predictive factors for discontinuing MTX treatment.A cross-sectional study was conducted using the baseline data of the Moroccan biotherapy registry for RBSMR (a multicentric study that aims to evaluate tolerance of biological therapy on patients affected with rheumatic diseases). Demographics and disease features were compared using descriptive statistics. Therapeutic maintenance levels were determined according to a Kaplan-Meier survival curve and a univariate Cox proportional hazards regression model was used to compare the strength of potential factors, followed by a multivariate Cox model to identify significant predictors of MTX discontinuation. Statistically significant results were considered for224 patients with rheumatoid arthritis were included in this study. The mean age of patients was 51.83±11.26 years with a majority of females (87.50%). The median duration of disease was 12 [1.66-41.02] years. The therapeutic maintenance level of MTX was 91.1% at 1 year, 87.1% at 2 years, and 68.3% at 5 years. The median of treatment duration was 2, 02 [0, 46-27,76] years. Causes of treatment interruption were side effects (66/88=75%), inefficiency (12/88=13.63%), and other reasons (10/88=11.36%). Predictive factors for stopping MTX were presence of rheumatoid factor (HR 2.24; 95% CI 1.14-5.15;The therapeutic maintenance level of MTX in our study was satisfactory and comparable to other series, and influenced by many factors such as the occurrence of a side effect. It is necessary to sensitise medical practitioners on symptomatic prevention and management of side effects.

Background Tuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare. Case presentation We report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution. Conclusions To avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.

Introduction Le switch d’un anti-TNF au rituximab a prouve son efficacite et sa bonne tolerance chez les malades ayant une polyarthrite rhumatoide. Or, dans un pays comme le notre ou le rituximab est frequemment prescrit autant que premier biologique, on est amene a switcher vers une autre biotherapie (souvent un anti-TNF) sans avoir assez de recul documente ou de donnees de litterature prouvant l’efficacite et la tolerance de ce switch. L’objectif de notre etude est d’evaluer l’efficacite et la tolerance des traitements biologiques recus apres un premier traitement par rituximab. Materiels et methodes Des 224 patients PR recrutes dans le registre RBSMR, 165 malades ont recu du rituximab comme premier biologique et ont ete inclus dans notre etude transversale multicentrique. Les donnees sociodemographiques, cliniques et paracliniques ont ete recueillies. Un switcher etait tout malade ayant change de biologique au moins une fois. L’efficacite du switch a ete evaluee par le DAS28 et le ΔDAS28 a l’inclusion, a 6 et 12 mois de suivi. La tolerance a ete evaluee par la survenue d’effets indesirables. La raison du switch a ete precisee ainsi que le type du nouveau biologique. Des comparaisons ont ete effectuees entre les 2 groupes switchers/non-switchers. Le seuil de significativite a ete fixe a p Resultats Cent soixante-cinq malades PR ont recu le rituximab comme premier biologique avec une predominance feminine (87,9 %). L’âge moyen etait de 51,79 ± 11,27 ans et la duree d’evolution de 13,84 ± 9,07 ans. Cent quarante-trois (93 %) patients avaient une forme seropositive, 156 (94,5 %) recevaient de la corticotherapie et 156 (97,5) etaient sous MTX. Trente-six (22 %) patients ont beneficie d’au moins un switch dont la cause etait l’inefficacite chez 72,2 % des cas. Le ΔDAS28 VS est plus important chez les switchers versus les non-switchers apres 1 an de suivi (−0,31 ± 2,22 et −0,17 ± 1,72 respectivement). Parmi les switchers, 53,6 % etaient en remission/LDA a 1 an de suivi versus 43,8 % des non-switchers. Parmi les switchers, 44,4 % ont presente des effets indesirables a la biotherapie versus 31 % des non-switchers avec predominance des infections dans les deux groupes (22,2 % et 13,2 % respectivement), des reactions a la perfusion dans le groupe des non-switchers (13,2 %), et absence des neoplasies dans les deux groupes. Conclusion Les switchs apres rituximab chez les patients PR pourraient etre aussi bien efficaces et tolerables que le switch apres anti-TNF.

Introduction Le CT-P13 (Remsima®) est un biosimilaire du produit de reference de l’infliximab INX (Remicade®) et est prescrit, la plupart du temps pour les memes indications que l’infliximab. Notre objectif etait de comparer l’efficacite et la tolerance du CT-P13 versus INX chez les patients atteints de spondyloarthrite (SpA) inclus dans le registre marocain des biotherapies (RBSMR). Patients et methodes Il s’agit d’une etude prospective multicentrique incluant 194 patients atteints de SpA recrutes dans le RBSMR (un registre historicoprospectif multicentrique de 419 patients ayant une polyarthrite rhumatoide (PR) ou une SpA, traites par des medicaments biologiques dans les 10 services universitaires de rhumatologie du Maroc). Les patients sont evalues tous les six mois et chaque fois qu’ils subissent un evenement indesirable ou un changement de traitement. La duree de suivi prevue est de 3 ans. Les donnees disponibles a ce stade portent sur les observations a l’inclusion, a la visite a 6 mois et a la visite a 12 mois. Parmi les 194 patients SpA, 48 etaient sous INX ou son biosimilaire (23 sous INX et 25 sous CT-P13). Les donnees sociodemographiques relatives aux patients ainsi que les donnees cliniques et paracliniques relatives a la maladie ont ete analysees avec une comparaison entre les deux groupes par le test t Student pour les variables quantitatives et le Chi2 pour les variables qualitatifs. L’efficacite a ete evaluee a travers l’evolution du BASDAI, ASDAS (CRP) et BASFI. La tolerance a ete evaluee, en termes de survenue d’effet secondaire entre l’inclusion et la visite de 12 mois. Le seuil de significativite est fixe a p Resultats Nos resultats ont montre que l’amelioration des scores d’evaluation de l’activite entre l’inclusion et la visite a 12 mois etaient similaires entre les deux groupes de traitement [BASDAI (INX : −2,52 contre CT-P13 : −2,98, p : 0,69), BASFI (INX : −2,11 contre CT-P13 : −1,95, p : 0,89), et ASDAS CRP (INX : −1,85 contre CT-P13 : −1,67, p : 0,36)]. Sur le plan de la tolerance, il n’y a pas eu de difference entre les deux groupes concernant l’incidence globale des evenements indesirables (INX : 30,4 % ; CT-P13 : 40 %, p : 0,55). Par type d’effets secondaires, les groupes INX et CT-P13 n’ont pas presente un ecart significatif en termes d’incidence de reactions a la perfusion (INX : 8,7 % ; CT-P13 8 % ; p : 0,93) et de tuberculose maladie (INX : 4,3 % ; CT-P13 : 8 % ; p : 0,6). En revanche une difference significative a ete relevee sur le plan d’apparition des infections (INX : 26,1 % ; CT-P13 : 4 % ; p : 0,04). D’autres effets secondaires ont ete egalement releves a savoir un cas de psoriasis paradoxal et un autre de diverticulite sous INX et un cancer des cordes vocales dans le groupe CT-P13. Conclusion Notre etude suggere l’absence de difference entre l’INX et son biosimilaire, en termes d’efficacite ce qui rejoint les resultats des etudes ulterieurs. Sur le plan de la tolerance l’INX a montre une frequence significativement plus elevee des infections.

Rheumatoid arthritis rarely involves the cricoarytenoid joint, symptoms of varying severity ranging from foreign body sensation, fullness or tension in the throat, hoarseness, odynophagia, speech or cough pain to stridor and respiratory distress during bilateral paralysis of the vocal cords. We are reporting a case of rheumatoid arthritis with bilateral involvement of the vocal cords. The diagnosis was clinically made and confirmed by endolaryngoscopy, responding to antirheumatic treatment but coming to the stage of permanent tracheotomy.

Introduction Le tocilizumab, anticorps monoclonal humanise specifique de la sous-unite alpha du recepteur de l’interleukine 6 (IL-6), occupe une place importante dans l’arsenal therapeutique de la polyarthrite rhumatoide active, moderee a severe, en cas de reponse inadequate ou intolerance a un ou plusieurs traitements de fond. L’objectif de notre travail est d’evaluer l’efficacite et la tolerance du tocilizumab dans le traitement des patients atteints de polyarthrite rhumatoide inclus dans le registre marocain des biotherapies (RBSMR). Patients et methodes Il s’agit d’une etude longitudinale, multicentrique, basee sur l’evaluation des donnees du registre marocain de biotherapies (RBSMR) incluant 224 patients atteints de polyarthrite rhumatoide. L’efficacite du tocilizumab par rapport aux autres biologiques est evaluee a 6 mois et a 12 mois par l’echelle visuelle analogique (EVA) douleur, le bilan inflammatoire (VS et CRP), le DAS 28 VS, le delta DAS 28 VS. La tolerance est evaluee par la survenue d’effets indesirables. Les variables qualitatives seront recueillies et exprimees par leur effectif et leur pourcentage. Quant aux variables quantitatives, elles seront decrites par leur moyenne et ecart-type. Une valeur p Resultats Sur les 224 patients suivis pour PR sous biologiques, 53 (23 %) etaient sous tocilizumab. Il a ete prescrit en premiere intention chez 51 % des patients, en deuxieme intention apres une biotherapie anterieure chez 30 % des patients et prescrit en monotherapie chez 19 % des patients. La PR etait seropositive chez 86 % des sujets sous tocilizumab et erosive chez 43 %. Les valeurs du bilan inflammatoire a 6 mois et a 12 mois : VS (mmH1) (p = 0,001 a M6 et M12), CRP (mg/L) (p = 0,000 a M6 et M12) ainsi que le score d’activite DAS 28 VS (p = 0,41 a M6 et p = 0,000 M12) etaient plus bas chez les patients sous tocilizumab par rapport aux autres biologiques. A 6 mois et a 12 mois, une amelioration statistiquement significative du delta VS a ete obtenue (p = 0,001). A 12 mois du traitement, 61 % des patients sous tocilizumab etaient en remission clinicobiologique avec un DAS 28 1,2 versus 30 % pour les patients sous autres biologiques. La corticotherapie a ete arretee chez 55 % des patients sous tocilizumab par rapport a 19 % des patients sous autres biologiques. Par ailleurs, une assez bonne tolerance clinicobiologique a ete rapportee : 4 infections (une infection urinaire, deux infections non specifiques et une infection ORL) ont ete enregistrees a 6 mois du traitement et une infection non specifique a 12 mois. En outre, 4 patients ont presente une neutropenie sous tocilizumab, un patient a presente une reaction a la perfusion a 6 mois et une hypercholesterolemie a ete retrouvee chez 14 patients soit 26 %. Aucun effet secondaire grave n’a ete note. Conclusion Notre etude confirme que le tocilizumab represente une alternative therapeutique de choix au vu de son efficacite et sa bonne tolerance chez nos patients marocains atteints de polyarthrite rhumatoide.

Introduction Le statut socioeconomique constitue un element determinant l’activite de la polyarthrite rhumatoide (PR) a plusieurs egards. Le niveau educationnel des patients atteints de PR, un des parametres les plus important du statut socioeconomique, pourrait avoir une influence sur l’evolution et le pronostic de la maladie. L’objectif de notre travail etait d’evaluer l’impact du niveau educationnel sur la reponse therapeutique chez les patients atteints de PR apres 1 an de suivi dans le Registre marocains des biotherapies (RBSMR). Patients et methodes Il s’agit d’une etude prospective multicentrique incluant 224 patients atteints de PR recrute dans le RBSMR. Les patients inclus dans l’etude sont evalues tous les 6 mois. Les donnees dont nous disposant a ce stade portent sur les visites a V0, V6 et V12. Les patients ont ete classes selon leur niveau d’instruction en deux categories : analphabete, non analphabete. L’evaluation de la reponse therapeutique a M12 a ete base sur les scores d’activites a l’inclusion (DAS28 VS a V0, VS a V0, EVA p a V0) et apres 1 an de suivi (DAS28 a V12, VS a V12, EVAp a V12). Les tests statistiques ont ete effectues en utilisant Test non parametrique de Mann–Whitney, le t Student et le Chi2 (p Resultats Deux cent vingt-quatre PR ont ete inclus dans l’etude, 46 % etait analphabete, 53,7 % etait non analphabete. La moyenne d’âge a V0 etait de 51,83 ± 11,26 avec une duree d’evolution moyenne de 14 ± 8,9 ans. Le groupe de PR analphabete a presente plus de comorbidites a V12 par rapport aux non analphabetes (17,2 % vs 15,8 %, p : 0,786). Parmi les PR non analphabetes, 62,5 % etaient en remission a V12 contre 37,5 % chez les PR analphabetes (p : 0,261). Aucune difference statistiquement significative n’a ete observe dans le Delta DAS 28 (p : 0,43). Il n’y avait pas de difference statistiquement significative concernant les parametres clinique et biologique a V0 et a V12 entre les 2 groupes de patients (NAS, NAD, EVA p VS, CRP) mais les parametres de mesures objectifs (NAS, VS et CRP) etaient plus eleve dans le groupe analphabete par rapport a celui avec niveau d’instruction eleve [NAS a V0 (3 vs 2), VS a V0 (33 vs 25), CRP a V0 (11,65 vs 11,17), NAS a V12 (0 vs 0), VS a V12 (23 vs 20), CRP a V12 (7 vs 5,87)]. Discussion Nos resultats suggerent que l’efficacite therapeutique est influencee par le niveau educationnel du patient PR puisque 62,5 % des patient instruits ont pu atteindre la remission contre seulement 37,5 % chez les patients analphabetes. Nos resultats vont de pair avec ceux des autres etudes qui confirment la forte correlation entre le niveau socioeconomique y compris le niveau educationnel et le profil de l’activite de la maladie. Conclusion Notre etude suggere que le niveau educationnel du patient PR influence le profil d’activite de la maladie et par consequent l’efficacite therapeutique. D’autres etudes sont necessaires pour confirmer ces resultats.

Introduction L’objectif de notre etude est de decrire les caracteristiques demographiques, cliniques, paracliniques et therapeutiques des polyarthrites rhumatoides (PR) d’apparition tardive par rapport aux PR a debut precoce. Patients et methodes Etude transversale cas-temoin incluant : un groupe de PR sujet jeune et un groupe de PR a debut tardif. La PR a debut tardif a ete definie par un âge de survenue superieur ou egal a 60 ans. Ont ete exclues les PR dont l’evolution est superieure a 10 ans. Les caracteristiques sociodemographiques, les donnees cliniques et paracliniques de la maladie ont ete recueillies ainsi que les traitements attribues aux malades. Une comparaison a ete effectuee entre les 2 groupes en utilisant les tests t Student et Mann–Whitney pour les variables quantitatives et le Chi2 pour les variables qualitatives. Le seuil de significativite est fixe a p Resultats Soixante-quinze patients ont ete colliges : 25 PR a debut tardif et 50 PR a debut jeune. L’âge moyen etait respectivement de 69,8 ± 8,2 ans et de 43,6 ± 9 ans et l’âge de debut des symptomes etait respectivement de 66,36 ± 7 ans et de 37,9 ± 8,5 ans. Une predominance masculine a ete notee dans les PR a debut tardif (36 % vs 8 %, p = 0,003). Le debut de la symptomatologie des PR a debut tardif etait aigu (p Discussion Notre etude suggere que l’atteinte des hommes etait plus frequente chez les PR a debut tardif. Malgre que l’activite soit similaire dans les 2 groupes, le recours a la CTC et aux biologiques etait moindre par rapport aux PR a debut jeune ce qui est concordant avec les donnees de la litterature. Ceci est probablement lie a la presence de plus de comorbidites dans les PR a debut tardif qui pourrait egalement expliquer le HAQ plus eleve dans ce groupe. Conclusion Les PR a debut tardif et a debut jeune avaient des caracteristiques demographiques differentes. L’activite etait similaire dans les deux groupes et le HAQ etait plus important dans le groupe PR a debut tardif. Ces derniers avaient plus de comorbidites ce qui peut expliquer le moindre recours a la CTC et aux traitements biologiques.

Introduction La keratite ulcerative peripherique est une inflammation oculaire impliquant la portion externe de la cornee dont la complication la plus severe est la perforation corneenne. C’est une manifestation rare de la polyarthrite rhumatoide (PR) avec une incidence de 3 cas par million d’habitants par an. Son traitement est determine par la severite de l’atteinte corneenne et par l’activite de la PR. Observation Patiente âgee de 45 ans, ayant comme antecedent une thyroidectomie il y a 18 ans sous traitement hormonal substitutif, suivie depuis 17 ans pour PR a serologie rhumatismale positive erosive deformante et refractaire aux traitements de fond classiques. En fevrier 2017, la patiente etait hospitalisee pour poussee severe de sa PR ou l’indication de biotherapie type Rituximab a ete posee. Elle a recu le premier cycle de Rituximab avec echec clinique et biologique. En juillet 2017, devant l’installation d’un œil gauche rouge douloureux avec baisse d’acuite visuelle, la patiente a consulte un ophtalmologue qui a objective une perforation corneenne de l’œil gauche et pre-perforation de l’œil droit. Elle a recu en urgence un bolus de corticotherapie 1 g/jour de solumedrol 3 jours de suite avec indication de biotherapie type anti-TNFα (Infliximab) pour agir a la fois sur l’atteinte oculaire et sur la PR qui etait en poussee active avec un DAS28 = 5,85. La patiente a recu l’Infliximab avec evolution favorable pour un recul de 13 mois. Discussion Il s’agit d’une polyarthrite rhumatoide en poussee active en echec du Rituximab compliquee de keratite ulcerative peripherique qui a evolue vers la perforation corneenne de l’œil gauche et l’ulcere corneen pre-perfore de l’œil droit ameliores sous Infliximab. L’Infliximab etait efficace a la fois sur l’atteinte rhumatismale par le refroidissement de la PR en poussee avec un DAS28 = 3,6 et sur l’atteinte corneenne droite en empechant son evolution vers la perforation permettant aussi de programmer le geste chirurgical pour la perforation corneenne de l’œil gauche. Conclusion Ce cas affirme les resultats de la litterature concernant l’efficacite de l’Infliximab dans le traitement des ulceres corneens compliquant la keratite ulcerative peripherique secondaire a la polyarthrite rhumatoide.

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.

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.

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.

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.

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.

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.

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 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.

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.